479: “Delta eclampsia” - a hypertensive encephalopathy of pregnancy in “normotensive” women

Vollaard, Esther; Zeeman, Gerda G.; Alexander, James A.; McIntire, Donald D.; Cunningham, F. Gary

doi:10.1016/j.ajog.2007.10.552

Cited by 11 publications

(3 citation statements)

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“…In all the women with a low platelet count in our study, the systolic blood pressure was above 160 mmHg, while the diastolic blood pressure was above 110 mmHg in only 63% of the cases. Especially, the combination of endothelial disease, thrombocytopenia (78% of women in this study) and sudden changes in blood pressure, 11 in otherwise outside pregnancy normotensive women (93% in this study), results in high risks for cerebral complications in women with pre‐eclampsia 12,13 …”

Section: Discussionmentioning

confidence: 69%

Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

Schutte

Schuitemaker

Roosmalen

et al. 2008

BJOG

107

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Objectives To review the standard of care in cases of maternal mortality due to hypertensive diseases in pregnancy and to make recommendations for its improvement. Design Care given to women with hypertensive disease in pregnancy was audited and substandard care factors identified. Setting Confidential enquiry by the Dutch Maternal Mortality Committee (MMC) from the Netherlands Society of Obstetrics and Gynaecology. Population All maternal deaths reported to the MMC due to hypertensive disease in pregnancy in the Netherlands during the years 2000–04. Methods Assessment for substandard care factors using a checklist based on the Dutch guideline of ‘Hypertensive Disorders in Pregnancy’. Main outcome measures Substandard care in cases of maternal mortality due to hypertensive diseases in pregnancy. Results A total of 27 cases of maternal death due to hypertensive disease in pregnancy were reported to the committee in the study period. In 26 cases (96%), substandard care factors were present, of which in 17 cases (63%), these were for more than five different items. In community midwifery care, the most frequent substandard care factor was no testing for proteinuria when clearly indicated (41%). In hospital care, the most frequent substandard care was related to insufficient diagnostic testing when indicated (41%), insufficient management of hypertension by obstetricians (85%), no use or inadequate use of magnesium sulphate (67%), inadequate stabilisation before transport to tertiary care centres and/or delivery (52%) and failure to consider timely delivery (44%). Conclusions Education of pregnant women concerning danger signs of hypertensive disease should be improved. Training of midwives and obstetricians should be improved in the following areas: performing basic diagnostic tests, adequate management of hypertension and eclampsia, with more attention to treatment of systolic blood pressure. This training should be guided by clear local protocols. Delivery should not be delayed in serious cases of hypertensive disease in pregnancy, not only after 32–34 weeks but also in early‐onset pre‐eclampsia as maternal risks often outweigh possible fetal benefits of temporising management.

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Section: Discussionmentioning

confidence: 69%

Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

Schutte

Schuitemaker

Roosmalen

et al. 2008

BJOG

107

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“…These findings are consistent with a Haitain pre-eclampsia cohort demonstrating ‘highest’ SBP and DBP during admission were not associated with additional risk of maternal death, eclampsia or antepartum stillbirth [25] . The poor relationship between eclampsia and increasing ‘highest’ SBP mirror findings from a secondary analysis study of 87 women with eclampsia and neuroimaging findings of posterior reversible leuco-encephalopathy syndrome, which showed that more than a third of women had BPs within normal limits (<140/90 mmHg) prior to their eclampsia [26] . A prospective observational study of all eclampsia cases in the UK in 1992 demonstrated that only 38% of in-hospital eclampsia cases were associated with documented proteinuria or hypertension prior to the fit [27] .…”

Section: Discussionmentioning

confidence: 53%

Early warning system hypertension thresholds to predict adverse outcomes in pre-eclampsia: A prospective cohort study

Nathan

Seed

Hezelgrave

et al. 2018

Pregnancy Hypertension

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“…Risk for eclampsia rises in the presence of signs of severe preeclampsia (eg, blood pressure over 160/110 mm Hg, multifetal pregnancy, preterm gestation, and family history of eclampsia). detected [ 9 ]. More than 90% of eclamptic convulsions present after gestational week 28, but reports exist of eclampsia presenting as early as gestational week 16 that was not associated with molar pregnancy [ 10 ].…”

Section: Epidemiologymentioning

confidence: 99%

Advances in the understanding of eclampsia

Karumanchi

Lindheimer

2008

Current Science Inc

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Preeclampsia, a serious hypertensive complication of pregnancy characterized by new-onset hypertension and proteinuria after midpregnancy, is a multisystem disorder that often involves the central nervous system. Neurologic signs and symptoms include hyperreflexia, headaches, visual disturbance, seizures, and cerebral hemorrhage. Eclampsia-new-onset seizures in the setting of preeclampsia-usually occurs before or within 48 hours of delivery, but can present as late as 1 month postpartum (late postpartum eclampsia). Magnesium sulfate is the drug of choice to prevent and treat eclampsia, a recommendation validated through large, randomized, and placebo-controlled trials. This review describes the pathogenesis, clinical features, and treatment of eclampsia, focusing on recent observations regarding roles of circulating antiangiogenic factors in the pathogenesis of the neurologic complications of eclampsia.

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479: “Delta eclampsia” - a hypertensive encephalopathy of pregnancy in “normotensive” women

Cited by 11 publications

References 0 publications

Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

Early warning system hypertension thresholds to predict adverse outcomes in pre-eclampsia: A prospective cohort study

Advances in the understanding of eclampsia

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