Active Management of the Unconscious Eclamptic Patient

Abstract

Of the many complications which may develop after eclamptic seizures, prolonged unconsciousness is one of the most difficult for obstetricians to manage as the pathophysiology of this condition remains largely unknown. Computed axial tomography (CT scan) was performed on 20 unconscious eclamptic patients, and autopsy was obtained on an additional two patients. Changes compatable with cerebral oedema were demonstrated in 75% of patients; cerebral haemorrhage occurred in 9%. A programme of intensive neurological management aimed at optimizing cerebral perfusion and controlling intracranial pressure is outlined. We have reduced the mortality rate for unconscious eclamptic patients from 50% to 17% in our institution.

Cerebrovascular Function in Pregnancy and Eclampsia

“…31 Both hypertensive encephalopathy and PRES can arise from an acute elevation in blood pressure that overcomes the myogenic vasoconstriction of cerebral arteries and arterioles causing loss of autoregulatory capacity, BBB disruption, and vasogenic edema. 8,[12][13][14][15] The concept that eclampsia can cause PRES has arisen from numerous similarities in clinical presentation including comparable imaging findings on computed tomography and MRI, 3,5,18,[31][32][33] the same neurologic symptoms (headache, vomiting, cortical blindness, and seizures), 3,9,16,17 and the prompt reversibility of symptoms after blood pressure has been restored. 3,9 The difference between hypertensive encephalopathy and PRES is that PRES can develop without a significant elevation in blood pressure.…”

Cerebral Vasospasm in Cortical Blindness Associated with Preeclamsia/ Eclampsia Syndrome

“…Cortical blindness is usually reversible. However, visual loss by infarcts may be permanent [66][67][68][69][70][71][72][73][74][75]. We do not have an explanation for the cortical blindness remission before resolution of vasospasm in patient 1 and 2.…”

Éclampsie : étude rétrospective de 16 cas

“…Une patiente (n o 7) avait des chiffres tensionnels normaux mais 8 g/24 h de protéinurie lors de la crise d'éclampsie en post-partum après un accouchement par voie basse à 39 SA. Six patientes n'avaient pas présenté de PE avant l'éclampsie (patientes n o 6,7,8,10,11,14).…”

“…La mortalité maternelle varie entre 0 et 1,8 % dans les pays développés et entre 14 et 15,6 % dans les pays en voie de développement [2][3][4][5][6][7][8][9][10][11][12][13]. L'éclampsie est responsable de 50 000 décès par an dans le monde [13].…”