Preeclampsia into eclampsia: Toward a new paradigm

OBJECTIVE: This study was undertaken to characterize aspects of the natural history of eclampsia. STUDY DESIGN: A retrospective analysis was performed on the records of pati ents with eclampsia who were delivered at two tertiary care hospitals. RESULTS: Fifty-three pregnancies complicated by eclampsia were identified. Thirty-seven of the women were nulliparous. The mean age was 22 years (rang e, 15-38 years). Mean gestational age at the time of seizures was 34.2 week s' gestation (range, 22-43 weeks' gestation). Twenty-eight women had antepa rtum seizures (53%); 23 of the 28 had seizures at home. Nineteen women had intrapartum seizures (36%). Eight of these women had seizures while receivi ng magnesium sulfate, and 7 had therapeutic magnesium levels. Six women had postpartum seizures (11%), 4 >24 hours after delivery. Headache preceded s eizures in 34 cases. Visual disturbance preceded seizures in 16 cases. The uric acid level was elevated to >6 mg/dL in 43 women. There were no materna l deaths or permanent morbidities. There were 4 perinatal deaths. Two patie nts had intrauterine fetal deaths at 28 and 36 weeks' gestation. These moth ers had seizures at home. One infant died of complications of prematurity a t 22 weeks' gestation and one died of respiratory complications at 26 weeks ' gestation. There were 4 cases of abruptio placentae, 1 of which resulted in fetal death. Of the 53 cases of eclampsia, only 9 were potentially preve ntable. One of these was that of a woman who was being observed at home. Th e other 8 women were hospitalized and had hypertension and proteinuria. Onl y 7 women could be considered to have severe preeclampsia before seizure (1 3%), and 4 of these 7 women were receiving magnesium sulfate. CONCLUSIONS: Eclampsia was not found to be a progression from severe preecl ampsia. In 32 of 53 cases (60%) seizures were the first signs of preeclamps ia. In this series eclampsia appeared to be more of a subset of preeclampsi a. Only 9 cases of eclampsia were potentially preventable with current stan dards of practice. Our paradigm for this disease, as well as our approach t o seizure prophylaxis, should be reevaluated.