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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eclampsia is a well-recognised major cause of maternal death and perinatal morbidity and mortality. The incidence of eclampsia, its presentation patterns, maternal and perinatal outcomes were investigated in a retrospective study conducted at the University of Benin Teaching Hospital, Nigeria over an 8-year period, 1995 - 2002. There were 103 cases of eclampsia of 7835 deliveries, giving an incidence of one in 76 (1.32%). The mean age of the women was 27.1 +/- 5.6 years. Eclampsia significantly (P < 0.001) occurred in nulliparous and unbooked mothers. Eighty-nine (86.4%) of the patients developed fits in the predelivery stage; 85 (83%) of the patients had at least one premonitory symptom including headache (82.4%) visual disturbance (10.6%) and epigastric pain (7%). There were nine stillbirths and 16 early neonatal deaths for a perinatal mortality rate of 214/1000. The major causes of perinatal mortality were prematurity and birth asphyxia. Eleven maternal deaths occurred with a maternal case fatality rate of 10.7% and a maternal mortality ratio from eclampsia of 140/100 000. The clinical causes of deaths were cardiopulmonary failure, acute renal failure, haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and cerebrovascular accident. Timely referral of high-risk patients coupled with availability of emergency obstetric and neonatal care services would reduce the incidence eclampsia associated mortality and morbidity in our facility.
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PMID:Maternal and fetal outcome in eclamptic patients in Benin City, Nigeria. 1576 83

A 34-year-old grand multipara (para 7, 4 alive) was managed at the National Hospital, Abuja, Nigeria for acute renal failure due to HELLP syndrome following referral from a peripheral hospital. She presented with a history of vomiting, headache, epigastric pain, loss of consciousness and tonic/clonic seizures. Though she was unsure of her exact dates, clinically the gestational age was estimated at 22 weeks. She was managed in the intensive care unit, following delivery of a macerated fetus within 15 h of hospital admission. The patient received mechanical ventilation and three sessions of haemodialysis as part of her successful management while in the intensive care unit. The uncommon presentation of eclampsia and HELLP syndrome before obvious preeclampsia is discussed, as well as the other signs and symptoms and patient management. The case also highlights the resource-poor environment of peripheral and tertiary hospitals in Nigeria.
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PMID:Acute renal failure due to HELLP syndrome and acute renal failure in mid gestation. 1593 39

A 32-year-old woman, gravida 0, para 0, was admitted for delivery at 40 weeks of gestation. She had no history of headache, hypertension, and toxemia. She was delivered of a healthy boy. Although she was given no medication during normal delivery, she suddenly became drowsy and developed left hemiparesis immediately after delivery. Computed tomographic (CT) scan of the brain performed on the admission day revealed a subarachnoid hemorrhage and right putaminal hemorrhage. A 4-vessel cerebral angiogram demonstrated multiple irregular narrowing of the anterior cerebral arteries, middle cerebral arteries, and posterior cerebral arteries. Her conditions seemed to improve without any medication, and the multiple stenoses were no longer observed by angiography in a follow-up examination. On the basis of these observations, she was diagnosed as having postpartum cerebral angiopathy (PCA). Pathogenesis of PCA still remaing unclear to date an ergot alkaloid derivate (ergonovine) and the hydrogenated form of the powerful vasoconstrictor ergot (bromocriptine) have been reported as cause of PCA. We will classify PCA into 3 categories: eclampsia, secondary PCA, and primary PCA. "Primary PCA" is of unknown etiology, "secondary PCA" results from a known etiology such as drugs, and "eclampsia" is a PCA with toxemia of pregnancy. We report here, that PCA may occur even in a normal pregnant woman who was given no medication, and should be considered in the diagnosis of postpartum cerebral vascular diseases in women.
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PMID:[A case of postpartum cerebral angiopathy with intracranial hemorrhage and subarachnoid hemorrhage immediately after delivery]. 1596 Jan 76

A reversible syndrome of headache, altered mental status, seizures and cerebral visual abnormalities with neuroradiological studies suggesting predominantly posterior white matter abnormalities has been described. This syndrome has been referred to as posterior reversible encephalopathic syndrome (PRES). PRES has been associated with hypertensive encephalopathy, eclampsia and treatment with immunosuppressive or cytotoxic agents. Rare case reports describe association with hypercalcemia. We present a patient with AIDS, Mycobacterium avium intracellulare related hypercalcemia with posterior reversible encephalopathic syndrome.
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PMID:Posterior reversible encephalopathic syndrome due to severe hypercalcemia in AIDS. 1601 20

Intravenously administered magnesium sulfate is effective in reducing the incidence of eclampsia in women with severe preeclampsia. However, the routine use of magnesium sulfate in all cases of preeclampsia is not justified as the incidence of eclampsia is likely to be lower in milder cases than in those with severe disease, and also in view of the adverse effects of magnesium sulfate. Magnesium sulfate should be considered for women with preeclampsia for whom there is concern about the risk of eclampsia, such as hyperreflexia, frontal headache, blurred vision, and epigastric tenderness. As it is an inexpensive drug, it is especially suitable for use in low income countries. Intravenous administration is preferable, where there are appropriate resources, as side effects and injection site problems seem lower. Duration of treatment should not normally exceed 24 hours, and if the intravenous route is used for maintenance therapy the dose should not exceed 1 g/hour Serum monitoring is not necessary. Clinical monitoring of respiration, tendon reflexes and urine out put are enough for monitoring of magnesium toxicity. Administration and clinical monitoring of magnesium sulfate can be done by medical, a midwife or nursing staff provided they are appropriately trained. However, the use of magnesium sulfate should not be misconstrued as a license for reduced surveillance of preeclamptic women. Progression from mild to severe disease and development of serious maternal complications during antepartum, intrapartum and postpartum cannot be predicted without close maternal surveillance. Therefore, continued close antepartum, intrapartum, and postpartum surveillance is crucial for optimal maternal and perinatal outcomes.
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PMID:Is magnesium sulfate for prevention or only therapeutic in preeclampsia? 1624 Oct 34

Reversible posterior leukoencephalopathy syndrome (RPLES), previously known as posterior reversible encephalopathy syndrome (PRES), is characterized by the presence of bilateral lesions located within the posterior border zones of the cerebral hemisphere and cerebellum. This condition commonly presents with headache, nausea, vomiting, decreased vision and level of consciousness, and seizures. RPLES has been associated with hypertensive encephalopathy, eclampsia, renal failure, and immunosuppressive therapy following transplant. We report the development of RPLES in a boy following implantation of a left ventricular assist device (LVAD). To our knowledge, this is the first report of RPLES in association with the use of LVAD.
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PMID:Reversible posterior leukoencephalopathy syndrome associated with left ventricular assist device. 1638 57

Eclampsia typically occurs in the antepartum or intrapartum period. Late-onset postpartum eclampsia is a controversial topic, which recently has been accepted as a true phenomenon. Late-onset postpartum eclampsia is a rare occurrence, although literature suggests that it is an increasing phenomenon. In this case study, an essentially healthy primigravida developed eclampsia 7 days postpartum after an unremarkable antepartum and intrapartum course. Because significant morbidity and mortality are associated with this disorder, it is imperative that efforts be made to prevent its occurrence. We recommend including patient education about the prodromal symptoms of late-onset postpartum eclampsia, including headache, visual changes, and abdominal pain at the time of hospital discharge.
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PMID:Late-onset postpartum eclampsia. 1639 11

Subarachnoid haemorrhage in pregnancy is often the result of aneurysmal rupture or severe hypertension. A young woman with postpartum eclampsia and 'normal' blood pressure developed sudden-onset head pain, and was found to have minor biconvexity subarachnoid hemorrhages. Serial angiograms of the cervicocranial vessels revealed no evidence of aneurysm or arteriovenous malformation. A follow-up angiogram revealed diffuse vessel narrowing, consistent with postpartum angiopathy. Treatment consisted only of nimodipine for the prevention of vasospasm. The patient made an excellent recovery, without residual neurological deficits.
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PMID:Eclamptic subarachnoid haemorrhage without hypertension. 1667 28

Eclampsia is a major cause of maternal and perinatal morbidity and mortality in developing countries including Nigeria. However, most studies on eclampsia have been in urban communities. The objective of this study was to determine the incidence, pattern of clinical presentation and maternal and fetal outcomes of cases of eclampsia in a rural tertiary hospital in Nigeria. A descriptive review of all cases of eclampsia seen between 1 January 1994 and 31 December 2003 in a tertiary hospital was undertaken. The incidence of eclampsia was 1 in 43 deliveries (2.3%). Most of the women (86.2%) were unbooked for antenatal care in our centre; 58.5% were nullipara, and the onset of seizures was in the ante-partum period (68.3%). Patients presenting were mostly from the traditional birth attendants (46.3%). The time interval between the onset of convulsions and hospital admission was less than 12 h in 52% of cases. The majority of the women had premonitory symptoms (78.8%) with headache being the most frequent (78%). The major route of delivery was abdominal (66.7%). The case fatality rate was 15.4%. Most of the deaths (89.5%) were in unbooked women and the most common causes of death were acute renal failure, cardiopulmonary failure, disseminated intravascular coagulopathy and cerebrovascular accident. The perinatal mortality rate was 195 per 1000 births. This study found a high incidence of eclampsia. It is recommended that community-based health education programmes should be pursued with vigour to enhance early utilisation of modern antenatal care services in rural areas. Traditional birth attendants need to be trained and integrated into the healthcare team. Appropriate mechanisms should be put in place to improve clinic referrals. The capacity of tertiary health institutions to provide intensive care for eclamptics need to be improved with continuous training of heathcare personnel and provision of necessary equipment.
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PMID:Eclampsia: ten-years of experience in a rural tertiary hospital in the Niger delta, Nigeria. 1684 66

We present the case of a multiparous parturient who developed hypertension associated with a severe headache in the immediate post-partum period. She subsequently suffered a generalised tonic clonic seizure on the fifth post-partum day. Following recovery of consciousness, she developed a left homonymous hemianopia. Apart from hypertension, headache and convulsion, she had no symptoms and no proteinuria or other biochemical or haematological changes associated with eclampsia. The magnetic resonance imaging findings were consistent with vasogenic oedema in the right posterior parieto-occipital white matter and these in turn are consistent with reversible posterior leucoencephalopathy syndrome. The differential diagnosis of convulsions in the post-partum period is discussed and the clinical and radiological features of reversible posterior leucoencephalopathy syndrome are described.
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PMID:Reversible posterior leucoencephalopathy syndrome in a peripartum patient. 1694 18


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