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Description of a black widow spider (Latrodectus mactans) envenomation in a term pregnancy.Case report conducted at an Air Force tertiary care hospital of a 27-year-old primigravida at 38 1/7 weeks pregnancy.Latrodectus mactans antivenin can be given to treat symptoms of black widow envenomation.Black widow envenomations can cause symptoms associated with acute intra-abdominal processes. In pregnancy, envenomations can result in symptoms and signs similar to those seen in preeclampsia (abdominal pain, headache, hypertension, and proteinuria). Latrodectism should be considered in patients complaining of these symptoms in association with a spider bite. If latrodectism is considered to be the underlying origin for these symptoms, appropriate treatment should be administered. In cases of pregnancy, treatment should include L. mactans antivenin if believed to be clinically indicated. There is no current evidence that this antivenin is contraindicated in pregnancy. (Curr Surg 57:346-348)
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PMID:Black widow spider (Latrodectus mactans) envenomation in a term pregnancy. 1102 47

Pre-eclampsia is usually defined on the basis of new onset hypertension and albuminuria developing after 20 weeks of pregnancy. There are difficulties with measurement of these variables. Conventional sphygmomanometry remains the gold standard for blood-pressure measurement. The value of ambulatory blood-pressure measurement has yet to be established. Oedema is now omitted from all definitions of preeclampsia, although the finding of widespread severe oedema of sudden onset should not be ignored for clinical purposes. Definitions of pre-eclampsia based solely on hypertension and proteinuria ignore the wide clinical variability in this syndrome. Women with no proteinuria but who do have hypertension and other features such as severe headache or other symptoms, thrombocytopenia, hyperuricaemia, disordered liver function, and fetal compromise are likely to have pre-eclampsia. This notion is accepted in the new Australasian definition of pre-eclampsia and more than hinted at in the new American College of Obstetricians and Gynecologists' definition. Definitions used for clinical purposes should be as safe as practical; they are likely to include a considerable number of false positives. Most research studies are weakened if patients without the disease are included. Therefore, a separate stringent research definition of pre-eclampsia we also suggest.
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PMID:Blood-pressure measurement and classification in pregnancy. 1119 13

A 63-year-old female with stage IE diffuse large B-cell lymphoma developed reversible posterior leukoencephalopathy syndrome (RPLS) following CHOP chemotherapy, with typical clinical and radiological findings. RPLS is a rare neurological syndrome characterised by visual disturbances, seizures, headaches and altered conscious level which has been associated with malignant hypertension, pre-eclampsia and some drugs, including ciclosporin. It has not been previously reported following CHOP chemotherapy. Alternative treatment should be considered for patients who develop this rare complication.
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PMID:Reversible posterior leukoencephalopathy syndrome following CHOP chemotherapy for diffuse large B-cell lymphoma. 1169 48

The coincidence of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and cortical blindness is an uncommon but very dramatic event. We describe a case of HELLP syndrome complicating with acute cortical blindness before delivery. A 27 year-old woman, gravida 1, para 0, with normal medical history, was referred to our emergency department at the 33th week of gestation due to headache, vomiting, and blurred vision. The ophthalmologic examination showed intact pupillary light reflexes and normal ophthalmoscopic findings, but no light perception in either eye. Brain computed tomography showed normal findings. HELLP syndrome and preeclampsia was diagnosed based on the findings of hypertension and proteinuria as well as laboratory data. Prompt delivery was performed in order to achieve good maternal and neonatal outcomes.
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PMID:Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with acute cortical blindness. 1172 Jan 49

A 45-year-old man presented with severe hypertension, headache, cortical blindness, and a depressed level of consciousness. A second patient, a 33-year-old woman, was admitted with pre-eclampsia. She developed lethargy, headache, bilateral extensor plantar responses, and seizures. The third patient, a 62-year-old man, presented with acute renal failure due to necrotising vasculitis and glomerulonephritis. Five days after treatment with immunosuppressive drugs had been initiated, he developed headache, confusion, seizures, and cortical blindness. Hypertensive encephalopathy is characterised by headache, vomiting, disturbances in cognition and level of consciousness, visual abnormalities, and seizures. Imaging studies often demonstrate oedema of the white matter in the posterior parietal and occipital areas of the brain. This so-called reversible posterior leucoencephalopathy syndrome is well known in patients with severe hypertension, but it is also associated with immunosuppressive drug use and renal failure. It can be recognised by its fairly characteristic clinical features (different combinations of headache, vomiting, changes in cognition and level of consciousness, seizures, muscle weakness, and visual symptoms) and by its specific imaging findings. Treatment consists of reducing the blood pressure and reducing or discontinuing the use of immunosuppressive drugs. If the treatment is started promptly, symptoms and imaging abnormalities are usually reversible.
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PMID:[Hypertensive encephalopathy: does not only occur at high blood pressure]. 1205 26

A meeting in Singapore of principal investigators from 7 countries in a WHO collaborative study on hypertensive disease of pregnancy, also called pre-eclampsia or eclampsia, pointed out women at risk, suggested management guidelines, and summarized operations research projects involving administration of aspirin or calcium supplements. Hypertensive disease of pregnancy may ultimately end in fatal seizures. It is often marked by warning signs of severe headaches and facial and peripheral edema. A survey in Jamaica found that 0.72% of a group of 10,000 pregnant women had eclamptic seizures. These were the cause of almost one-third of all obstetric deaths in the period 1981-1983. 10.4% of the pregnant women had hypertension, and half of these had proteinuria. Associated risk factors were primigravida, age 30, abnormal weight gain, edema, 1+ proteinuria. A phased program of management guidelines for identifying and treating affected women is being instituted in half of Jamaica's parishes. An operations research project involves administration of low-dose aspirin vs. placebo. Another controlled trial, in Peru, is testing calcium supplements. A third trial in Argentina will compare 2 drug regimens.
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PMID:Hypertensive diseases of pregnancy. 1228 29

Eclampsia, an obstetrical emergency described in medical texts going back over a century, is characterized by convulsion, loss of consciousness, and high risk of death in the absence of careful medical treatment. Many cases can be prevented if the signs are recognized and treated in time. High blood pressure often giving rise to severe headaches, proteinuria, and edema causing abnormal swelling of the arms, legs, and face are precursors. The possibility of preventing eclampsia led the World Health Organization to undertake a collaborative study of the prevalence, causes, and effects of hypertensive disorders of pregnancy in different parts of the world. The principal investigators of 7 countries who met in Singapore to compare their findings noted strikingly different rates of eclampsia and preeclampsia in the 4 Asian countries represented. Edema was found to be a useful indicator of increased risk where health resources are scarce and the incidence of hypertension and edema are low. A study of maternal mortality in Jamaica around this time found that about 1/3 of deaths from direct obstetrical causes resulted from hypertensive disorders, most often eclampsia. The Jamaican researchers proposed a research project using techniques developed during the collaborative study. Data on more than 10,000 pregnant women allowed detailed study of hypertension, preeclampsia, and eclampsia. Among the women, .72% had had a crisis of eclampsia and 10.4% had hypertension, accompanied by proteinuria in about half the cases. Primigestes, women over 30, and those gaining more than normal amounts of weight during pregnancy were identified as at increased risk. The best indicator of risk was the coexistence of at least 2 out of 3 factors: edema, diastolic pressure of 80 mmHg or over, and proteinuria. The findings caused Jamaica to launch 2 programs, the 1st to screen pregnant women for risk factors for eclampsia and provide special care, and the 2nd to provide small doses of aspirin to half of pregnant women and a placebo to the other half to verify whether small doses of aspirin are an effective means of preventing eclampsia. The World Health Organization is supporting a controlled study of the efficacy of calcium tablets in preventing eclampsia in Peru and is considering a study comparing 2 different regimes for treating eclampsia in Argentina.
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PMID:[Blood pressure complications of pregnancy: through collaborative studies, WHO seeks solutions]. 1228 57

We present the cases of three women who, within a 6-month period, suffered post-partum generalized tonic-clonic seizures. All had received an epidural in labour for analgesia and were subsequently diagnosed as suffering from postdural puncture headache. All were treated for that headache with Synacthen and one also received sumatriptan before her seizures. All made satisfactory recoveries and were discharged home. None displayed classical patterns suggestive of pre-eclampsia, meningitis, cortical venous thrombosis or any other pathological process that might explain these events adequately, and the specific precipitating factors were left unidentified.
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PMID:Unexplained fitting in three parturients suffering from postdural puncture headache. 1276 2

Headaches tend to improve in the majority of migraineurs during pregnancy, but some patients report a worsening of migraine and present a management challenge because of the restrictions of pharmacotherapy during pregnancy. Treatment options become even more limited for pregnant migraineurs who develop preeclampsia. Labetalol was tried successfully in reducing the frequency, duration, and intensity of migraine attacks in a pregnant woman with preeclampsia. There were no significant side effects and the patient delivered a healthy baby without complications.
Headache
PMID:Labetalol for prophylactic treatment of intractable migraine during pregnancy. 1248 17

There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre-eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late-onset pre-eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report.
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PMID:Recurrent post-partum seizures after epidural blood patch. 1253 86


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