Abstract
A 23-year-old primigravida with unknown last menstrual period and 20 weeks gestation by ultrasound presented to Daeyang Luke Hospital in Lilongwe, Malawi with a history of headache, fever, vomiting and new-onset of convulsions. At the time of her admission the full blood count instrument at our hospital was out of service. A rapid blood test for malaria was positive.
Highlights
Hypertensive disorders of pregnancy cause 14% of all maternal deaths globally, approximately 42,000 each year. 99% of these deaths occur in low resource settings [2]
Onset preeclampsia makes up the rest of the affected pregnancies and is characterized by an inadequate and incomplete trophoblast invasion of maternal spiral arteries and clear signs of fetal growth restriction [8]
She was discharged home on nifedipine 10 mg PO BD on her second postpartum day. Her blood pressure was 130/80 two weeks postpartum on no antihypertensives. This case presentation is remarkable for the early gestational age of 20 weeks at which the convulsions occurred. 91% of all cases of eclampsia develop at or after 28 weeks gestation. 7.5% occur between 21 and 28 weeks
Summary
Hypertensive disorders of pregnancy cause 14% of all maternal deaths globally, approximately 42,000 each year. 99% of these deaths occur in low resource settings [2]. The second stage, the maternal syndrome, results from the failure of cytotrophoblast remodeling of uterine spiral arteries. This cytotrophoblastic failure is thought to release secreted factors that enter the maternal circulation resulting in the signs and symptoms of preeclampsia [7,8]. In 2003 Maynard hypothesized that placental ischemia is an early event in preeclamptic pregnancies, leading to placental production of a soluble factor or factors that cause maternal endothelial dysfunction. He found that excess circulating sFlt secreted by the Citation: Makin MS (2021) Eclampsia at 20 Weeks of Gestation: A Case Report. A prior diagnosis of epilepsy should be ruled out [1,14]
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