Eclamptic Patient Research Articles

Comparative Study on Fetomaternal Outcome after Lower Uterine Segment Caesarean Section and Vaginal Delivery in Eclamptic Patient

Eclampsia has a high prevalence in our country with a high mortality rate. Eclampsia is uniquely a disease of pregnancy and regardless of gestational age. It is recognized that termination of pregnancy is the only definitive care of pathophysiological event in eclampsia. This study was done to observe fetomaternal outcome in Lower Uterine Segment Caesarean Section (LUCS) and vaginal delivery in eclamptic patient. This cross sectional analytical study was carried out in eclampsia department of Obst and Gyane in Dhaka Medical College Hospital from July 2016 to June 2018. A uniform protocol was followed in all cases to have appropriate history, physical findings and laboratory investigations. In this study 98.0% patients were conscious on admission in group I and 96.0% in group II. This study showed significant difference in recurrence of convulsion after delivery between two groups. Recurrence of convulsion was 30% in vaginal delivery group and 6% in the cesarean section group. Total complications were found in 46.0% and 16.0% patients in group I and group II respectively in this study. The difference was statistically significant (p<0.05) between two groups. In this study PPH was the most common complication in both the groups. Abruptio placenta was found more common among the vaginal delivery group. On the other hand, electrolyte imbalance was found more in cesarean section group. Maternal death was only 2% and 1% in group I and group II respectively. In this study live birth was found 64.0% and 79% in group I and group II respectively. Asphyxia was more in neonates in group I than group II which was statistically significant. Referral of asphyxiated babies to NICU was found 63.0% and 56.0% in group I and II respectively. The difference was statistically not significant between two groups. Faridpur Med. Coll. J. Jan 2020;15(1): 16-20

Posterior reversible encephalopathy syndrome complicated with subarachnoid hemorrhage in an eclamptic pregnant patient: case report

BackgroundPosterior reversible encephalopathy syndrome (PRES) is a neurotoxic condition which comprises various neurological symptoms. This syndrome could be complicated by intracranial hemorrhage including subarachnoid hemorrhage (SAH). However, SAH is rarely seen in eclamptic patients with PRES.Case presentationA 34-weeks-pregnant woman at the age of 33 was admitted to the obstetrics department because of an episode of generalized tonic-clonic seizure. Before the seizure, the patient had a headache and was found to have an abnormal systolic blood pressure of 160 mmHg. On admission, systolic and diastolic blood pressures were up to 182 and 99 mmHg, respectively. Emergent cesarean section was then performed. On hospital day (HD) 2, cranial non-contrast computed tomography (CT) revealed the existence of SAH. Multiple areas of high signals on T2-weighted and fluid attenuated inversion recovery (FLAIR) sequences were shown by cranial magnetic resonance imaging (MRI) performed 2 days later. CT-angiography studies didn’t reveal intracranial aneurysm. After anti-hypertensive treatment, arterial blood pressure of the patient was gradually tapered to normal values. Eventually, the patient was discharged without any residual symptoms.ConclusionsSAH is a rare complication of PRES in eclamptic patients. In patients with PRES, occurrence of SAH is related to increased morbidity and mortality especially when the hemorrhage is diffuse or massive. Our patient had a minor hemorrhage. The good prognosis might also be due to immediate elimination of the risk factor of PRES by emergent delivery.

Interdisciplinary Obstetric Simulation for Common Obstetric Emergencies

BACKGROUND: Duty hour restrictions limit trainee exposure to obstetric emergencies. Additionally, nursing turnover creates an area of need for increased education for preparation for these emergencies. Simulation has been used to improve physician performance, communication, and medical documentation; however, whether these benefits extend to all providers is understudied. METHODS: We conducted a quasi-randomized prospective educational trial targeted toward L&D nurses with less than 2 years' experience and junior obstetric residents. Participants were exposed to a pretest examining their knowledge (multiple choice, yes/no, free text responses) and comfort level (measured utilizing the Likert scale) with three common obstetric emergencies: shoulder dystocia, emergency cesarean delivery, and eclampsia. Participants underwent a simulation of one of the scenarios, watched their video-taped performance, participated in a debrief and educational session, and then repeated the simulation. Participants were administered a posttest following the simulation. RESULTS: Eighteen L&D nurses and 17 obstetric residents participated. Examination of the pre- and posttest results revealed improvements in the comfort level with shoulder dystocia maneuvers (P=.0178), communication during a shoulder dystocia (P=.0339), medical management of an eclamptic seizure (P=.0190), and knowledge of how to appropriately administer magnesium to an eclamptic patient without an IV (P=.0047). DISCUSSION: Interdisciplinary collaboration through the use of obstetric simulation can be utilized to improve knowledge and comfort necessary for the management of obstetric emergencies for both obstetric residents and L&D nurses.

Fluid and Nutritional Management Can Significantly Reduce the Mortality of Patients with Eclampsia in Resource Poor Settings

Objective: To observe fluid and nutritional management along with specific management and close clinical monitoring without intensive care management improve the condition of unconcious eclamptic patients in the resource poor setting.Method: Six hundred and nine(609) eclamptic patients were admitted in Mymensingh Medical College Hospital from January to December 2008. Twenty four (24) unconscious eclamptic patients were enrolled for this clinical trial study. These patients were managed in eclampsia ward with fluid therapy of 0.9% sodium chloride, 25% glucose, 5% aminoacids along with hydrocortisone and in some cases nasogastric feeding in addition to other regular medications. They were compared with 26 eclampsia patients treated with normal regular hospital management. A systematic guideline was followed and patients were closely monitored until the outcome.Results: The mean age of 23 years, 18 cases were primi-gravida; 16 had intrapartum, 6 had postpartum and 2 had antepartum eclampsia. The mean number of convulsion before admission was 12. The mean Glasgow Coma Scale (GCS) of these patients during admission was 5, which improved to 10.3 in 24 hours and 14.5 in 36 hours. None of these patients had fatal outcome in compare to observation group where three patients died following complications.Conclusion: Close monitoring with fluid and nutritional management can significantly reduce the mortality of unconscious eclamptic patients in resource poor settings where intensive care facility is limited. Development and adaptation of feasible systematic guideline for the management of unconscious eclamptic patient should be scaled up for the resource poor settings of developing and under developed countries.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(1) : 18-20

56 Posterior reversible encephalopathy syndrome and cerebral vasoconstriction in eclamptic and pre-eclamptic patients

Introduction Posterior reversible encephalopathy syndrome (PRES) is frequently observed in patients with eclampsia, and some of them also develop cerebral vasoconstriction. These radiological changes have been suggested as an essential component of eclampsia-mediated primary central nervous system injury. On the other hand, it is also reported that some pre-eclamptic patients with neurological symptoms develop PRES and cerebral vasoconstriction; however, the incidence is still unclear. Objectives The aim of this study was to determine the incidence of PRES and cerebral vasoconstriction in pre-eclamptic and eclamptic patients and to assess whether these two patient groups share similar pathophysiological backgrounds by comparing clinical and radiological characteristics. Materials & methods This was a retrospective cohort study of 4849 pregnant patients. A total of 49 eclamptic and pre-eclamptic patients with neurological symptoms underwent magnetic resonance imaging (MRI) and magnetic resonance angiography; 10 patients were excluded from further analysis because of a history of epilepsy or dissociative disorder. The age, parity, blood pressure, and routine laboratory data at the onset of symptoms were also recorded. For data that were considered to be normally distributed, unpaired t test or Welch’s test was used based on the homogeneity of variances. Otherwise, the Mann–Whitney U test was used for continuous data. Results Among 39 patients with neurological symptoms, 12 out of 13 (92.3%) eclamptic patients and 5 out of 26 (19.2%) pre-eclamptic patients developed PRES. Among PRES patients, 4 out of 12 (33.3%) eclamptic patients and 2 out of 5 (40.0%) pre-eclamptic patients developed cerebral vasoconstriction. Whereas age and systolic and diastolic blood pressure at onset were not different between PRES and non-MRI abnormality patients, hematocrit, serum creatinine, aspartate transaminase, alanine transaminase, and lactate dehydrogenase were higher in patients with PRES than those without MRI abnormalities. In contrast, eclamptic patients with PRES did not show any significant differences in clinical and laboratory data compared with pre-eclamptic patients with PRES. In addition to the parieto-occipital regions, atypical regions such as the frontal and temporal lobes, and basal ganglia were also involved in both eclamptic and pre-eclamptic patients with PRES. Finally, intraparenchymal hemorrhage was detected in one eclamptic patient, and subarachnoid hemorrhage was observed in one pre-eclamptic patient. Both of them developed PRES and cerebral vasoconstriction. Conclusion Although the incidence of PRES was high in eclamptic patients, nearly 20% pre-eclamptic patients with neurological symptoms also developed PRES. The similarities in clinical and radiological findings of PRES between the two groups indicate a shared pathophysiological background. Similar incidence of cerebral vasoconstriction in eclamptic and pre-eclamptic patients with PRES also supports this hypothesis. PRES was not benign and reversible disease, and coincidence of PRES and cerebral vasoconstriction might be a high-risk group of hemorrhagic complications. Therefore, MRI studies should be considered for patients with the recent onset of neurological symptoms regardless of the development of eclampsia.

Troponin I and D-Dimer levels in preeclampsia and eclampsia: prospective study

Objective: The aim of this study was to evaluate serum cardiac troponin I and D-Dimer (D-Di) levels in preeclampsia (PE), eclampsia(E), and normotensive healthy pregnant women in third trimester in order to define their diagnostic value. Materials and Methods:The study group consisted of 42 preeclamptic patients and 16 eclamptic patient; 108 healthy normotensive pregnant women in thirdtrimester who were chosen from outpatients clinic and examined regularly used as a control group. Serum cardiac troponin I and D-Dilevels were measured using an immunoassay. Results: The average levels of troponin I were 0.0134 ± 0.0091, 0.017 ± 0.0085, 0.180 ±0.136 in control group, preeclamptic, and eclamptic patients, respectively. The levels of troponin in eclamptic patients were statisticallyhigher than the normotensive and preeclamptic group (p = 0.016, p = 0.014). There were no differences in terms of troponin I level betweenpreeclamptic group and normotensive pregnant women in third trimester (p = 0.089). The average D-Di levels were 634 ± 228ng/ml, 1426 ± 430 ng/ml, 2067± 580 ng/ml in control group, preeclamptic, and eclamptic patients, respectively. The levels of D-Di inpreeclamptic and eclamptic patients were found significantly higher than the control groups (p = 0.034, p = 0.020). Conclusion: Serumtroponin I levels increased in eclamptic patient because of myocardial damage. An increased level of troponin was not detected inpreeclamptic patients. However; D-Di level increased in preeclamptic and eclamptic patients.

Association of serum calcium and uric acid level with hypertensive disorders of pregnancy [pre eclampsia and eclampsia] and there correlation with disease severity

Background: Hypertensive disorders are the most common medical complications during pregnancy and are associated with high maternal and fetal mortality and morbidity.One way to reduce the impact of arterial hypertension on maternal mortality is to establish the correct diagnosis of preeclampsia, and to proceed with an early intervention when it is diagnosed. The clinical signs are considered to be a late manifestation of a disease. The utility of two biochemical markers like hyperuricemia and hypocalcemia for the diagnostic purposes and for the prognosis remains largely to be explored. Objectives: (1) To determine the role of calcium & uric acid in the pathogenesis of preeclampsia. (2) To determine the serum level of calcium and uric acid & its correlation with the severity with preeclampsia. Study Design: Hospital based cross sectional case control study. Methods: The study was conducted in the Ante Natal Ward in Obstetrics &Gynaecology Department, BankuraSammilani Medical College, Bankura, WB, which serves a rural population where majority of the patients belong to the tribal groups. Mild pre eclamptic patient defined as blood pressure of at least 140/90 mm of Hg. at least on two occasions at least 6 hrs apart accompanied by proteinuria of at least 300 mg per 24 hrs or at least 1+ on dipstick testing. 64 Severe preeclamptic patient defined as having one or more criteria of the following-  BP ≥160/110 mm of Hg at least on two occasions at least 6 hrs apart  Proteinuria of ≥5gm/24hrs or at least 3+ on dipstick testing  Oliguria<500ml/24hrs or Cerebral or visual disturbances or Pulmonary edema or any other features of end organ damage. Statistical Analysis: Student's t test, Chi square test and statistical software Medcalc 11.3.0, Q1 Macros 2012. Results: There were no statistical significant difference in age, BMI, or birth weight of the baby between normal pregnant women and women with PIH but preeclamptic patients present early in gestational age and that was statistically significant. The serum calcium level in eclampsia and severe pre-eclampsia were significantly less than normal pregnant woman but there was no significant difference in serum calcium between normal pregnant woman and mild pre-eclamptic woman. The serum uric acid level in eclamptic woman and severe pre- eclamptic woman were significantly more than that of normal pregnant woman but there was no significant difference in serum uric acid between noral pregnant woman and mild pre-eclamptic woman. Conclusion: So the study indicates that hyperuricemia and Hypocalcaemia is significantly associated with Preeclampsia and their level varies with the severity of the disease process. Routine estimation of serum uric acid and calcium level may be useful as diagnostic marker in high risk pregnancies.

Prolonged upper airway obstruction in an eclamptic patient – challenges of management

Prolonged upper airway obstruction in an eclamptic patient – challenges of management

Not All Swelling Is Edema in Eclampsia: A Rare and Life-threatening Potential Complication of Eclamptic Seizures

A 24-yr-old, 65-kg, 152-cm primigravida woman with severe pre-eclampsia and a history of asthma was admitted at 38 weeks’ gestationfor magnesium administration and oxytocin induction of labor. Herlaboratory studies and physical examination were within normal limitsexcept for proteinuria, hypertension, and moderate generalized edemawithout obvious facial edema at admission. Because of her preeclamp-sia, an epidural catheter was easily inserted early before onset of activelabor or pain. Three hours later, the patient had a witnessed tonic–clonic eclamptic seizure, which subsided shortly after administrationof 4 mg intravenous lorazepam and assisted mask ventilation. Becauseof recurring fetal heart rate deceleration, an urgent cesarean deliverywas planned. However, the patient was combatively uncooperativedespite a bilateral T4 anesthetic level achieved epidurally while heroxygen saturation remained 100% and blood pressure was 140/85mmHg. The patient was noted to have a Mallampati class I airway withmoderate generalized edema and mild facial edema. Rapid sequencegeneral anesthesia induction was performed with successful atrau-matic intubation on the first attempt, followed by verification of bilat-eral symmetrical breath sounds. Maintenance of anesthetic consisted ofvolume-controlled mechanical ventilation, 50% oxygen, 50% nitrousoxide, 1–2% sevoflurane, midazolam, and opioid without the need foradditional neuromuscular blocker other than succinylcholine at induc-tion. Intraoperative blood pressure and heart rate were maintainedwithin 20% of preoperative values while oxygen saturation was main-tained at 99–100%, end-tidal carbon dioxide between 30–35 mmHg,and airway pressures less than 25 cm H

Prematurity represents an independent risk factor for eclampsia in preeclamptic women being treated with MgSO4

PREECLAMPTIC WOMEN BEING TREATED WITH MGSO4. MICHAEL BELFORT, JOHN ANTHONY, GEORGE SAADE, STEVEN CLARK, GARY DILDY, JANALEE THOMPSON, University of Utah, Obstetrics and Gynecology, Salt Lake City, Utah, University of Cape Town, Obstetrics and Gynaecology, Cape Town, South Africa, University of Texas Medical Branch at Galveston, Obstetrics & Gynecology, Galveston, Texas, University of Utah, Salt Lake City, Utah, Louisiana State University Medical Center at New Orleans, Obstetrics & Gynecology, Salt Lake City, Utah, St. Mark’s Hospital, Hospital Corporation of America, Maternal-Fetal Medicine, Salt Lake City, Utah OBJECTIVE: Magnesium sulfate (MgSO4) has an approximately 1% seizure prophylaxis failure rate in preeclampsia. Currently, factors predictive of seizure in such patients are unclear. STUDY DESIGN: Prospective data from preeclamptic women randomized to MgSO4 therapy were analyzed with univariate and multiple logistic regression analysis to determine independent variables associated with intrapartum and postpartum seizures. Variables included maternal age, race, gestational age, gravidity, previous preeclampsia, diabetes, chronic hypertension, epigastric pain, scotomata, headache, systolic BP, diastolic BP, platelet count, AST, ALT, and serum creatinine. A p ! 0.05 was used to denote statistical significance. RESULTS: 2038 patients were enrolled in two separate studies, of which 921 patients were randomized to MgSO4. Nine women or 0.98%, (95 percent confidence limits = 0.45% to 1.85%) on MgSO4 experienced seizure prophylaxis failure (8 intrapartum and 1 postpartum). No eclamptic patient had intracranial hemorrhage or other significant long-term neuropathology diagnosed and all recovered completely. By univariate analysis, lower gestational age and lower platelet count were identified as predictors of MgSO4 prophylaxis failure. On the multivariate regression analysis, only gestational age remained significantly associated with eclampsia (p = 0.04). 89% of patients in the seizure group (8/9) were !37 weeks while 61% (559/912) were preterm in the non-seizure group. CONCLUSION: Preterm preeclamptic patients (8/559 = 1.43%) receiving MgSO4 eclampsia prophylaxis are more likely to convulse than term patients (1/362 = 0.27%).

Effect Of Anaesthesia On Morbidity And Mortality In Emergency Caesarean Section Patients In Calabar, Nigeria

The outcome of obstetric anaesthesia following emergency Caesarean sections was studied retrospectively. The study which was carried out in the University of Calabar Teaching Hospital covered the period between 1st August 1995 – 31st August 2000. The aim was to evaluate the morbidity and mortality from anaesthesia during the period under review. Out of 1533 Caesarean sections performed 920 were emergency giving an emergency Caesearean section rate of 60%. The main indications for the emergency Caesearean sections were obstructed labour 220 (23.9%), foetal distress 193 (19.9%) and pre-eclampsia/eclampsia 142 (15.4%). General anaesthesia was employed in 555 (60.3%) while spinal was used in 365 (39.7%). Morbidity recorded in the spinal anaesthesia group were severe hypotension 110(30%), post dural puncture headache (PDPH) 46(2.6%) and transient neurologic symptoms (TNSs) 1 (0.022%). No mortality was recorded in the spinal anaesthesia group. Morbidity in the general anaesthesia group was mainly sore throat 364(65.6%) Five deaths were recorded in the general anaesthesia group. Four deaths occurred probably due to hypoxia following failed intubation, while the fifth death followed an unsuccessful cardiopulmonary resuscitation in an eclamptic patient, or due to eclampsia. From this study, mortality was recorded in the general anaesthesia group. Spinal anaesthesia, when there is no contra- indication is therefore recommended for safe obstetric anaesthesia. Brisk pre-operative evaluation, optimization of pre-operative clinical status of parturients and competent anaesthetist are of paramount importance. Key words: Obstetric anaesthesia; emergency caesarean section; morbidity and mortality. Nigerian Journal of Physiological Sciences Vol.18(1-2) 2003: 77-81

Orofacial injuries in eclamptic Nigerians.

A retrospective review of one hundred and seventy three cases of eclampsia seen between 1994 and 2002 was conducted. Twenty one patients (12.1%) whose ages ranged from 18 to 35 years sustained orofacial injuries during the course of their eclamptic fits. Lacerations and bruises on the tongue, gingivae and lips accounted for injuries in all the patients. Temporomandibular joint dislocation was also recorded in one patient. Tongue lacerations were mainly due to tongue biting. Forceful insertion of objects during convulsive episodes was responsible for the bruises and deep lacerations at the ventral surface of the tongue in two patients. Two patients died from severe and uncontrolled bleeding complicated by renal failure and aspiration pneumonia from lacerations on the tongue and gingivae. Vigorous campaign should be carried out to encourage antenatal care attendance by pregnant mothers so that potential cases of eclampsia could be nipped in the bud before progressing to frank eclampsia. Furthermore, additional injuries usually inflicted on pregnant women by anxious relatives from forceful insertion of unpadded objects as mouth props should be discouraged through public health promotional campaigns. Obstetricians should be aware of the possibility of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. The need to seek appropriate and early dental or maxillofacial consultation where such injuries are suspected and where services are available is imperative.

Anaesthetic dilemma: spinal anaesthesia in an eclamptic patient with mild thrombocytopenia and an “impossible” airway

We present our anaesthetic management of a 27-year-old woman with antepartum eclampsia, mild thrombocytopenia, difficult airway and clinical evidence of impending upper airway obstruction. She required urgent delivery by caesarean section, which was conducted uneventfully under spinal anaesthesia. We discuss the management conundrums presented by this case and why we chose spinal anaesthesia over other anaesthetic options.

Postpartum blindness: Two cases

We present 2 cases, one eclamptic patient and one noneclamptic patient, of headache, cortical blindness, and seizures. Both patients demonstrated findings consistent with posterior leukoencephalopathy syndrome. Posterior leukoencephalopathy syndrome is a rapidly evolving neurologic condition that is characterized by headache, nausea and vomiting, seizures, visual disturbances, altered sensorium, and occasionally focal neurologic deficits. Posterior leukoencephalopathy syndrome can be triggered by numerous conditions, including preeclampsia-eclampsia, and can be seen in the postpartum period. It is characterized predominately by white matter vasogenic edema of the occipital and posterior parietal lobes. This condition can be difficult to differentiate clinically from cerebral ischemia, and magnetic resonance imaging with diffusion-weighted imaging and apparent diffusion coefficient are needed to do so. In most cases of posterior leukoencephalopathy syndrome, the prognosis is excellent, with full resolution of symptoms.

Tongue piercing in an eclamptic patient

Tongue piercing in an eclamptic patient

Continuous spinal anesthesia for cesarean section in a parturient with severe preeclampsia

Epidural anesthesia is a widely accepted technique for cesarean section in the preeclamptic patient with normal coagulation. Regional anesthetic techniques avoid the hazards associated with tracheal intubation in the preeclamptic or eclamptic patient. To date, continuous spinal anesthesia in the preeclamptic parturient has not been described. We present a case in which continuous spinal anesthesia was administered for cesarean section in a morbidly obese parturient with severe preeclampsia. Continuous spinal anesthesia was successfully administered without significant hemodynamic consequences or maternal or fetal morbidity. This case suggests that continuous spinal anesthesia may be a viable alternative anesthetic technique for operative delivery in the preeclamptic parturient when epidural anesthesia cannot be established.

Severe pre-eclampsia and eclampsia: a broad overview with discussion of the nursing care required for the eclamptic patient

Severe pre-eclampsia and eclampsia are conditions which are rarely seen in A & E departments today. Although the percentage of patients suffering from these conditions in extremely small, the author has been involved in the care and treatment of two patients with this severe complication of pregnancy. A lack of clear guidelines on this subject was the motivation which prompted further study. This paper covers definitions of pre-eclampsia, eclampsia, history, incidence, risks and pathophysiology. The main discussion is the nursing care and treatment of the eclamptic patient in the acute phase of the condition. The author hopes that by the end of this paper it is evident that all health care professionals should be aware of this dangerous condition and know the appropriate treatment to give to ensure the best quality of care possible.

Thromboprophylaxis, coagulation disorders, and regional anaesthesia.

The surgery and trauma-induced modulation of the coagulation system includes a considerable risk of perioperative thromboembolic complications unless effective thromboprophylactic treatment is given. In the present survey the patient at risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) is characterized and the documented efficacy of different currently used thromboprophylactic regimens is summarized. Systemic thromboprophylactic treatment may include a risk of an increased bleeding tendency which may lead to haemorrhagic complications. In patients with a coagulation abnormality or in patients receiving anticoagulants for perioperative thromboprophylaxis there is a fear among anaesthesiologists that the use of regional anaesthesia (spinal or epidural) may be associated with spinal haemorrhagic complications, i.e. with spinal haematoma formation leading to compression of the spinal cord and severe neurologic sequelae. Present aspects on the risk of spinal haematoma formation at the combined use of pharmacological thromboprophylactic regimens and spinal or epidural anaesthesia/ analgesia are therefore summarized. Pregnancy is associated with changes in the haemostatic system, which in the preeclamptic or eclamptic patient may be rather pronounced and constitute a clinical problem since regional anaesthetic techniques are often preferred for obstetric anaesthesia/analgesia. The specific problems to be considered prior to the choice of regional anaesthesia/analgesia for a parturient with a suspected coagulation disorder are therefore commented on in more detail. Finally, recommendations are given for safe spinal and epidural analgesic and anaesthetic routines in patients with potential haemostatic disturbances due to thromboprophylactic treatment with anticoagulants or bleeding disorders.

Cerebral Vasospasm in Eclampsia: Transcranial Doppler Ultrasound Findings

Transcranial Doppler ultrasound was used to evaluate the middle cerebral artery blood flow-velocity in an eclamptic patient. An elevated middle cerebral artery pulsatility index, compatible with severe vasospasm, was demonstrated. Computed tomography of the brain showed regions of hypoden-sity. Normalization of the Doppler waveform correlated with clinical and tomographic improvement.

Abnormal Hemostasis and Coagulopathy in Preeclampsia and Eclampsia

Preeclampsia and eclampsia appear to be a state of increased coagulopathy as evidenced by an increase in fibrin formation, activation of the fibrinolytic system, platelet activation and a decrease in platelet count. Routine tests used to assess decompensated disseminated intravascular coagulopathy are of limited value in the preeclamptic and eclamptic population. More sophisticated tests such as determinations of antithrombin III, thrombin-antithrombin III complex, D-dimer, factor VIII antigen/activity ratio, and beta-thromboglobulin, however, show a compensated coagulopathy in the preeclamptic patient. These hemostatic changes, probably the result of endothelial damage, are implicated in the pathogenesis of this disease. A better understanding about the abnormalities of hemostasis and coagulation in the preeclamptic and eclamptic patient may allow the clinician to provide improved management and possibly peripartum therapy.