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. After an initial blood pressure of 164/127 and 3+ proteinuria on urinary dipstick the diagnosis of eclampsia was made. She was given magnesium sulfate by intravenous protocol and labor was induced with vaginal misoprostol. She delivered a nonviable premature infant after six hours. This case is presented because of the rarity of eclampsia at 20 weeks gestation [1] and to discuss some of the recent advances in the pathogenesis of preeclampsia especially as it pertains to early developmental changes in the maternofetal junctional zone. Check for updatesIn 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 sFlt1 secreted by the
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