Diagnosis and management of atypical preeclampsia-eclampsia

Sibai, Bahaeddine M; Stella, Caroline L.

doi:10.1016/j.ajog.2008.07.048

Cited by 286 publications

(211 citation statements)

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“…Lee et al [29] identified that various categories of genes were differentially expressed in placenta undergoing labor and vaginal delivery. Late postpartum preeclampsia is defined as the development of signs and symptoms of preeclampsia for the first time at more than 48 h but less than 4 weeks after delivery, and classified as atypical preeclampsia [30]. But, it has been regarded that the placenta plays a central role in preeclampsia pathogenesis, since the signs of preeclampsia can occur in molar pregnancies and in most cases, the clinical symptoms rapidly resolves once the placenta is delivered.…”

Section: Discussionmentioning

confidence: 99%

Preeclampsia leads to dysregulation of various signaling pathways in placenta

Kang

Song

Yoon

et al. 2011

Journal of Hypertension

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Section: Discussionmentioning

confidence: 99%

Preeclampsia leads to dysregulation of various signaling pathways in placenta

Kang

Song

Yoon

et al. 2011

Journal of Hypertension

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“…In our study because of the evidence of end organ dysfunction, a diagnosis of eclampsia or imminent eclampsia was made. These cases without proteinuria were described as atypical cases of preeclampsia and eclampsia by Baha M. Sibai [13]. Society of Obstetrics and Gynaecology of Canada (SOGC) Note: In high risk cases of eclampsia, though we mentioned one reason for Caesarean section, many other factors would be taken into consideration: the total number of convulsions, level of consciousness, time from the onset of convulsions, response to induction methods, the salvageability of the foetus, the lab, parameters and the concern of the family.…”

Section: Discussionmentioning

confidence: 99%

Management of Eclampsia and Imminent Eclampsia, Maternal and Perinatal Outcome in 666 Cases—2003-2007 at Government Maternity Hospital in Hyderabad

Devabhaktuni¹,

Addula²,

Ponnur³

et al. 2017

OJOG

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Objective: This is an audit to evaluate the maternal and perinatal outcome in eclampsia and imminent eclampsia with the management adopted at a tertiary hospital. Methods: During a period of 34 months, from [2003][2004][2005][2006][2007] at Government maternity hospital, Osmania medical college, Hyderabad, 666 women with eclampsia and imminent eclampsia were managed. The number of eclampsia and imminent eclampsia (IE) was 532 and 134, respectively. We have analyzed the clinical profile, parity, age, degree of proteinuria, the period of gestation in weeks, the antenatal care, the number of antenatal visits, referrals from other hospitals, the diastolic B.P. at the time of admission, the recurrence of convulsions and the complications. 1) All the cases of eclampsia and IE were managed with magnesium sulphate as an anticonvulsant. 2) Oral nifedipine, IV labetalol, sublingual nifedipine and nitroglycerine infusion were used to control severe hypertension. 3) Prostaglandin E1 (PGE1) was used for induction of labour (IOL) 194nary embolisim in 2, aspiration pneumonia in one and sepsis in one. The perinatal mortality was 167/582 (28.69%), PNM when birth weight was >1.5 kg was 59/426 (13.84%), intrauterine fetal deaths at admission were 54 (8.5%), there were four sets of twins. Conclusions: 1) More effective measures to control hypertension and routine administration of anticonvulsant, magnesium sulphate to women with eclampsia should be practised from the first referral unit itself. 2) Our caesarean delivery rate of 33.54% in the very high risk cases of eclampsia and imminent eclampsia is very low compared to others. 3) Induction of labour with misoprostol was successful in 81% with consequent reduction in caesarean section rate and morbidity and mortality associated with caesarean deliveries. Misoprostol has proved to be a safe and effective inducing agent in eclampsia. 4) The maternal mortality in our series is 2.55%.

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“…Very little is known about severe PE at \20 weeks of gestation [1][2][3]. Sibai et al [1] suggested that pregnancy complicated with this condition should be evaluated to rule out the presence of other conditions, such as molar change in the placenta, lupus nephritis, hemolytic-uremic syndrome, antiphospholipid antibody syndrome, or thrombotic thrombocytopenic purpura.…”

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confidence: 98%

“…Sibai et al [1] suggested that pregnancy complicated with this condition should be evaluated to rule out the presence of other conditions, such as molar change in the placenta, lupus nephritis, hemolytic-uremic syndrome, antiphospholipid antibody syndrome, or thrombotic thrombocytopenic purpura. Although our patient did not have these complications, she had other potential risk factors, predisposing to the development of superimposed PE [4,5].…”

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Atypical severe preeclampsia superimposed on chronic hypertension without molar change at 19 weeks of gestation: a case report

Ochiai

Nakamura

Sakurai

et al. 2012

Arch Gynecol Obstet

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Atypical severe preeclampsia (PE) at \20 weeks of gestation is an extremely rare yet serious cause of perinatal morbidity [1]. Severe PE that occurs at \20 weeks of gestation has been reported with molar change in the placenta; however, data describing this condition in cases without molar change are limited. To our knowledge, there is only one reported case of severe PE without molar change at 15 weeks of gestation [2]. We describe the clinical course of a pregnancy without molar change that was complicated by atypical severe PE superimposed on chronic hypertension at 19 weeks of gestation.A 40-year-old gravid 2, para 1 woman was referred at 12 weeks of gestation with multiple risk factors affecting her pregnancy, including hypertension, a family history of cardiovascular disease (father suffered from hypertension and ischemic cardiovascular disease at 48 years), severe PE at 28 weeks in a previous pregnancy, obesity (body mass index 27.2), advanced maternal age, and conception by intracytoplasmic sperm injection (ICSI) and transfer of a single embryo. At referral, mild hypertension (148/94 mmHg) without proteinuria was observed and at 18 weeks of gestation, her blood pressure was 137/94 mmHg without proteinuria. At 19 3/7 weeks, the following findings suggested atypical severe PE superimposed on chronic hypertension: blood pressure 165/98 mmHg, urinary protein excretion 400 mg/day, extreme edema in the hands and lower extremities, and headache. A first and a second trimester ultrasound screening test did not reveal any abnormalities except for bilateral early diastolic notches in the uterine artery (uterine artery pulsatility index, 1.92; [95th percentile). At 19 5/7 weeks, the patient's body weight increased by 3 kg in 2 days, and this weight gain was associated with exacerbation of edema and oliguria. Her blood pressure and 24-h urinary protein excretion increased to 175/102 mmHg and 6.2 g, respectively. She did not show any clinical symptoms of systemic lupus erythematosus and did not present any autoantibody such as anti-dsDNA, anti-Sm, antiphospholipid, and antinuclear antibody. In addition, platelet count and liver function tests were normal. Although magnesium sulfate and nicardipine hydrochloride were administered, her blood pressure remained high at 185/113 mmHg. The pregnancy was terminated and a 250 g stillborn male was delivered at 20 4/7 weeks. Pathological examination of the placenta revealed an absence of physiologic transformation in the decidual segment of the spiral artery and ischemic changes, such as increase in cytotrophblastic cellular proliferation, syncytial knot formation, and hyalinized villous spots; however, there was no evidence of molar change. Protein excretion decreased to 200 mg/day on postpartum day 2 and disappeared by day 7. She was prescribed nifedipine (30 mg/day) to control her blood pressure, which was 130-140/80-90 mmHg on postpartum day 8, and she was subsequently discharged in good health.Very little is known about severe PE at \20 weeks of gestation [1-3]. Sibai et al...

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Diagnosis and management of atypical preeclampsia-eclampsia

Cited by 286 publications

References 52 publications

Preeclampsia leads to dysregulation of various signaling pathways in placenta

Preeclampsia leads to dysregulation of various signaling pathways in placenta

Management of Eclampsia and Imminent Eclampsia, Maternal and Perinatal Outcome in 666 Cases—2003-2007 at Government Maternity Hospital in Hyderabad

Atypical severe preeclampsia superimposed on chronic hypertension without molar change at 19 weeks of gestation: a case report

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