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Preeclampsia into eclampsia: toward a new paradigm.

Publication ,  Journal Article
Katz, VL; Farmer, R; Kuller, JA
Published in: Am J Obstet Gynecol
June 2000

OBJECTIVE: This study was undertaken to characterize aspects of the natural history of eclampsia. STUDY DESIGN: A retrospective analysis was performed on the records of patients with eclampsia who were delivered at two tertiary care hospitals. RESULTS: Fifty-three pregnancies complicated by eclampsia were identified. Thirty-seven of the women were nulliparous. The mean age was 22 years (range, 15-38 years). Mean gestational age at the time of seizures was 34.2 weeks' gestation (range, 22-43 weeks' gestation). Twenty-eight women had antepartum seizures (53%); 23 of the 28 had seizures at home. Nineteen women had intrapartum seizures (36%). Eight of these women had seizures while receiving magnesium sulfate, and 7 had therapeutic magnesium levels. Six women had postpartum seizures (11%), 4 >24 hours after delivery. Headache preceded seizures in 34 cases. Visual disturbance preceded seizures in 16 cases. The uric acid level was elevated to >6 mg/dL in 43 women. There were no maternal deaths or permanent morbidities. There were 4 perinatal deaths. Two patients had intrauterine fetal deaths at 28 and 36 weeks' gestation. These mothers had seizures at home. One infant died of complications of prematurity at 22 weeks' gestation and one died of respiratory complications at 26 weeks' gestation. There were 4 cases of abruptio placentae, 1 of which resulted in fetal death. Of the 53 cases of eclampsia, only 9 were potentially preventable. One of these was that of a woman who was being observed at home. The other 8 women were hospitalized and had hypertension and proteinuria. Only 7 women could be considered to have severe preeclampsia before seizure (13%), and 4 of these 7 women were receiving magnesium sulfate. CONCLUSIONS: Eclampsia was not found to be a progression from severe preeclampsia. In 32 of 53 cases (60%) seizures were the first signs of preeclampsia. In this series eclampsia appeared to be more of a subset of preeclampsia. Only 9 cases of eclampsia were potentially preventable with current standards of practice. Our paradigm for this disease, as well as our approach to seizure prophylaxis, should be reevaluated.

Duke Scholars

Published In

Am J Obstet Gynecol

DOI

ISSN

0002-9378

Publication Date

June 2000

Volume

182

Issue

6

Start / End Page

1389 / 1396

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Pregnancy
  • Pre-Eclampsia
  • Postpartum Period
  • Obstetrics & Reproductive Medicine
  • Magnesium Sulfate
  • Labor, Obstetric
  • Infant, Newborn
  • Infant Mortality
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Katz, V. L., Farmer, R., & Kuller, J. A. (2000). Preeclampsia into eclampsia: toward a new paradigm. Am J Obstet Gynecol, 182(6), 1389–1396. https://doi.org/10.1067/mob.2000.106178
Katz, V. L., R. Farmer, and J. A. Kuller. “Preeclampsia into eclampsia: toward a new paradigm.Am J Obstet Gynecol 182, no. 6 (June 2000): 1389–96. https://doi.org/10.1067/mob.2000.106178.
Katz VL, Farmer R, Kuller JA. Preeclampsia into eclampsia: toward a new paradigm. Am J Obstet Gynecol. 2000 Jun;182(6):1389–96.
Katz, V. L., et al. “Preeclampsia into eclampsia: toward a new paradigm.Am J Obstet Gynecol, vol. 182, no. 6, June 2000, pp. 1389–96. Pubmed, doi:10.1067/mob.2000.106178.
Katz VL, Farmer R, Kuller JA. Preeclampsia into eclampsia: toward a new paradigm. Am J Obstet Gynecol. 2000 Jun;182(6):1389–1396.
Journal cover image

Published In

Am J Obstet Gynecol

DOI

ISSN

0002-9378

Publication Date

June 2000

Volume

182

Issue

6

Start / End Page

1389 / 1396

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Pregnancy
  • Pre-Eclampsia
  • Postpartum Period
  • Obstetrics & Reproductive Medicine
  • Magnesium Sulfate
  • Labor, Obstetric
  • Infant, Newborn
  • Infant Mortality
  • Humans