Eclampsia in the Previable Period of 22w5d

Abstract

We herein report a case of eclampsia presenting at 22w5d gestation. The patient was a 25-year-old African American gravida 1 para 0 (G1P0) with no history of chronic hypertension or prior seizures. Her only antenatal issues included a remote history of marijuana use and an echogenic intracardiac focus noted on anatomy ultrasound. At 22w1d, she was noted to have blood pressure (BP) of 135/91 mm Hg in office. Four days later, she presented with generalized tonic-clonic seizures. In the emergency department (ED), obstetric providers were notified and recommended immediate initiation of 6 g bolus of intravenous (IV) magnesium. Fetal heart tones were present. Patient subsequently had another seizure in the ED. BP was 200s/130s mm Hg. Magnesium sulfate infusion was started and, with obstetric Doctor of Medicine at bedside, labetalol 20 mg IV was administered with improvement in BP to 160s/100s mm Hg. On labor and delivery, eclampsia diagnosis and severity, and preservation of mothers life as preferred course were explained. After tearful discussion, patient and family proceeded with induction of labor. The patient exhibited signs of fluid overload and chest X-ray showed pulmonary edema. Repeat lab work was consistent with hemolysis, elevated liver enzymes, low platelet count syndrome . Due to persistent headache, a computed tomography of head was performed that showed posterior reversible encephalopathy syndrome. About 10 h after initial Cytotec dose, the patient delivered a pulseless intact fetus. Cerebrovascular involvement leading to seizures is termed eclampsia and is caused by massive release of excitatory neurotransmitters. Preeclampsia-eclampsia syndrome can present anywhere from 20 weeks through the postpartum period. However, eclampsia with associated complications is exceedingly rare in the second trimester. No reports of eclampsia at 22 weeks gestation have been found in the literature.

J Clin Gynecol Obstet. 2022;11(1):14-18
doi: https://doi.org/10.14740/jcgo763