DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20214327
Published: 2021-10-27

Comparative study of neuroimaging features and clinical symptoms in patients with eclampsia

Neha Meena, Suman Meena, Khushbu Meena, Savitri Verma

Abstract


Background: Eclampsia is a life-threatening emergency that remains a major cause for feto-maternal morbidity and mortality. The purpose of our study was to access various computed tomographic scan (CT) findings in eclampsia patients and compare neurological symptoms with radiological findings. 

Methods: A prospective analytical study was undertaken in department of obstetrics and gynecology, J. K. Lon hospital, Kota during the period of 2019-2020. Women who presented as eclampsia and admitted in indoor wards were included in the study. Data analyzed included various maternal and fetal parameters, CT scan findings and outcome of pregnancy. 

Results: The incidence of eclampsia was 1.1% of total deliveries. High risk factors associated with eclampsia were primigravida (70%), maternal age (70% in 21-25 years age group), illiteracy (64%), inadequate antenatal care (96%), early gestation (68%). On CT scan findings 52% patients had abnormal CT scan findings of which most common was cerebral edema (57.7%). Parieto-occipital lobe was most common region to be affected. Altered sensorium was found to be significantly associated with abnormal CT scan findings.

Conclusions: Eclampsia is a major cause of fetal and maternal morbidity and mortality.  CT scan in eclampsia have significant role in early diagnosis of patients with cerebral pathologies and these CT scan findings were associated with the level of consciousness and number of convulsive episodes.  Thus, CT scan helps in further management of these patients by multidisciplinary approach.


Keywords


Eclampsia, CT scan, Blood pressure, Neurological complications in pregnancy

Full Text:

PDF

References


Hypertensive disorders in pregnancy. Williams Obstetrics, 24th edition. McGraw-Hill Companies Inc. 2014;40;731.

Das R, Biswas S. Eclapmsia: the major cause of maternal mortality in Eastern India. Ethiop J Health Sci. 2015;25(2):111-6.

Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstetr, Gynecol, Reproduct Biol. 2013;170(1):1-7.

Matter F, Sibai BM. Eclampsia viii risk factors for maternal morbidity. Am J obst gynecol. 2000;182:307-12.

Leitch CR, Cameron AD, Walker JJ. The changing patterns of eclampsia over a 60-year period. Br J Obstet Gynaecol. 1997;104: 917-22.

Mass JL, Lamy C. Stroke in pregnancy in postpartum period. In: Ginsberg MD, Bogousslavsky J, editors. Cerebrovascular disease: pathophysiology, diagnosis and management. Malden: Blackwell sci. 1988;1684-97

Kanki T, Mihara F, Nakanoh. Diffusion weighted images and vasogenic edema in pregnancy. Obstet Gynaecol. 1999;93:821-3.

Zeeman G. Flankenstein JJ, Twickler DM. Cerebral infarction in eclampsia. Am J Obstet Gynaecol. 2002;100:140.

Manfredi M, Baltramello A. Eclamptic encephalopathy, neuroimaging and pathological consideration. Acta neurol Scand. 1997;96:277-82.

Gabbe Sibai BM. Hypertension, 6th edi. Section 6. 2009;35:852.

Marques R, Braga J, Leite I, Jorge CS. Neurological involvement in preeclampsia/ eclampsia: the role of neuroimaging. Acta Med Port. 1997;10:585-8.

Harandou M, Madani N, Labibe S, Messouak O, Boujraf S, Benkirane S et al. [Neuroimaging findings in eclamptic patients still symptomatic after 24 hours: a descriptive study about 19 cases. Ann Fr Anesth Reanim. 2006;25:577-83.

Akan H, Küçük M, Bolat O, Selçuk MB, Tunali G. The diagnostic value of cranial computed tomography in complicated eclampsia. J Belge Radiol. 1993;76:304-06.

Pradhan K, Nath SS, Panigrahi SK. Intracerebral changes detected by CT scan of brain in post-delivery eclampsia patients. EJPMR. 2018;5(11):468-75.

Rajeswari KSR. Computed tomography scan findings in eclampsia. Int J Reprod Contracept Obstet Gynecol. 2018;7(11):4432-8.

Agarwal M, Gautam A. study of fetomaternal outcome in eclampsia. Int J Reprod Contracept Obstet Gynecol. 2020;9(10):4155-9.

Jain R, Bindal J. Maternal and perinatal outcomes in eclampsia: a retrospective analysis in a referral hospital. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):2806-11.

Parihar BC, Yadav B, Patel J. Critical care management of eclampsia patients - one year study. Int J Reprod Contracept Obstet Gynecol. 2020;9(12):4850-4.

Chibber R, Al-Hijji J, Amen A, Fouda M, Kaleemullah ZM, El-Saleh E, Mohammed AT. Maternal and perinatal outcome of eclampsia over a decade at a tertiary hospital in Kuwait. J Maternal-Fetal Neonatal Med. 2016;29(19):3132-7.

Dasgupta A, Biswas SK, Jana SK, Nandy D. Brain CT scans findings in Eclampsia mothers and its clinical evaluation: a cross sectional study. JMSCR. 2019;7:4.

Agrawal S, Walia GK, Staines-Urias E, Casas JP, Millett C. Prevalence of and risk factors for eclampsia in pregnant women in India. Family Med Community Health. 2017;5(4):225-44.

Haque H, Thapa K. Maternal and Fetal Outcome in Eclampsia: A Study from Tertiary Care Hospital. JNGMC. 2017;15:2-17.

Nazneen N, Laskar MS, Barua PP, Haque SD. Factors influencing pregnancy induced hypertension in Khulna Medical College Hospital. Mediscope. 2016;3(2):31-5.

Brouh Y, Jean KK, Ouattara A, Tetchi Y, Pete Y, Koffi N et al. Brain lesions in eclampsia. Indian J Crit Care Med. 2016:20(3):178-81.

Khandaker S, Haldar M, Munshi S. Intra Cerebral Changes Detected by CT scan of Brain in Eclampsia. Austin J Obstet Gynecol. 2014;1(3):4.

Brewer J, Owens MY, Wallace K, Reeves AA, Morris R, Khan M et al. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol. 2013;208(6):468.e1-6.

Gurjar B, RP Rawat. CT scan findings in patients of eclampsia. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3405-08.

Harandou M, Madani N, Labibe S, Messouak O, Boujraf S, Benkirane S et al. Neuroimaging findings in eclamptic patients still symptomatic after 24 hours: a descriptive study about 19 cases. Ann Fr Anesth Reanim. 2006;25:577-83.

Akan H, Küçük M, Bolat O, Selçuk MB, Tunali G. The diagnostic value of cranial computed tomography in complicated eclampsia. J Belge Radiol. 1993;76:304-06.

Milliez J, Dahouna, Boudraa M. Computed tomography of the brain in eclampsia. Obstet Gynecol. 1990;75:975-80.