Book of Medical Disorders in Pregnancy - Tintash

cases are said to occur up to 1 week after
delivery. Frequently, poor antenatal care
and ignoring of premonitory symptoms
i.e. apprehend-sion, excitability,
hyperreflexia precede convulsion. The
description of the fit is typically like
grand mal epilepsy. It is followed by
coma of varying duration. Fits may recur
at short or long intervals. Status
epilepticus picture may super-vene.
Coma or, more usually, rapid convulsive
episodes may terminate fatally.
Tachypnea with acidosis and pyrexia up
to 39.44 Celsius is often present.
Proteinuria, oliguria or even anuria may
result in some cases. Hemo-globinuria,
passage of casts due to renal
involvement can also occur. Edema is
usually massive. Diuresis after delivery
is usually a good prognostic sign. Edema
and proteinuria disappear within a week
after delivery. Blood pressure usually
returns to normal within 2 to 6 weeks
from delivery. Persistence of high blood
pressure beyond this time suggests
chronic hypertension. In antepartum
eclampsia, labour may be precipitated
similarly, intrapartum eclampsia may
shorten labor. "Inter current eclampsia"
has been described where the patient
does not go into labour but returns to
normality. Recurrent eclampsia is also a
strong possibility and can occur.
Fatalities usually result from pulmonary
edema which must be consi-dered a
grave prognostic sign. Other signs of
cardiac failure are rising pulse rate,
cyanosis, and falling blood pre-ssure.
Massive cerebral hemorrhage may result
in hemiplegia. Post eclamptic psychosis
rarely occurs and remains for 1 to 2
weeks. Post-eclamptic visual problem
such as blindness is usually the result of
retinal edema but has good prognosis,
since complete recovery often takes
place.
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Differential diagnosis of eclampsia -
Convulsions and coma are common
features in eclampsia and a number of
other medical disorders, completely
unrelated to pregnancy. It is important
that it should be differentiated from
other clinical disorders where convulsions
and coma occurs. Convulsions
result due to central nervous system dysfunction.
They are usually sudden in
onset and commonly followed by state
of unconsciousness. Epilepsy, encephalitis,
cerebral tumor, acute porphyria,
ruptured cerebral aneurysm, uremia, diabetic
coma or even hysteria may simulate
this condition.
Post epileptic coma may last for few
minutes after a single epileptic att-ack or
persist for hours between re-peated
attacks of status epilepticus. Past history
of epilepsy is helpful. Vital signs and
blood pressure are usually normal.
Sub arachnoid hemorrhage:
This usually occurs in young adults from
rupture of the congenital aneurysm. The
onset is sudden and there is history of
severe headache, neck stiffness, nausea
and vomiting. Examination of spinal
fluid obtained by lumbar puncture will
reveal the presence of blood.
Hysterical fits: These occur in the
hysterical subject in the presence of the
audience. The tongue is not bitten,
similarly there is no incontinence of
urine. The Plantar response is flexor in
contrast to extensor. These features can
help differentiate this condition from
epilepsy.
Epilepsy: This condition is
characterized by a premonitory aura.
There is loss or disturbance of