Journal of Hypertension: Open Access

Atypical Eclampsia at a Regional Hospital in Northern Kwa Zulu-Natal: Lessons to Learn

Abstract

Suvarnah Bodasingh, Nassim Mayat, Jagidesa Moodley and Surandhra Ramphal

Background: Recent publications indicate that eclampsia (convulsions associated with hypertension and proteinuria in pregnancy) may occur without the classical clinical signs of hypertension and proteinuria. Such cases labelled atypical eclampsia can occur for the first time antenatal, intrapartum or 48 hours after but within four weeks of childbirth in the absence of hypertension and proteinuria. Raising awareness of atypical eclampsia may improve the clinical management including appropriate investigations.
Objectives: To describe the prevalence and maternal and perinatal outcome of atypical eclampsia in a rural northern KwaZulu-Natal Province. Methods: This was a chart review of cases diagnosed as eclampsia admitted to a regional hospital serving 19 maternity clinics and 17 district hospitals in northern Kwa Zulu-Natal over a 2 year period (2016-2017). The details of those cases considered be atypical were analysed.
Results: There were 168 cases of eclampsia; seven cases had atypical eclampsia giving an incidence of 4.2%. Convulsions occurred antenatal in four cases (57.1%); intrapartum in two (28.6%) and postpartum in one case (14.3%). Six (85.7%) were referred from district hospitals, and all six received antenatal care; the seventh case had antenatal care at a clinic. The mean age was 20.4 years (range: 16-29); 42.9% were 16-19 years old. Four (57.1%) were primigravida and there was one maternal death. Surprisingly there was no evidence of neurological imaging studies.
Conclusion: This study confirms that atypical eclampsia is an uncommon finding at the study site. Of concern is the lack of imaging studies to exclude neurological causes of the convulsions.