Atypical Presentation of Antenatal Eclampsia

Most women who develop eclampsia have preceding preeclampsia (proteinuria and hypertension). This is especially true for otherwise healthy nulliparous women. However, recently, there has been a paradigm shift in this philosophy. There is mounting evidence that preeclampsia can develop even in the absence of proteinuria and hypertension and that eclampsia itself may be the initial manifestation of hypertensive disorder during pregnancy. We report a rare case of a 24-year-old primigravida at 30 weeks of gestation who presented with new-onset generalised tonic-clonic seizures without prior hypertension or proteinuria in her antenatal records. A thorough workup revealed this presentation to be the initial feature of atypical eclampsia. She was managed appropriately and discharged with an excellent outcome. This experience highlights some of the difficulties in managing a case of atypical eclampsia, namely, erratic onset and an unpredictable course, all of which interfere with timely diagnosis and treatment and contribute to maternal and fetal morbidity and mortality.