Atypical Presentation of Antenatal Eclampsia.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Neurology

Background:

• Traditionally, eclampsia is preceded by preeclampsia, characterized by proteinuria and hypertension.
• This is particularly common in nulliparous women, indicating a typical progression of hypertensive disorders in pregnancy.
• Recent evidence suggests a paradigm shift, with eclampsia potentially occurring without these preceding signs.

Observation:

• A rare case of a 24-year-old primigravida at 30 weeks gestation presented with new-onset generalized tonic-clonic seizures.
• Antenatal records showed no prior history of hypertension or proteinuria.
• Diagnostic workup confirmed this as the initial manifestation of atypical eclampsia.

Findings:

• Atypical eclampsia can manifest as the first sign of a hypertensive disorder during pregnancy.
• The absence of preceding hypertension and proteinuria complicates the timely diagnosis of eclampsia.
• This case underscores the unpredictable nature and erratic onset of atypical eclampsia.

Implications:

• Highlights the importance of considering atypical eclampsia in pregnant women presenting with seizures, even without documented hypertension or proteinuria.
• Emphasizes the challenges in early diagnosis and management, which can impact maternal and fetal outcomes.
• Suggests a need for increased awareness and potentially revised diagnostic criteria for hypertensive disorders in pregnancy.