Recurrent eclampsia. Clinical data, morbidity and pathogenic considerations

The analysis of 24 patients with recurrent eclampsia showed that (i) the first attack complicated the second or later pregnancies in nine cases, (ii) there was one or more apparently normal gestations before the second eclampsia in one-third of the patients, (iii) total maternal and neonatal mortality were twice those of general eclampsia, (iv) four autopsies revealed chronic pyelonephritis and cardiac hypertrophy in addition to the characteristic glomerular and hepatic lesions, (v) all six deaths were due to brain damage, and (vi) chronic hypertension was diagnosed in half of the survivors. The results of this study demonstrate that (i) one or several normal pregnancies after eclampsia do not cancel the possibility of another attack, (ii) recurrent eclampsia is an extremely severe event even though most clinical data are no different from general eclampsia, (iii) underlying diseases seem to play a decisive role, and (iv) some aspects of recurrent eclampsia challenge single cause pathogenic mechanisms.