Abstract
Introduction: Hypertensive disorders of pregnancy comprising of pre-eclampsia and eclampsia are a major cause of adverse pregnancy outcomes. Neurological manifestations of pregnancy induced hypertension are the most common cause of maternal and foetal morbidity and mortality. Cranial neuro-imaging reveals focal regions of symmetric hemispheric oedema; with parietal and occipital regions getting most commonly affected.
Methods: The study was conducted among 65 antenatal women diagnosed with pre-eclampsia and eclampsia at gestational age >20 weeks in the Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and child IGMC Shimla. Clinical signs and symptoms, Laboratory tests neuroimaging findings were recorded for study purpose.
Results: About 17.6% of severe pre-eclampsia and 100% of eclampsia had findings observed on cranial MRI. Headache and visual complaints were most frequently recorded. PRES was the predominant neuroradiographic finding in present study and occipital lobe was commonly affected region. In subjects with MR imaging findings, hematocrit, LDH, serum uric acid and ApTT were significantly higher than those without MR imaging findings. Subjects with MRI finding had abnormal RBC morphology whereas none of MR negative subjects had abnormal RBC morphology. No significant difference was observed regarding blood pressure parameters between MRI positive and negative subjects.
Conclusion: Neuroimaging in antenatals with severe hypertensive disorders might aid in better understanding of the poorly explained phenomenon. In addition this would be helpful in better management of the disorders along with their much dreaded complications. Patients with hypertensive disorders of pregnancy with deranged biochemical tets should be subjected routinely to cranial imaging for the better perinatal outcomes.
Keywords: Antenatal women, Pregnancy induced hypertension, Biochemical tests, neuro-imaging.
References
- Chamotra S, Pathania K, Verma SK, Chaudhary A. Predicting pregnancy outcomes from homocysteine level: an evidence from a North Indian study. Int J Reprod Contracept Obstet Gynecol 2020; 9:1498-502.
- Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol 2000; 183:S1–22
- World Health Organization. WHO Recommendations for Prevention and Treatment of Pre-Eclampsia and Eclampsia. Geneva, Switzerland: World Health Organization; 2011
- Patil Mithil M. Role of Neuroimaging in Patients with Atypical Eclampsia. J of Obstet & Gynecol of India 2012; 62 (5): 526-30
- Roybart M, Seidman DS, Serr DM, Mashiach S. Review. Neurological Involvement in Hypertensive Disease of Pregnancy. Obstet & gynaecol Survey 1991; 46(13): 656-64.
- Diwan AG, Agrawal PH, Panchanadikar TM, Yadav SV, Joshi P. Late post-partum eclampsia with reversible encephalopathy syndrome: an interesting case. Indian J of Medical Specialities 2012
- Chiou YH, Chen PH, Reversible Posterior Encephalopathy Syndrome as the Presentation of Late Post Partam Eclampsia: A case Report. Acta Neurologica Taiwanica 2007; 16 (3):158-62.
- Bartynski WS, Posterior Reversible Encephalopathy Syndrome, Part I: Fundamental Imaging and Clinical Features. Am J Neuroradiol 2008; 29: 1036-42.
- Junewar V, Verma R, Sankhwar PL, Garg RK, Singh MK, Malhotra HS et al. Neuroimaging Features and Predictors of Outcome in Eclamptic Encephalopathy: A Prospective Observational Study. AJNR Am J Neuroradiol.2014; 35:1728-346
- Sharma G, Joshi G, Purohit CR, Divyashree. Cranial MR Imaging in Eclampsia and Severe preeclampsia: A Prospective study. Journal of evolution of medical and dental sciences 2014;3(13):3250-59
- Schwartz RB, Mulkern RV, Gudbjartsson H and Jolesz F: Diffusion-Weighted MR Imaging in Hypertensive Encephalopathy: Clues to Pathogenesis. AJNR Am J Neuroradiol 1998;19:859–62
- Sharma G, Bhatt D, Yadav K, Agarwal S, Kochar S: Eclampsia Preeclampsia; Clinical and Neurological Correlates, IOSR Journal of Dental and Medical Sciences (IOSR-JDMS).Volume 15, Issue 5 Ver. III (May. 2016), PP 87-91
- Dahiya K, Rathod M, Rohilla S, Dahiya P: Correlation between Neuroimaging and Clinical Presentation in Eclampsia, International Journal of Obstetrics and Gynaecology Research (IJOGR) Vol. 3 (2016) No.6, pp. 375-384.
- Demirtas O, Gelal F, Vidinli BD, Demirtas LO, Uluc E, Baloglu A. Cranial MR Imaging with clinical correlation in preeclampsia and eclampsia. Diagn Interv Radiol 2005; 11: 189-94.
- Swain S, Ohha KN, Prakash A. Maternal and perinatal mortality due to eclampsia. Indian Pediatr 1993 Jun; 30(6):771-73.
- Richard BS, Steven KF, Joseph FP, De Girolami U, Lalia A, Beckner KM. Preeclampsia-Eclamsia: Clinical and Neuroradiographic Correlates and Insights into the Pathogenesis of Hypertensive Encephalopathy. Radilogy 2000; 217: 37.
- Cunnighum FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL. Williams obstetrics: Hypertensive disorders in pregnancy. 24th Newyork: McGraw-Hill Education; 2014. Chapter no. 10 : 1508-6135.
Corresponding Author
Dr Rohit Dogra
Department of Obstetrics and Gynecology Civil Hospital Jaisinghpur
DOI: https://dx.doi.org/10.18535/jmscr/v8i6.60
