Introduction: Cerebral & visual disturbances, epigastric pain, nausea, and vomiting, pulmonary edema, impaired liver function of unclear etiology & thrombocytopenia. RBC morphology is the strongest predictor of abnormal radiographic findings. The only laboratory parameter that has been found to be abnormal a week prior to the development of neurological symptoms is serum Lactate dehydrogenase (LDH) level which is higher in the group that later developed hypertensive encephalopathy related brain oedema. Alteration in Liver function tests (LFTs) includes elevated levels of serum aminotransferase, namely, aspartate aminotransferase (AST) or alanine aminotransferase (ALT).

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. Laboratory tests and 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. 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.

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 results should be subjected routinely to cranial imaging for the better perinatal outcomes.

Keywords: Antenatal women, Pregnancy induced hypertension, laboratory biochemical results, Neuro-imaging.

1. 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
2. World Health Organization. WHO Recommendations for Prevention and Treatment of Pre-Eclampsia and Eclampsia. Geneva, Switzerland: World Health Organization; 2011
3. Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ERM et al. Obstetrics: Normal and problem pregnancies: Hypertension. 6^th edition Philadelphia. Saundars An imprint of Elsevier Publications; 2013, 779-824
4. Cunnighum FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL. Williams obstetrics: Hypertensive disorders in pregnancy. 24^th Newyork: McGraw-Hill Education; 2014. Chapter no. 10 : 1508-6135
5. PatilMithil M. Role of Neuroimaging in Patients with Atypical Eclampsia. J of Obstet & Gynecol of India 2012; 62 (5): 526-30
6. Roybart M, Seidman DS, Serr DM, Mashiach S. Review. Neurological Involvement in Hypertensive Disease of Pregnancy. Obstet & gynaecol Survey 1991; 46(13): 656-64.
7. 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
8. 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.
9. 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.
10. Bartynski WS, Posterior Reversible Encephalopathy Syndrome, Part I: Fundamental Imaging and Clinical Features. Am J Neuroradiol 2008; 29: 1036-42.
11. 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.
12. Schifmann R. An MRI-based approach to the diagnosis of white matter disorders.Neurology.2009;72(8): 750-59.
13. 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
14. Chang WN, Lui CC, Chang JM: CT and MRI findings of eclampsia and their correlation with neurologic symptoms, Zhonghua Yi XueZaZhi (Taipei). 1996 Mar;57(3):191-7.
15. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A: A reversible posterior leukoencephalopathy syndrome, N Engl J Med. 1996 Feb 22;334(8):494-500.
16. 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.
17. Schwartz RB, Feske SK, Polak JF, DeGirolami U, Iaia A and Beckner KM: Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy, Radiology.2000 No34v;217(2):371-6.
18. McKinney AM, Short J, Truwit LC, McKinney ZJ, Kozak OS: Posterior Reversible Encephalopathy Syndrome: Incidence of Atypical Regions of Involvement and Imaging Findings, AJR 2007; 189:904–912
19. Wagner SJ, Acquah LA, Lindell EP, Craici IM, Wingo MT, Rose CH et.al .Posterior Reversible Encephalopathy Syndrome and Eclampsia: Pressing the Case for More Aggressive Blood Pressure Control. Mayo din Proc.2008; 86(9) 851-56
20. Topuz S, Kalelioğlu I, Iyibozkurt AC, Akhan S and Has R: Cranial imaging spectrum in hypertensive disease of pregnancy. ClinExpObstet Gynecol. 2008;35(3):194-7.
21. Lu HY, Xie BD, Cheng Y, Niu XM: Clinical features of preeclampsia-eclampsia patients with reversible posterior leukoencephalopathy syndrome, Zhonghua Yi XueZaZhi. 2010 Jan 19;90(3):178-81.
22. Kokila MS, Dwiwedi AD. Correlation of clinical and neuroimaging findings affecting management in Postpartemeclampsia. Journal of South federation of Obstetrics and Gynaecology 2011;3(3):125-30.
23. Tatapudi R, Tripurasundari M, Asra K, Moothi NL: Study of neuroradiological and biochemical abnormalities in 100 women with preeclampsia-eclapmsia, Pregnancy Hypertens. 2012 Jul;2(3):190
24. Limana TG, Bohnerc G, Heuschmannb PU, Scheelc M, Endresa M, and Siebertc E: Clinical and radiological differences in posterior reversible encephalopathy syndrome between patients with preeclampsia-eclampsia and other predisposing diseases, European Journal of Neurology 2012, 19: 935–943.
25. Brewer J, Owens MY, Wallace K, Reeves AA and Morris R, MD: Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia, Am J Obstet Gynecol 2013;208:468.e1-6.
26. Jindal MA, Gaikwad HS, Hasija BD, Vani K: Comparison of neuroimaging by CT and MRI and correlation with neurological presentation in eclampsia. Int J Reprod Contracept Obstet Gynecol. 2013 Mar;2(1):83-87.
27. Fisher N, Saraf S, Egbert N, Homel P, Stein EG, Minkoff H. Clinical Correlates of Posterior Reversible Encephalopathy Syndrome in Pregnancy. The Journal of Clinical Hypertension 2014;123:1-11
28. 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.
29. 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.
30. 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.
31. Mayama M, Uno K, Tano S, Yoshihara M and Ukai M: Incidence of posterior reversible encephalopathy syndrome in eclamptic and patients with preeclampsia with neurologic symptoms, Am J Obstet Gynecol. 2016 Aug;215(2):239.
32. Mirzamoradi M, Hosseini MS, Saleh M and Esmaeili S : Posterior Reversible Encephalopathy Syndrome (PRES) Associated With Eclampsia: A Case Study International Journal of Medical Research & Health Sciences, 2017, 6(3): 48-53
33. Singh T et al. Socio-economic status scales updated for 2017.Int J Res Med Sci. 2017 Jul;5(7):3264-3267.
34. Swain S, Ohha KN, Prakash A. Maternal and perinatal mortality due to eclampsia. Indian Pediatr 1993 Jun; 30(6):771-73.
35. Census of India. Literacy Estimates of mortality indicators 2010. http://www.censusindia.gov.in/vital_statistics/srs/Chap_4_2010. pdf (accessed June 2013).
36. Park K. Park’s Textbook of preventive and social medicine: Preventative medicine in obstetrics, pediatrics & geriatrics. 22nd ed. Jabalpur (M.P.). M/s Banarasidas Bhanot publishers; 2013, 480-562.

Rohit Dogra

Department of Obstetrics and Gynaecology, Civil Hospital, Jaisinghpur, Kangra, Himachal Pradesh, India