Delta hypertension as an emerging predictor of post-partum eclampsia in normotensive patients: a case study and implications for clinical practice

Abstract

Delta hypertension is defined as a significant late-pregnancy increase in mean arterial pressure (MAP) as compared to its mid-pregnancy value. This case report details a rare instance of post-partum eclampsia in a normotensive patient, emphasizing delta hypertension's role in predicting eclamptic events at blood pressure readings conventionally considered to fall within normotensive range.  A 23-year-old primigravida, with a normal medical history and consistent prenatal care, experienced unexpected post-partum eclampsia. Her pregnancy was uneventful until delivery, despite thrombocytopenia noted during labour. Initially recording a blood pressure range of 90/60 mmHg to 100/60 mmHg, the patient's blood pressure rose to 130/80 mmHg at term. Post-delivery she suffered from an episode generalized tonic-clonic seizure, despite maintaining blood pressure within normotensive limits. Extensive investigations were done to evaluate the episode- CT and MRI brain were done to rule out brain parenchymal defects, additionally 2D echocardiography, blood biochemistry panels, USG abdomen and pelvis revealed no abnormalities, indicating no typical eclamptic pathologies. Treatment included emergency seizure management and subsequent monitoring showing a return to pre-existing ante-natal blood pressure values without further incident or need for anti-hypertensive medications. Delta hypertension, a significant yet often overlooked rise in blood pressure later in pregnancy, was pivotal in this patient's clinical course. This condition suggests underlying endothelial dysfunction leading to critical end-organ damage, exemplified by this patient's post-partum eclampsia. Delta hypertension underscores the necessity for close longitudinal blood pressure monitoring protocols in ante-natal period, advocating for more nuanced assessments that could better predict and manage eclampsia in patients.