Early onset imminent eclampsia with antiphospholipid antibody syndrome and recurrent epilepsy with HELLP syndrome

Abstract

Early-onset pre-eclampsia and eclampsia superimposed on antiphospholipid antibody syndrome (APLA) and a pre-existing seizure disorder represent one of the most challenging constellations in contemporary obstetric practice. The convergence of these conditions demands coordinated multidisciplinary expertise and carries very high maternal and foetal morbidity and mortality with known case of epilepsy on treatment.We report a 28-year-old woman (G6P1L1A4) at 18–23 weeks of gestation who presented across three sequential hospital admissions between 18-23 weeks with recurrent eclamptic seizures, severe hypertension (180/100 mmHg), moderate-to-severe anaemia, bilateral uterine artery diastolic notching indicating uteroplacental insufficiency, and a prior caesarean scar. Despite optimisation of antihypertensive and antiepileptic therapy including intravenous levetiracetam loading, eclampsia remained refractory. Multidisciplinary evaluation encompassing obstetrics, neurology, nephrology, haematology, psychiatry, ophthalmology, and neonatology ultimately concluded that continuation of the pregnancy posed imminent and extreme risk to maternal life. Medical termination of pregnancy (MTP) was performed at 23 weeks.This case underscores the catastrophic potential of untreated APLA syndrome in a patient with recurrent pregnancy loss, the diagnostic challenge of eclampsia superimposed on known epilepsy, and the critical importance of multidisciplinary management, proactive social support, and comprehensive pre-conception counselling in high-risk obstetric populations.