DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20160382

Correlation between neuroimaging (CT scan) and neurological presentation in antepartum and postpartum eclampsia

Shruti M. Ugran, Kasturi V. Donimath

Abstract


Background: Eclampsia is a pregnancy related condition with high mortality and morbidity along with perinatal mortality and morbidity. The following study is designed to correlate the neurological presentation with neuroimaging (CT scan brain) in antepartum and postpartum eclampsia patients, which will guide in proper management of the patients.

Methods: A prospective study conducted over a period of one year. 100 patients were included in all. The neurological presentation and neuroimaging findings were correlated in all antepartum and postpartum eclampsia patients who met the study criteria. The comparison was done using chi-square test and unpaired student ‘t’ test. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to find the accuracy of neurological presentation in determining the diagnosis and kappa agreement.

Results: Out of the 100 patients studied, 52 had significant CT scan findings. Of these 52, 35 women had neurological signs and symptoms, and 17 cases did not have neurological signs and symptoms (p=0.003). The sensitivity, specificity, positive predictive value and negative predictive value were found to be 67.31%, 62.5%, 66.04% and 63.83% respectively and the diagnostic accuracy was found to be 65%.

Conclusions: Evaluation of neurological signs and symptoms in women with eclampsia is an important assessment which helps for the further management. Neuroimaging has limited role in uncomplicated cases. Neuroimaging is indicated in atypical presentation, fatal cases and those resistant to standard anti-eclamptic therapy, where the signs and symptoms fail to predict the likelihood diagnosis.


Keywords


Eclampsia, Neuroimaging, Neurological presentation

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References


Kuntz GA, Renato M, Rodrigues CA. Hellp syndrome, reversible posterior leukoencephalopathy syndrome and eclampsia. Arq Neuro-Psiquiatr. 2009;67(4):1103-5.

Mishra R. Ian Donald’s practical obstetric problems. 6th ed., New Delhi; Advert Arnold B I Publication; 2007.

Choudhary A. Eclampsia a hospital based retrospective study. Kathmandu University Med J. 2003;1(4):237-41.

Arias F, Duftary SN, Bihndi AG. Practical Guide to high risk pregnancy and delivery. 3rd ed., Noida; Elsevier. 2008.

Kokila MS, Dwivedi AD. Correlation of Clinical and Neuroimaging Findings affecting Management in Postpartum Eclampsia: A Prospective Study. J South Asian Federation Obstet Gynaecol. 2011;3(3):125-30.

Ross MG, Ramus RM. Eclampsia. Access online from 2013.

Chakravarty A, Chakrabarti SD. The neurology of eclampsia: some observations. Neurol India. 2002;50:128.

Majoko F, Mujaji C. Maternal outcome in eclampsia at Harare Maternity Hospital. Cent Afr J Med 2001;47(5):123-8.

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;2(1):83-7.

Cunningham FG, Twickler D. Cerebral edema complicating eclampsia. Am J Obstet Gynecol. 2000;182:94-100.

Felz MW, Barnes DB, Figueroa RE. Late postpartum eclampsia 16 days after delivery: Case report with clinical, radiologic and pathophysiologic correlations. J Am Board Fam Pract. 2000;13(1):39-46.

Lubarsky SL, Barton JR, Friedman SA, Nasreddine S, Ramadan MK, Sibai BM. Late postpartum eclampsia revisited. Obstet Gynecol. 1994;83:502-5.

Chames MC, Livingston J, Invester TS, Barton JR, Sibai BM. Late postpartum eclampsia : a preventable disease? Am J Obstet Gynecol. 2002;186:1174-7.

Zak IT, Dulai HS, Kish KK. Imaging of neurologic disorders associated with pregnancy and the postpartum period. Radiographics. 2007;27(1):95-108.