Work

Characteristics of eclampsia not preceded by hypertensive disorders of pregnancy: a case control study

Year: 2025

Type: article

Abstract: Background Eclampsia, a severe complication of pregnancy characterized by seizures, has traditionally been associated with hypertensive disorders of pregnancy (HDP). However, a significant proportion of eclampsia cases occur without a prior diagnosis of HDP, suggesting the existence of alternative pathophysiological mechanisms. This study aimed to explore the characteristics of eclampsia not preceded by HDP and to offer insights into its underlying mechanisms and potential risk factors.Methods We conducted a retrospective analysis of eclampsia in 31 singleton pregnancies diagnosed at nine Japanese hospitals with perinatal and maternal centers between May 2007 and March 2023. Data on background factors, blood pressure measurements, laboratory test results, and imaging findings were collected and analyzed. Patients were classified into two groups: eclampsia preceded by HDP and eclampsia not preceded by HDP, and comparisons were made regarding background factors, perinatal outcomes, and test results were compared.Results Of the 30 cases of eclampsia, 17 (57%) were not preceded by HDP, while the remaining cases had been diagnosed with HDP prior to the onset of eclampsia. In the eclampsia not preceded by HDP group, compared to the eclampsia preceded by HDP group, the BMI was lower, the gestational week at delivery was earlier, and the proportion of male neonates was higher (P < 0.05). When comparing the onset periods among the three groups—antepartum, intrapartum, and postpartum—the eclampsia not preceded by HDP group exhibited the highest number of cases during the intrapartum period, with 9 cases (52.9%). Conversely, the eclampsia preceded by HDP group showed the highest number of cases during the postpartum period, with 8 cases (61.5%). Furthermore, in the Eclampsia not preceded by HDP group, the white blood cell count was significantly higher immediately after onset (P < 0.05).Conclusions Eclampsia not preceded by HDP may involve inflammatory and immune responses triggered by labor, unlike typical eclampsia, which is associated with a rapid increase in blood pressure. Recognizing atypical eclampsia as a separate entity may aid in developing more effective prediction, prevention, and treatment strategies for this life-threatening condition.

Source: BMC Pregnancy and Childbirth

DOI: 10.1186/s12884-025-07891-8