Serdar YALVAÇ, Erdem FADILOĞLU, Tuğba KINAY, Funda AKPINAR, Ömer L. TAPISIZ

An Unusual Case of Eclampsia at 21 Weeks of Gestation with Multiple Risk Factors Except Molar Pregnancy

Preeklampsi/eklampsi gebeliğin ciddi bir komplikasyonudur ve erken başlangıçlı hastalık çoğunlukla molar gebelik ile ilişkilidir. Biz gebeliğin çok erken haftalarında gelişen, çok sayıda risk faktörüne sahip ancak molar gebeliği bulunmayan nadir bir eklampsi olgusunu sunduk. Otuz beş yaşındaki hasta (gravida 11, parite 1) 21. gebelik haftasında eklampsi geçirdi. Hastanın önceki gebeliğinde preeklampsi, kronik hipertansiyon, tekrarlayan gebelik kaybı (6-21. gebelik haftaları arasında toplam 9 abort) ve metiltetrahidrofolatredüktaz (MTHFR) heterozigot mutasyon öyküsü mevcuttu. Gebelik histerotomi ile sonlandırıldı. Plasentada molar değişiklik izlenmedi. Postoperatif komplikasyon olmadı ve hasta antihipertansif tedavi ile taburcu edildi. Eklampsi preeklampsinin şiddetli bir formudur ve klinisyenler preeklampsi için çok sayıda risk faktörüne sahip hastalarda çok erken gebelik haftalarında hastalığın gelişebileceğini akılda tutmalıdırlar

Yirmi Birinci Gebelik Haftasında Gelişen Molar Gebelik Dışında Birçok Risk Faktörüne Sahip Nadir Bir Eklampsi Olgusu

Preeclampsia/eclampsia is a serious complication of the pregnancy and earlyonset disease is mostly associated with molar pregnancy. We present a rare case of eclampsia that occurred at very early weeks of gestation and had multiple risk factors for preeclampsia, but not molar pregnancy. A 35-year-old woman (gravidity 11, parity 1) presented with eclampsia at 21 weeks of gestation. She had history of preeclampsia in previous pregnancy, chronic hypertension, recurrent pregnancy loss (a total of 9 abortions at 6-21 weeks of gestation) and methyltetrahydrofolatereductase (MTHFR) heterozygous mutation. The pregnancy was terminated by hysterotomy. Molar change was not observed in the placenta. No postoperative complication occurred and the patient was discharged with antihypertensive therapy. Eclampsia is a severe form of the preeclampsia and clinicians should keep in mind that it may be occurred at very early weeks of gestation in patients with multiple risk factors for preeclampsia

PDF

___

1. Pauli JM, Repke JT. Preeclampsia: Short-term and Long-term Implications. Obstet Gynecol Clin North Am. 2015;42:299-313
2. Cuero MR, Varelas PN. Neurologic Complications in Pregnancy. Crit Care Clin. 2016;32:43-59.
3. Sibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005;105:402-10.
4. Ito M, Katabuchi H, Yoshimura T, Matsui K, Nakayama M, Maeyama M. A Case of Eclampsia during the 18th Week of Gestation. Int J Gynaecol Obstet. 1985; 23: 395-8
5. Sampson MB, Thomason JL, Tomasi AM, Work BA Jr. Pregnancy termination in patients with pregnancy-induced hypertension or eclampsia at less than 22 weeks' gestation. Am J Obstet Gynecol. 1982;143:474-5.
6. Gürel SA, Gürel H. Early development of HELLP syndrome associated with eclampsia: a case report. European Journal of Obstetrics & Gynecology and Reproductive Biology 1998; 76: 241– 3
7. Sibai BM, Mercer B, Sarinoglu C. Severe preeclampsia in the second trimester: recurrence risk and long-term prognosis. Am J Obstet Gynecol1991;165:1408-12.
8. Trogstad L, Magnus P, Moffett A, Stoltenberg C. The effect of recurrent miscarriage and infertility on the risk of pre-eclampsia. BJOG. 2009;116:108-13
9. Roberts JM. Pathophysiology of ischemic placental disease. Semin Perinatol. 2014;38:139-45.
10. Livrinova V, Lega MH, Dimcheva AH, Samardziski I, Isjanovska R. Factor V Leiden, Prothrombin and MTHFR Mutation in Patients with Preeclamsia, Intrauterine Growth Restriction and Placental Abruption. Open Access Maced J Med Sci. 2015;3:590-4.