Correlation of Clinical and Neuroimaging Findings affecting Management in Postpartum Eclampsia: A Prospective Study

Abstract

ABSTRACT Objectives To correlate clinical and radiologic findings, to determine whether brain tomography affects management and routinely indicated in uncomplicated postpartum eclampsia and to differentiate it from other potentially treatable conditions. Methodology: This was a prospective hospital-based study of 28 postpartum eclamptics with atypical or complicated course. Neuroimaging was done after stabilizing them with standardized eclampsia regimen. The relationship between maternal demographic, clinical and neuroimaging data with the cause for postpartum seizures was statistically analyzed with Yate's Chi-square test and Odds ratio with 95% confidence interval. Results The eclampsia incidence was 3.64% (326/8944 deliveries). Noneclamptic organic cause for seizures was more in late postpartum eclamptics. Among ten early postpartum eclamptics, 80% had normal neuroimaging, one cerebral edema and one neurocysticercosis. Among 18 late postpartum eclamptics, four had normal neuroimaging, one falcian calcification, one cerebral hypoxia, eight (28.6%) cortical venous thrombosis, three granuloma and one gliosis. Conclusion Despite many abnormalities seen on imaging studies, some are incidental and transient, without chronic neurologic sequelae. Thus, expensive neuroimaging has limited role in uncomplicated cases with typical clinical course and prompt response to standard therapy. Thus, neuroimaging is indicated in atypical and fatal cases where specific therapy may be required.