OS012. Eclampsia with progressing disease correlates to severe diastolicblood pressure.

INTRODUCTION

Eclampsia is MRI-radiologically defined as posterior reversible encephalopathy syndrome (PRES), which indicate cases with eclampsia might improve spontaneously and reversibly. On the other hand the central nervous system is the main target organ affected by the disease of severe preeclampsia. Eclampsia is thought to be one of the severe states of this disease. We should recognise some eclamptic cases to grow worse resulting in disastrous stroke or poor prognosis. Especially the symptoms of long lasting unconsciousness or repeating seizures, or the sings with cerebrovascular vasospasms or brain stem lesion are considered as the progressing disease among the disease of eclampsia. We studied what factors among obstetrics features are related to this progressing disease of eclampsia.

OBJECTIVES

Thirty six cases with eclampsia were entered in this study. All cases were managed in our hospital from 1995 to 2011. All cases had hypertensive disorders and 23 cases complicated with preeclampsia or superimposed preeclampsia. Four cases were antepartum eclampsia, 12 cases intrapartum and 10 cases postpartum. 20 cases were diagnosed as progressing disease of eclampsia, and 16 cases were no progressing disease.

METHODS

As obstetric features, the peak values of hypertension at the onset of eclampsia, the proteinuria severity, the organ involvements such as HELLP syndrome or renal failure, parity and maternal age were studied. The values of systolic blood pressure (sBP) and diastolic blood pressure (dBP) were considered as independent parameters each other in this study. Statistical analysis was performed how these obstetric confounding features were to be correlated with progressing disease of eclampsia by logistic regression analysis (LRA). Univaiate and multivariate LRA were performed using with peak sBP, peak dBP, peak proteinuria, or other features as covariates, and progressive disease as dependent variable.

RESULTS

Univariate analysis showed that ⩾210mmHg of sBP, ⩾105mmHg of dBP and ⩾10g/day of proteinuria were related to the progressing disease of eclampsia compared with the no progressing disease. And multivariate analysis showed that ⩾105mg of dBP had significantly the highest adjusted odds ratio of 10.0 (95%CI 0.96-103, p=0.05).

CONCLUSION

We had shown previously CNS disorders such as eclampsia had the strongest correlation with severe sBP ⩾200mmHg among 108 cases of preeclampsia with severe hypertension and severe proteinuria, whereas other organ involvements such as HELLP syndrome had the strongest correlation with severe dBP ⩾110mmHg (now not in published, presented in ISSHP 2010). Other studies also strengthen the significance of high sBP in the management of eclampsia [1,2]. Controversially we noticed in this study that the progressing disease of eclampsia significantly related to severe dBP ⩾105mmHg. This indicates that severe dBP are the important marker as for predicting serious organ involvements either in central nervous system or in other organs in the disease of preeclampsia/eclampsia.