Sato Maki, Iino Kaori, Ozaki Takashi, Hashimoto Tetsuji, Osawa Yuki, Hashimoto Rikako, Tando Tomoe, Takeda Aisa, Takahashi Sota, Taniguchi Ryosuke, Oishi Maika, Ito Asami, Tanaka Kanji, Tomita Tetsu, Yokoyama Yoshihito
Department of Obstetrics and Gynecology, Graduate School of Medicine, Hirosaki University, 5 Zaifu, Hirosaki, Aomori, 036-8562, Japan.
Perinatal Maternal and Child Center, Aomori Prefectural Central Hospital, Aomori, Japan.
BMC Pregnancy Childbirth. 2025 Jul 19;25(1):774. doi: 10.1186/s12884-025-07891-8.
Eclampsia is traditionally considered a complication of hypertensive disorders of pregnancy (HDP). However, atypical cases occur without preceding HDP, and their pathophysiological mechanisms remain unclear. This study aimed to compare the clinical features of eclampsia with and without prior HDP diagnosis.
We retrospectively analyzed 31 singleton pregnancies with eclampsia diagnosed at nine Japanese perinatal centers between 2007 and 2023. Cases were classified into two groups: eclampsia preceded by HDP (n = 14) and eclampsia not preceded by HDP (n = 17). Clinical characteristics, laboratory findings, and perinatal outcomes were compared.
Of the 31 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 significantly lower (22.07 ± 2.05 vs. 25.60 ± 6.19 kg/m, P = 0.047), the gestational week at delivery was significantly later (median 40.0 [32.0-41.0] vs. 37.5 [26.0-41.0] weeks, P = 0.020), and the proportion of male neonates was significantly higher (58.8% vs. 14.3%, P = 0.024). When comparing the onset periods-antepartum, intrapartum, and postpartum-the eclampsia not preceded by HDP group exhibited the highest number of cases during the intrapartum period, with 9 cases, while the eclampsia preceded by HDP group showed the highest number during the postpartum period, with 8 cases. Furthermore, in the eclampsia not preceded by HDP group, the white blood cell count was significantly higher immediately after onset (20,626 ± 7,956 vs. 14,687 ± 5,664 /μL, P = 0.039).
Atypical eclampsia without preceding HDP shows distinct clinical features, including later gestational age at onset, higher intrapartum incidence, and elevated inflammatory markers. These findings suggest a need for further investigation into alternative pathophysiological mechanisms and tailored clinical strategies for such cases.
子痫传统上被认为是妊娠高血压疾病（HDP）的一种并发症。然而，非典型病例在无先前HDP的情况下发生，其病理生理机制仍不清楚。本研究旨在比较有和无先前HDP诊断的子痫的临床特征。
我们回顾性分析了2007年至2023年期间在日本9个围产期中心诊断为子痫的31例单胎妊娠病例。病例分为两组：HDP为先兆的子痫（n = 14）和无HDP为先兆的子痫（n = 17）。比较临床特征、实验室检查结果和围产期结局。
在31例子痫病例中，17例（57%）无HDP为先兆，其余病例在子痫发作前已诊断为HDP。在无HDP为先兆的子痫组中，与有HDP为先兆的子痫组相比，体重指数显著更低（22.07±2.05 vs. 25.60±6.19 kg/m²，P = 0.047），分娩孕周显著更晚（中位数40.0 [32.0 - 41.0] vs. 37.5 [26.0 - 41.0]周，P = 0.020），男婴比例显著更高（58.8% vs. 14.3%，P = 0.024）。比较发病时期——产前、产时和产后——无HDP为先兆的子痫组在产时发病的病例数最多，为9例，而有HDP为先兆的子痫组在产后发病的病例数最多，为8例。此外，在无HDP为先兆的子痫组中，发病后即刻白细胞计数显著更高（20,626±7,956 vs. 14,687±5,664 /μL，P = 0.039）。
无先前HDP的非典型子痫表现出独特的临床特征，包括发病孕周更晚、产时发病率更高和炎症标志物升高。这些发现表明需要进一步研究此类病例的替代病理生理机制和量身定制的临床策略。
