Leucoencefalopatía posterior reversible en una paciente con eclampsia posparto / Posterior reversible leukoencephalopathy in a patient with postpartum eclampsia

Describimos el caso clínico-radiológico de una paciente de 25 años que desarrolló una leucoencefalopatía posterior reversible (LPR) en el periodo posparto, sin evidencia de preeclampsiaeclampsia o hipertensión arterial crónica. La LPR se asocia a entidades clínicas diversas, incluyendo la eclampsia. La paciente presentó, diez días después del parto, un cuadro clínico compuesto por cefalea, hipertensión arterial y convulsiones. El edema vasogénico reversible que afecta a la sustancia blanca de las regiones posteriores constituye el hallazgo característico en la resonancia magnética cerebral. Aunque el pronóstico es favorable, el tratamiento debe ser precoz y agresivo, efectuando un control rápido de las convulsiones y de la hipertensión arterial, con la finalidad de evitar el desarrollo de isquemia e infarto cerebral. Es necesario tener un alto índice de sospecha y considerar el diagnóstico de eclampsia posparto y LPR en mujeres que presenten convulsiones y otros síntomas neurológicos en el puerperio

We report the clinical-radiological case of a 25 year-old female patient who developed reversible posterior leukoencephalopathy syndrome (RPLS) in the postpartum period, without evidence of preeclampsia-eclampsia or chronic arterial hypertension. RPLS is associated with diverse clinical entities including eclampsia. Ten days after giving birth, the patient presented with clinical symptoms of headache, elevated blood pressure and seizures. Reversible vasogenic oedema affecting the white matter in the posterior regions was the characteristic finding in magnetic resonance imaging (MRI) of the brain. Although the prognosis is favourable, treatment needs to be early and aggressive, with rapid control of the convulsions and arterial hypertension, with the aim of preventing ischemia and cerebral infarct from developing. There is a need to be highly alert and to consider the diagnosis of RPLS in women presenting with convulsions and other neurological symptoms in postpartum

Posterior reversible leukoencephalopathy in a case of postpartum eclampsia.

This case report describes an atypical presentation of eclampsia. A 26-year-old lady presented 5 days' postpartum with a series of grand mal seizures after an uneventful pregnancy and delivery. An MRI scan of the brain showed areas of low signal involving cerebral white matter and right cerebellum. Within 2 weeks, all symptoms and radiologic abnormalities had resolved.

An audit of the use of magnesium sulphate in severe pre-eclampsia and eclampsia.

Over the last decade there has been an increase in the use of MgSO4 for the prevention of seizures in women with severe pre-eclampsia or eclampsia. At the Rotunda Hospital it is regularly used for this purpose. The aim of this study was to audit the use of MgSO4 at the hospital, to determine whether the drug was being used according to the hospital's protocol and to observe its effectiveness in the prevention of eclampsia in our population. A retrospective chart review over the two years from 1/1/2000 to 31/12/2001 was undertaken. Outcome measures assessed were; Patient selection, Administration of the drug - whether recommended protocols were adhered, Effectiveness of therapy for seizure prophylaxis, Maternal and neonatal outcomes. There were 12,910 deliveries at the Rotunda hospital over this period of time. Fifty of these women were treated with MgSO4 (0.4%). Patient selection was appropriate in all cases. The correct loading dose of MgSO4 was administered in all cases, however MgSO4 levels were recorded in only 30 (60%) of women. There were no seizures in the treated group. Two women presented with seizures (one was antenatal the other post-natal period), both were treated with MgSO4. There were no maternal or neonatal mortality. Seventy two percent (36) of these women were delivered by lower segment caesarean section. The mean gestation at delivery was 36 weeks (range 28-41 weeks). Thirty eight percent (13) of babies required admission to the neonatal intensive care unit. The mean birth weight at delivery was 2.54 kg (range 1.11-3.68 kg). MgSO4 use in the Rotunda hospital appears to be safe and effective for the prevention of seizures in women with severe pre-eclampsia or eclampsia. Serum MgSO4 levels were only recorded in 60% of patients and the hospital's protocol was not adhered to regarding monitoring of patients on treatment. This needs to be addressed.

Presentation and management outcome of eclampsia at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: This study was carried out evaluate to epidemiology, clinical presentation and prognostics aspects of patients presenting with eclampsia. METHODS: This study was carried out at Gynae "C" unit of Ayub Teaching Hospital Abbottabad from 1st July 2003 to 31st October 2004. All patients presenting with eclampsia to the labor ward were included in the study. The diagnosis was based on history and confirmed on clinical findings of hypertension, oedema, proteinuria superimposed with fits. Patients with history of fits during pregnancy, labor and peurperium other than eclampsia were excluded from study. History physical findings and base line investigation were recorded on a proforma. RESULTS: A total of 2100 admissions were made in the labor ward during this period and out of them 68 cases (3.23%) were of eclampsia. Out of them 28 were primigravidae, 14 multigravidae and 26 grandmultigravidae. The seasonal frequency of cases was 29.41% in winters, 42.64% in autumn, 19.11% in summers and 8.82% in spring. Out of these 11.76% cases were complicated with retroplacental haemorrage and the same number with aspiration pneumonia, while Cerebrovascular Accident (2.94%) Acute tubular necrosis (2.94%) and Disseminated intravascular clotting (4.4%) were also seen. Among the new borns prematurity was found to be the major cause of perinatal mortality. CONCLUSION: Eclampsia is a dreadful complication of Pre Eclamptic Toxemia of pregnancy associated with high perinatal and maternal mortality. A qualitative and quantitative improvement in prenatal consultation should make it possible to reduce incidence of eclampsia measuring arterial blood pressure daily during antenatal period and for at least 14-days postpartum appears to be necessary for diagnosis and treatment for all cases of hypertension.

Comparison of referral and non-referral hypertensive disorders during pregnancy: an analysis of 271 consecutive cases at a tertiary hospital.

BACKGROUND: This retrospective cohort study analyzed the clinical manifestations in patients with preeclampsia and eclampsia, assessed the risk factors compared to the severity of hypertensive disorders on maternal and perinatal morbidity, and mortality between the referral and non-referral patients. METHODS: 271 pregnant women with preeclampsia and eclampsia were assessed (1993 to 1997). Chi-square analysis was used for the comparison of categorical variables, and the comparison of the two independent variables of proportions in estimation of confidence intervals and calculated odds ratio of the referral and non-referral groups. Multivariate logistic regression was used for adjusting potential confounding risk factors. RESULTS: Of the 271 patients included in this study, 71 (26.2%) patients were referrals from other hospitals. Most of the 62 (87.3%) referral patients were transferred during the period 21 and 37 weeks of gestation. Univariate analysis revealed that referral patients with hypertensive disorder were significantly associated with SBP > or =180, DBP > or =105, severe preclampsia, haemolysis, elevated liver enzymes, low platelets (HELLP), emergency C/S, maternal complications, and low birth weight babies, as well as poor Apgar score. Multivariate logistic regression analyses revealed that the risk factors identified to be significantly associated with increased risk of referral patients included: diastolic blood pressure above 105 mmHg (adjusted odds ratio, 2.09; 95 percent confidence interval, 1.06 to 4.13; P = 0.034), severe preeclampsia (adjusted odds ratio, 3.46; 95 percent confidence interval, 1.76 to 6.81; P < 0.001), eclampsia (adjusted odds ratio, 2.77; 95 percent confidence interval, 0.92 to 8.35; P = 0.071), HELLP syndrome (adjusted odds ratio, 18.81; 95 percent confidence interval, 2.14 to 164.99; P = 0.008). CONCLUSION: The significant factors associated with the referral patients with hypertensive disorders were severe preeclampsia, HELLP, and eclampsia. Lack of prenatal care was the major avoidable factor found in referral and high risk patients. Time constraints relating to referral patients and the appropriateness of patient-centered care for patient safety and better quality of health care need further investigation on national and multi-center clinical trials.

Are we increasing serious maternal morbidity by postponing termination of pregnancy in severe pre-eclampsia/eclampsia?

The objective of this study was to evaluate the impact of admission--delivery interval on maternal morbidity in patients with severe pre-eclampsia/eclampsia. This was a retrospective study, which involved review of case sheets of 188 women (admitted to St John's Medical College Hospital during the year 2000--2001 with the above diagnosis). The incidence of severe pre-eclampsia and eclampsia was 5.18% (188/3,627) with 119 primigravida and 69 multigravida. The incidence of serious maternal complications in the post partum period was 17% (11/68) in the category of women who delivered within 12 hours of admission compared with 40.6% (28/69) in the 12--48-h category and 60.8% (31/51) in the>48-h category. The incidence of serious maternal complications in the subset with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome was 33.4% (7/21) in the12-h. We concluded that termination of pregnancy within 12 hours of admission in severe pre-eclampsia/eclampsia especially in patients with HELLP syndrome helps to prevent avoidable serious maternal morbidity.

Permanent visual deficits secondary to the HELLP syndrome.

A 34-year-old woman with eclampsia and the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome developed encephalopathy, cardiomyopathy, pulmonary edema, liver failure, and disseminated intravascular coagulation (DIC), all of which resolved. She also had retinal hemorrhages in both eyes and a hemorrhagic infarct in the left occipital lobe that resulted in a permanent right homonymous hemianopia and a persistently depressed acuity of 20/100 OS. This case is unusual in demonstrating permanent visual deficits. In nearly all cases of preeclampsia or eclampsia, visual deficits are reversible. The superimposition of the HELLP syndrome may create more neurologic damage. Clinicians should be alert to patients at risk for HELLP syndrome and manage them aggressively.

Outcomes of severe pre-eclampsia/eclampsia in Yorkshire 1999/2003.

OBJECTIVE: To establish the risk of serious complications from severe pre-eclampsia and eclampsia in a region using a common guideline for the management of these conditions. DESIGN: A five-year prospective study. SETTING: Sixteen maternity units in Yorkshire. POPULATION: All women managed with severe pre-eclampsia and eclampsia. METHODS: A common guideline was developed for the management of women with these conditions. A network of midwives prospectively collected outcome data. MAIN OUTCOME MEASURE: Incidence of the conditions and serious complication rates. RESULTS: A total of 210,631 women delivered in the 16 units between 1 January 1999 and 31 December 2003. One thousand eighty-seven women were diagnosed with severe pre-eclampsia or eclampsia (5.2/1000). One hundred and fifty-one women had serious complications including 82 women (39/10,000) having eclamptic seizures and 49 women (23/10,000) requiring ICU admission. There were no maternal deaths but 54 out of 1145 babies died before discharge, giving a mortality rate of 47.2/1000. Of the 82 cases of eclampsia, 45 occurred antenatally (55%), 18 before admission to the maternity unit. Eleven cases occurred in labour (13%), including 1 during a caesarean section, and 26 cases occurred following delivery (32%). Twenty-five women developed pulmonary oedema (2.3% of cases) and six women required renal dialysis (0.55% of cases). One hundred and sixty-five (15%) required no antihypertensive therapy and 489 (53%) of the remainder required only oral therapy. Two hundred and one (18.5%) required more than one drug. CONCLUSION: A regional guideline for severe pre-eclampsia and eclampsia can be developed and implemented. Its use may contribute to a low rate of serious complications.

Cerebral edema on MRI in severe preeclamptic women developing eclampsia.

OBJECTIVE: The aim of this study is to identify suitable applications for cerebral MR (magnetic resonance) scanning in cases of severe preeclampsia and eclampsia through comparison of clinical course and easily accessible parameters. METHODS: From January 2001 to December 2003, cerebral MR scans were performed on 43 women with severe preeclampsia; of those 41 were enrolled in data analyses. Twenty clinical parameters, including age, body mass index, blood pressure, liver and renal function, and coagulation status, were compared for each patient. Data were analyzed using the SPSS program on a VAX main frame. RESULTS: Among 41 severe preeclamptic women, abnormal MR images were observed in 11 cases including six with systemic seizures. Predictive accuracy of eclampsia with abnormal cerebral MR imaging was 84.9% (P=0.00001), while only 14.3% of severe preeclampsia cases had been diagnosed radiologically. Statistical analysis suggests diastolic BP and serum AST as predictive parameters for abnormal MR images with 82.9% predictive accuracy (P=0.0007). CONCLUSIONS: Cerebral edema can be observed in preeclamptic patients developing eclampsia. Rapid delivery is indicated when diastolic BP and AST are elevated. MR scanning is useful when delivery is delayed due to fetal immaturityin cases of severe preeclampsia.

Encefalopatía posterior reversible en el posparto / Postpartum posterior reversible encephalopathy

En el síndrome de encefalopatía posterior reversible es característico encontrar en los estudios de resonancia magnética (RM) focos de hiperseñal de distribución occipital en las series potenciadas en T2. Las imágenes potenciadas en difusión nos permiten diferenciar si se trata de un edema vasogénico o citotóxico. Presentamos el caso de una paciente que en el período del posparto inmediato, y en relación con un cuadro de hipertensión arterial, presenta edema vasogénico reversible demostrado mediante RM

Magnetic resonance (MR) studies of posterior reversible encephalopathy syndrome characteristically find hyperintense foci in the occipital zone on T2-weighted sequences. Diffusion-weighted MR images enable differentiation between vasogenic and cytotoxic edema. We describe the case of a patient with reversible vasogenic edema demonstrated on MR in the immediate postpartum period related arterial hypertension

Hipofisitis linfocitaria durante la gestación / Limphocit hypofisitis during pregnancy

Presentamos un caso de hipofisitis linfocitaria que se desarrolla durante el embarazo. La paciente ingresa en el tercer trimestre por hipertensión e insuficiencia cardíaca, desarrollando diabetes gestacional y cuadro confusional agudo. Presenta una lesión hipocaptante en adenohipófisis y eclampsia, por lo que se realiza una cesárea. En el puerperio desarrolla hipotiroidismo e insuficiencia gonadotropa y cortico suprarrenal. Tras el tratamiento con corticoides se normaliza la resonancia y la función tiroidea y gonadotropa, persistiendo la insuficiencia corticosuprarrenal. El agrandamiento pituitario asociado a hipopituitarismo durante el embarazo y puerperio, puede llevarnos a un diagnóstico incorrecto de tumor hipofisario

We present a case of lymphocytic hypophysitis that is developed during preguancy. The patient enters in the third trimester for hypertension and heart failure, developing diabetes gestacional and acute con Dusional syndrome. She presents a hypointensity of the anterior pituitary and eclampsia, for what a caesarean section is made. In the postpartum she develops hypo thyroidism and lost of adrenal cortical andgonadotropic function. With a corticosteroid theraphy the resonance, thyroid and gonadotro picfunctios is normalized, persisting adrenal cortical insufficiency. The pituitary enlargement associated to hipopituitarismo during the pregnancy and postpartum, it can take us to an incorrect diagnosis of pituitary tumor

Late postpartum eclampsia as an obstetric complication seen in the ED.

Preeclampsia is a complication of pregnancy associated with hypertension and proteinuria. Preeclampsia may be associated with grand mal seizures and is termed eclampsia. Historically, eclampsia occurring more than 48 hours after delivery, known as late postpartum eclampsia, was thought to be uncommon; however, recent evidence suggests that its incidence is increasing. In addition, the presentation of late postpartum preeclampsia-eclampsia may differ from that occurring during the pregnancy. This contributes to difficulty in diagnosing late postpartum preeclampsia-eclampsia in an emergency department setting. We report 2 cases of late postpartum eclampsia presenting 8 days after delivery, which highlight the unique features of this disorder and discuss some of the difficulties in managing these patients. Greater awareness and knowledge of this disorder by ED physicians should improve outcomes in these potentially life-threatening cases.

Evento cerebro-vascular hemorrágico en paciente eclámptica: reporte de un caso / Hemorragic cerebro-vascular event in an eclamp patient: case report

La hemorragia, la infección y los trastornos hipertensivos que complican el embarazo son las causas mas frecuentes de muerte materna. Una de las complicaciones más graves de los trastornos hipertensivos de la embarazada, ocurre a nivel cerebral la que se manifiesta como edema, trombosis y hemorragia. Presentamos el caso de una primigesta de 20 años, cuyo embarazo se complicó con eclampsia, se le realizó cesárea de manera oportuna; sin embargo se deterioró en forma rápida, curso con hemorragia y muerte cerebral y desafortunadamente muere 48 horas después...(AU)

Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome.

OBJECTIVE: Our purpose was to find out and compare perinatal outcomes in pregnancies complicated by severe preeclampsia-eclampsia with and without HELLP syndrome. METHODS: Clinical and laboratory findings, and perinatal-neonatal outcomes of all pregnants with severe preeclampsia, eclampsia and HELLP have been prospectively recorded. Results were compared by means of Student's t test, chi2 analysis and Fisher's exact test as appropriate. RESULTS: Among 367 consecutive severe preeclampsia, 106 (29%) had HELLP syndrome, 261 (71%) had severe preeclampsia and eclampsia. Mean gestational age and birth weight at delivery in severe preeclampsia without HELLP syndrome and in HELLP syndrome were 34.1 +/- 6.1 vs. 33.0 +/- 5.8 weeks (p = 0.119) and 1,886 +/- 764 vs. 1,724 +/- 776 g (p = 0.063), respectively. Comparing overall fetal mortality (4.6 vs. 10.3%, p = 0.009) and perinatal mortality (8.0% vs. 16.8%, p = 0.026) in severe preeclampsia-eclampsia and HELLP syndrome, respectively, there were statistically significant differences. But when analyses were performed according to gestational age before and after 32nd gestational week, the difference of perinatal mortality between the two groups was non-significant (p = 0.644 and p = 0.250), suggesting borderline difference. The most common contributing factor for fetal death after 32nd week was due to abruptio placenta without prenatal follow-up. Neonatal morbidity and neonatal mortality (4.8 vs. 6.3%, p = 0.905) in severe preeclampsia-eclampsia and HELLP syndrome respectively were similar and the difference was statistically nonsignificant. CONCLUSIONS: Perinatal mortality and neonatal morbidity-mortality according to gestational age before and after the 32nd week were similar in HELLP syndrome compared with severe preeclampsia-eclampsia without HELLP but overall fetal mortality was higher in HELLP syndrome with no regular prenatal care.

Oxidative-antioxidative system in peripartum acute renal failure and preeclampsia-eclampsia.

BACKGROUND: Preeclampsia-eclampsia and acute renal failure in peripartum women can be the cause of mortality and morbidity. There are many different reports about oxidative-antioxidative systems in preeclampsia-eclampsia. Until now, products of activated oxidative-antioxidative systems were not evaluated in peripartum women with acute renal failure. In this study, our aim was to evaluate the oxidative-antioxidative systems in peripartum women with acute renal failure and/or preeclampsia-eclampsia. METHODS: The study groups consisted of 17 peripartum women (first week of delivery) with acute renal failure (G I), 11 preeclamptic (G II), 11 healthy pregnancy (> or = 30 weeks of pregnancy) (G III), and 11 healthy women (G IV) aged between 18-38 years. Superoxide dismutase (SOD), glutathione peroxidase (GSHPx) in erythrocytes, and plasma malondialdehyde (MDA) levels were measured in all groups. SOD, GSHPx, and MDA levels were also measured at the onset of acute renal failure (G IA), regression of renal dysfunction (G IB) and recovery of renal functions (G IC). RESULTS: MDA levels were 11.95+/-4.25, 9.22+/-3.62, 5.10+/-3.65, 3.40+/-1.27, 4.91+/-2.06, 4.24+/-1.67 mmol/mL in G IA, G IB, G IC, G II, G III, and G IV, respectively. SOD activity in erythrocyte were 3269.23+/-1437.83, 2641.35+/-1411.13, 2056.35+/-1143.11, 924+/-160.04, 1057.91+/-257.03, 861.63+/-243.28 Ug/Hb in G IA, G IB, G IC, G II, G III, and G IV, respectively. GSHPx activity in erythrocyte was 70.17+/-23.52, 58.27+/-23.75, 45.44+/-17.60, 24.48+/-6.77, 26.28+/-7.27, 32.95+/-8.24 Ug/Hb in G IA, G IB, G IC, G II, G III, and G IV, respectively. MDA levels and activities of SOD, GSHPx in erythrocytes were highest in GIA The values of MDA, SOD, and GSH-Px in G IA, G IB, and G IC were significantly different from each other and decreased while regaining of renal functions. Preeclampsia-eclampsia or normal pregnancy did not cause elevation of plasma MDA levels and GSHPx, SOD in erythrocyte. CONCLUSION: Although SOD and GSHPx in erythrocytes and plasma MDA level were found to be similar in healthy women, pregnant women, and preeclamptic women; SOD, GSHPx, and MDA increased at the beginning and decreased during recovery of renal functions in peripartum women with acute renal failure.

[An analysis of using the graphic monitoring of ventilation for an optimal choice of respiratory management parameters in patients with acute respiratory distress syndrome]. / Graficheskii monitoring ventiliatsii pri vybore optimal'nykh parametrov respiratornoi podderzhki u patsientov s ostrym respiratornym distress-sindromom.

The potentialities of graphic ventilation monitoring (graphic monitor "Servo Screen 390", Siemens Elema, Sweden) were analyzed for optimizing the respiratory management parameters in 48 obstetric and gynecology patients with acute respiratory distress syndrome (ARDS). The ventilation loops and curves, ALV parameters, mechanical lung properties, gas blood composition and gas indices were dynamically evaluated during examination stages. The graphic ventilation monitoring, when used for respiratory management in patients with ARDS, provides for optimizing, in the real time mode, the PEEP and Vt levels, which is in line with the AVL "safety" concept.

Acute renal failure during eclampsia: incidence risks factors and outcome in intensive care unit.

OBJECTIVE: To assess the incidence, risk factors and the outcome of acute renal failure (ARF) associated with eclampsia in intensive care unit (ICU). DESIGN: Prospective and analytic study. SETTING: A surgical ICU in a university hospital. PATIENTS: 178 consecutive women with eclampsia admitted to an intensive care unit during seven years. ARF was defined by a serum creatinine concentration >140 micromol/L. RESULTS: The incidence of ARF was 25.8%. In univariate analysis the severity of patient illness, the complications associated with eclampsia (disseminated intravascular coagulation, Hellp syndrome, neurologic complications, abruptio placenta, aspiration pneumonia, delivery hemorrhage) were significantly associated with ARF. In a logistic regression model, risk factors for ARF included organ system failure (OSF) odds ratio (OR)=1.81 confidence interval (CI) [1.08-3.05], bilirubin >12 micromol/L OR=4.42 CI [1.54-12.68], uric acid >5.9 g/dL OR=16.5 CI [3.09-87.94], abruptio placenta OR=0.2 7 CI [0.08-0.99], and oliguria OR=0.10 CI [0.03-0.44]. In contrast, severity of blood pressure or proteinuria on dipstick were not associated with ARF. However, in this series, 15 women required dialysis in the short term and one required long-term dialysis. ARF associated with eclampsia was significantly associated with mortality (32.6% versus 9.1% p=0.0001). CONCLUSION: ARF with eclampsia is a frequent situation that required intensive management when risks factors were present. The need for dialysis was a rare condition.

Eclampsia and abnormal QTc.

BACKGROUND: Abnormalities of calcium and magnesium metabolism are known risk factors for QT interval prolongation and have been reported in eclampsia. OBJECTIVE: To determine if eclampsia is associated with QT abnormalities METHODS: In a prospective study, the QT interval corrected for heart rate (QTc), serum calcium, magnesium and potassium were compared among 30 intrapartum eclamptics and 30 age, parity and gestational age-matched women with uncomplicated pregnancy RESULTS: Primigravidae made up 93.3 % of patients. Mean age was 19.5+/-4.2 years Blood pressure was significantly higher among patients than controls (163.0+/-34.7mmHg versus 120.4+/-18.6mmHg systolic, p<0.05) and (104.7+/-15.2mmHg versus 79.6+/-10.7mmHg, p<0.05). Heart rate ranged from 76 to 163 beats per minute (bpm) and 65 to 112bpm among patients and controls respectively. The corresponding QTc were 390-572 and 390-460 respectively. Compared to the controls, patients had significantly higher mean heart rate (121.1+/-24.9bpm versus 89.3+/-12.9bpm, p<0.05) and higher QTc (470.4+/-42.4 versus 436.3+/-17.7; p<0.05). Compared to the controls, the eclamptics also had higher frequency of sinus tachycardia (90% versus, 13.3%) Odd Radio (OR) =29.57; 95% Confidence Interval (CI) = 5,87-174.08, p=0.00), abnormal QTc (46.7% versus 6.6%, OR = 9.2; 95% CI =1.61-68.48, p=0.01) and T-axis deviation (26.6% versus 3.3%, OR=10.55, 95% CI=1.2-244.3, p=0.03) Serum calcium level was significantly lower among patients than controls (2.0+/-0.4mmol/L versus 2.3+/-0.2mmol/L, p<0.05). The eclamptics had higher frequency of hypocalcaemia than the controls (40 % versus 6.6%; OR = 14, 95% Cl = 1.58-316.9, p=0.01). Serum magnesium, potassium, urea and creatinine levels were similar between the two groups. CONCLUSION: Eclampsia is associated with abnormal QTc that may be related to maternal hypocalcaemia. Correction of electrolyte abnormalities and cautions about agents that have potential for QT prolongation are vital in the care of eclamptics.