The neurology of pregnancy
- aDivision of Clinical Neurology, bDepartment of Obstetrics and Gynaecology, Queens Medical Centre, Nottingham NG7 2UH, UK
- Dr GV Sawle, Division of Clinical Neurology, Queens Medical Centre, Nottingham NG7 2UH, UK. Telephone 0044 115 970 9792; fax 0044 115 970 9738.
- Received 22 May 1997
- Revised 2 March 1998
- Accepted 3 March 1998
The neurology of pregnancy can be split into two. On the one hand, there are women who develop neurological symptomsduring pregnancy. Some have simple neurological disorders such as carpal tunnel syndrome, which are more common during pregnancy. Others have disorders that are either peculiar to or very much commoner during pregnancy, such as eclampsia, pelvic neural compression, or even tumours arising from the placenta. The most common, serious, and important of these conditions is eclampsia. Other women have neurological problems such as epilepsy or myasthenia first and then become pregnant. For these patients, pregnancy may affect the course of the disease, and there may be important issues with respect to investigation, treatment, and prognosis.
Eclampsia
Eclampsia is one of the commonest causes of maternal death. In the United Kingdom, recent figures show that 15.5% of direct maternal deaths were due to the hypertensive disorders of pregnancy, and more than half of these women had eclampsia.1 As many as 50 000 maternal deaths annually world wide are thought to be as a consequence of eclampsia.2 The incidence of eclampsia during a recent nationwide survey in the United Kingdom was about one in 2000 maternities, with a case fatality ratio of almost one in 50.3 We do not know how many women presenting with the fulminating features described below will go on to have convulsions, or whether drug treatment can reduce the chance of progression. In one observational study, only one in 75 women with severe pre-eclampsia developed eclamptic convulsions.4
DEFINITIONS
Pregnancy induced hypertension (also known as pre-eclampsia and pregnancy toxaemia) develops after 20 weeks of gestation in previously normotensive women and resolves by three months postpartum; the pressure is considered raised if greater than 140/90 mm Hg, or if the diastolic blood pressure rises 15–25 mm Hg above …
