eclampsia with no symptoms; question about risks?

[expert@preeclampsia.org]

My name is Deb, and I'm mom to Max who was delivered at 31 weeks after I had an eclamptic seizure. I had not been dx with pre-e, because my presentation was rather unusual (extremely low bp, no protein in the urine, no swelling). I was in a well-respected high risk practice for unrelated reasons, so I was being watched by doctors who know what to look for! I plan to try to get pregnant again next Spring, and will not deliver until I am 35 years old.

My understanding is that my risks are higher, and that I should anticipate that if I have certain symptoms I will likely be on bedrest for the remainder of this next pregnancy. Unfortunately, nothing I have found can give me any indication of HOW much higher the risks might be, or if the likelihood of seizure being even more severe exists.

Thank you so much for any information you can provide, or a direction you can point me in.

[expert@preeclampsia.org]

For women with severe pre-eclampsia (eclampsia would thus qualify), early-onset pre-eclampsia (onset before 34 weeks), or pre-eclampsia associated with a perinatal loss (stillbirth or neonatal death), the recurrence risk is in the order of 40% in a later pregnancy. However, this recurrence, if it occurs, is likely to be milder and of later onset than on the first occasion.

I would suggest that Deb seek risk stratification once she is pregnant again (having used folate prior to conception). By this I mean a first trimester PAPP-A (low conferring increased risk), and second trimester HCG and AFP (high of either or both conferring increased risk), and uterine artery Doppler studies (High resistance or presence of 'notching' conferring increased risk). The corollary is that if these are all normal, then her recurrence risk is <10%.

Through this means, she may be able to be reassured or, if not, be provided with increased surveillance for the remainder of the pregnancy (+/- rest at home). The new Canadian guidelines for the hypertensive disorders of pregnancy will discuss this in some detail - they should be published before the end of this calendar year (2007) in the Journal of Obstetrics and Gynaecology Canada.