18380              ECLAMPSIA

The patient was a woman aged 23 and this was her first pregnancy.  She was admitted to hospital in labour at term and was found to be over breathing, with tetanic and opisthotonic spasms.  She was transferred to the Queen Victorian Maternity Home in coma.  The B.P. had risen from 160/90 to 230/140.  A still-born male infant was delivered with forceps.  Forty-five minutes later there was an episode of apnoea.  At this time the CSF pressure was 150 mm and the fluid was xanthochromic with protein 730 and sugar 65.  Blood sugar and blood urea were normal.  She was maintained on a respirator for 18 hours and then died.  At postmortem there was a haemorrhage in the right corpus striatum which had ruptured directly into the lateral ventricle and extended into the subarachnoid space through the medullary exit foramina.  There were haemorrhages in the skin, trachea and pericardium and the liver was enlarged (weight 1740 gms).

The specimen shows the liver.  The surface is smooth but there are extensive blotchy acute haemorrhages beneath Glisson’s capsule.  The cut surface shows similar haemorrhages extending irregularly throughout the substance of liver.  Histology shows the characteristic acute focal necroses of eclampsia, associated with fibrinous exudation and infiltration by polymorphs.  Blood has pooled in these foci, which are mostly related to the areas of hepatic venous outflow.