Eclampsia is the onset of generalised seizures in the setting of pre-eclampsia.1 Traditionally eclampsia occurring more than 48 hours into the postnatal period was thought rare and termed; late onset postpartum eclampsia.2 Evidence shows a changing pattern of disease with eclampsia rates falling however a comparative increase in late postpartum seizures.3 4 These may lack classical symptoms and signs and may not be identified before seizure onset.1 2
A 27 year old parous patient presented 7 days postnatally with generalised tonic-clonic seizures, severe hypertension and neurological irritability with no proteinuria. This was preceded acutely with severe headache. Previous history was uncomplicated by hypertensive disease and her partner was unchanged. There was no symptomatology of pre-eclampsia in the antenatal or immediately postnatal period. Antenatal history was uneventful showing generalised oedema only and there was concurrent and progressive fetal growth. Following routine discharge after caesarean section for failure to progress in labour this patient represented with a seizure from home. There was a normal CT of brain. This patient responded to magnesium sulphate and labetalol with no further seizures and a large diuresis. Ongoing blood pressure control proved to be difficult, requiring multispecialty input.
We conclude that the “classic” definitions of these diseases may present barriers for rapid diagnoses and treatment with late postpartum variants showing atypical symptomatology, signs and disease progression with a non-linear relationship between pre-eclampsia and eclampsia. We advocate increased vigilance and reporting in the late postpartum period.
Munjuluri N, Lipman M, Valentine A, et al. Postpartum eclampsia of late onset. BMJ 2005;331:1070–1.
Dziewas R, Stögbauer F, Freund M, et al. Late onset postpartum eclampsia: a rare and difficult diagnosis. J Neurol 2002;249:1287–91.
Leitch CR, Cameron AD, Walker JJ. The changing pattern of eclampsia over a 60-year period. Br J Obstet Gynaecol 1997;104:917–22.
Chames MC, Livingston JC, Ivester TS, et al. Late postpartum eclampsia: a preventable disease? Am J Obstet Gynecol 2002;186:1174–7.
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