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Postpartum Eclampsia


Presentation

  • The present study reported the case of a 15‑year old female presenting with convulsions that began 5 weeks after delivery.[spandidos-publications.com]
  • Clinically significant proteinuria was present from 30 weeks onwards.[bmj.com]
  • Furthermore, this case presents a rare but dangerous presentation of eclampsia. Case report.[ncbi.nlm.nih.gov]
  • Many women who present with postpartum eclampsia have not previously had signs or symptoms of preeclampsia.[exxcellence.org]
  • Preeclampsia and eclampsia is related with serious fetal and maternal morbidity and mortality and may present with atypical course.[panafrican-med-journal.com]
Fatigue
  • Its characteristic symptoms — fatigue, swelling, nausea, shortness of breath, headaches and pain in the back or shoulders — can be difficult to distinguish from more run-of-the-mill maternal complaints.[parenting.nytimes.com]
  • This could include physical and emotional changes such as: fatigue vaginal discharge or cramping constipation tender breasts sore nipples if you’re breastfeeding feeling blue or weepy, or mood swings problems with sleep and appetite abdominal pain or[healthline.com]
Crying
  • I held the spoon up and asked Chris what it was, he told me it was a spoon, I started to panic and cry and told him that I didn't know what it was, so he asked me to sit down.[huffingtonpost.ca]
Morning Sickness
  • I'm not just talking about the unpleasant but garden-variety side effects like morning sickness or the fear of what pushing a giant head out of your nethers will do to your vagina.[popsugar.com]
Severe Abdominal Pain
  • I had been hospitalized overnight a few days prior due to severe abdominal pain. While I was at the hospital my right leg had swelled to more than twice the size of my left.[huffingtonpost.ca]
Visual Hallucination
  • Because the vasogenic edema typically involves the occipital lobes, approximately 40% of patients have visual symptoms, including visual hallucinations, blurred vision, and diplopia. [6], [7], [8], [9], [10] Although PRES has gained substantial recognition[sccj-sa.org]
Headache
  • The postpartum period was uneventful until the 6th day, when she complained of headache and scotoma.[neurologyindia.com]
  • Review of systems at the time of the Ob-Gyn examination was positive for headaches. The patient was uncooperative with ordered blood work and assessments. Blood pressure of the right leg was obtained at 199/97 mm Hg.[ncbi.nlm.nih.gov]
  • […] have a warning symptom of headache.[consultant360.com]
  • My headaches started the day after we came home. I figured they were just spinal headaches, so I didn't worry too much. I was also extremely swollen but remembered being swollen after my first C-section, too.[huffingtonpost.ca]
  • Eclampsia can consist of many prodromal symptoms including headache, visual changes, right upper quadrant pain, and hypertension.[emra.org]
Forgetful
  • I was having panic attacks when I would forget little things, I was crying a lot while trying to deal with the reality that I almost wasn't here anymore and I was just an overall emotional mess.[huffingtonpost.ca]
  • That way, you won't forget anything important that you want to ask, and you can make the most of your time with your health care provider. Below are some basic questions to ask your health care provider about postpartum preeclampsia.[drugs.com]
Tremor
  • She was conscious and oriented with no nystagmus, ataxia, tremors, or other cerebellar signs.[sccj-sa.org]
Paresis
  • Basilar artery thrombosis can present with progressive neurologic deficits and can result in tetra paresis, coma, or locked-in syndrome.[sccj-sa.org]
Reduced Consciousness
  • Conditions such as venous sinus thrombosis, subdural, intracerebral, or subarachnoid hemorrhage can all present with headache, seizures, reduced consciousness, and focal neurologic signs.[sccj-sa.org]
Oliguria
  • The patient underwent Cesarean-section, as presumptive diagnosis of eclampsia was made secondary to hypertension, altered mental status, hemoconcentration, and oliguria.[ncbi.nlm.nih.gov]
  • Persistent oliguria is treated with a carefully monitored fluid challenge. Diuretics are usually not used.[merckmanuals.com]
  • Close maternal and fetal monitoring by a physician and nursing staff are advised during the treatment of acute-onset, severe hypertension, and judicious fluid administration is recommended even in the case of oliguria.[m.acog.org]
Uremia
  • Autoimmune encephalitis and metabolic encephalopathies such as deranged serum glucose, sodium (including central pontine myelinolysis), uremia, or drug toxicity (e.g., cyclosporine) can also have similar progressive symptoms.[sccj-sa.org]

Workup

  • Ms A was transferred to Ob-Gyn for a postpartum preeclampsia workup. Results of her HELLP (hemolysis, elevated liver enzyme, low platelet count) laboratory measures were within normal limits as was her protein-creatinine ratio.[ncbi.nlm.nih.gov]
  • If a pregnant woman has already been diagnosed with pre-eclampsia during the current pregnancy and then develops a seizure, she may be assigned a 'clinical diagnosis' of eclampsia without further workup.[en.wikipedia.org]
Albuminuria
  • She had albuminuria and a uric acid level of 8.9mg%. Other renal parameters were normal. Baseline hematological investigations including platelet count and liver function tests were within normal limits.[neurologyindia.com]
  • Antenatal period was irrelevant apart from having hypertension (pregnancy-induced hypertension), but, there was no albuminuria, and all other investigations were within normal limits; also, there were no seizures.[sccj-sa.org]

Treatment

  • Treatment of anticoagulation, anti-platelet aggregation, cerebral edema reduction, anti-inflammatory treatment and other supportive treatment were administered.[qims.amegroups.com]
  • Treatment Postpartum preeclampsia may be treated with medication, including: Medication to lower high blood pressure.[drugs.com]
  • Only a doctor can diagnose postpartum preeclampsia and determine a plan for symptom management and treatment.[flo.health]
  • Treatment of high blood pressure while breastfeeding requires agreement among the mother, obstetrician, and pediatrician.[preeclampsia.org]
  • Any recently postpartum woman who presents with prodromal symptoms requires early detection and aggressive treatment of pre-eclampsia/eclampsia. This is critical in preventing adverse effects like intracranial hemorrhage. References 1.[emra.org]

Prognosis

  • The condition is generally highly treatable, so if your physician is able to catch it early, your prognosis is very good.[fairygodboss.com]
  • It is important to consider the diagnosis of posterior circulation stroke because its treatment (which may include urgent thrombolysis) and prognosis both differ from those in PRES.[sccj-sa.org]
  • Treatment of PRES With correct diagnosis and timely and effective early treatment, the patient prognosis is usually good.[qims.amegroups.com]
  • What Is the Prognosis for a Woman with Eclampsia? Most women will have good outcomes for their pregnancies, even when complicated by preeclampsia or eclampsia.[emedicinehealth.com]
  • Cerebrovascular complications during pregnancy and postpartum: clinical and prognosis observations in 240 Hispanic women. Eur J Neurol. 2011 ; 18 :819–825. doi: 10.1111/j.1468-1331.2010.03259.x. Crossref Medline Google Scholar 26.[ahajournals.org]

Etiology

  • Further prospective studies comprising larger sample size and different etiologies of PRES are warranted in this regard. References 1. Niyadurupola N, Burnett CA, Allen LE.[ijo.in]
  • Etiology and pathogenesis of preeclampsia: Current concepts. Am J Obstet Gynecol 1998;179:1359-75. 18. Lin JT, Wang SJ, Fuh JL, Hsiao LT, Lirng JF, Chen PM, et al. Prolonged reversible vasospasm in cyclosporin A-induced encephalopathy.[sccj-sa.org]
  • The etiology of PRES is not clear.[qims.amegroups.com]
  • Although its etiology is not entirely known, it is thought to consist of common endothelial damage, increased systemic vascular resistance, and generalized vasospasm caused by inadequate trophoblastic invasion and placentation ( 9, 10 ).[scielo.br]
  • Etiology of preeclampsia is unknown.[merckmanuals.com]

Epidemiology

  • Alyshah Abdul Sultan, PhD, of the division of epidemiology and public health at the University of Nottingham, and colleagues evaluated data from 168,077 women who had 222,334 pregnancies between 1997 and 2010.[healio.com]
  • Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011;25:391-403. Watson DM, Sibai BM, Shaver DC, Dacus JV, Anderson GD. Late postpartum eclampsia. An update.[ijrcog.org]
  • Epidemiology of Preeclampsia and Stroke Hypertensive disorders of pregnancy serve as risk factors for both ischemic and hemorrhagic strokes in pregnancy.[ahajournals.org]
  • Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011;25:391-403. [ PubMed ] Sibai BM1, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia.[qims.amegroups.com]
Sex distribution
Age distribution

Pathophysiology

  • No conclusive evidence supports a clear relationship between clinical conditions and specific imaging findings of severity or location of edema. [12], [13], [14] The underlying pathophysiology of PRES remains elusive.[sccj-sa.org]
  • Pathophysiology of PRES The exact mechanism of PRES is not yet fully elucidated. There exist two opposing pathophysiological mechanisms explanation. The first hypothesis is the vasospasm/hypoperfusion doctrine.[qims.amegroups.com]
  • PubMed/NCBI 15 Bartynski WS: Posterior reversible encephalopathy syndrome, part 2: Controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 29:1043–1049. 2008.[spandidos-publications.com]
  • In the pathophysiology of pre-eclampsia, although endothelial cell damage and impaired endothelial cell function play an important role, the cause of vascular endothelial cell dysfunction remains unknown ( 2 ).[scielo.br]
  • The pathophysiology underlying preeclampsia remains incompletely characterized.[ahajournals.org]

Prevention

  • […] gestational diabetes and postpartum haemorrhage – the most common cause of maternal ... maternal age of more than 40 years, family history of pre- eclampsia and multiple pregnancy) may benefit from taking 150mg aspirin RCOG release: New measures to prevent[rcog.org.uk]
  • Can postpartum preeclampsia be prevented or avoided? This condition cannot be prevented or avoided. Know your body. If you have any of the symptoms listed, contact your doctor immediately.[familydoctor.org]
  • Medication to prevent seizures. Magnesium sulfate can help prevent seizures in women with postpartum preeclampsia who have severe signs and symptoms. Magnesium sulfate is typically taken for 24 hours.[drugs.com]
  • What can you do to prevent postpartum preeclampsia? It’s unclear whether postpartum preeclampsia can be prevented, but your doctor may recommend the following lifestyle changes: Follow a healthy diet.[whattoexpect.com]
  • Medication to prevent seizures. An anticonvulsive medication, such as magnesium sulfate, can help prevent seizures. Magnesium sulfate is typically taken for 24 hours.[nchmd.org]

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