Late postpartum eclampsia: A preventable disease?

Chames, Mark C.; Livingston, Jeffrey; Ivester, Thomas; Barton, John R.; Sibai, Bahaeddine M

doi:10.1067/mob.2002.123824

Cited by 182 publications

(129 citation statements)

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“…[1][2][3]6 Failure to recognize early signs of LPPE can lead to seizures that require hospitalization. Rehospitalization of a recently postpartum mother will present additional psychological and social stress.…”

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confidence: 99%

“…More than 20% of all eclamptic seizures occur more then 48 hours after delivery. 2 The etiology of late LPPE is believed to be similar to that for preeclampsia; however, both are not fully understood, and studies to clarify the etiology of both preeclampsia and LPPE are ongoing.Kathy (not the patient's actual name), a 28-yearold woman, came to the emergency department at our community hospital 6 days postpartum (para 1, gravida 1) after having 2 tonic-clonic seizures. The first was witnessed by her husband, and the second occurred en route to the hospital in the ambulance and required intubation.…”

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confidence: 99%

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confidence: 99%

“…Late postpartum eclamptic seizures are convulsions that occur between 48 hours and 4 weeks after delivery. [1][2][3] Forty percent of patients who have LPPE do not experience preeclampsia 1 and may have been asymptomatic before the convulsion. More than 20% of all eclamptic seizures occur more then 48 hours after delivery.…”

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Tonic-Clonic Seizures in a Postpartum Patient: Case Report

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Cannava

Casey

et al. 2010

American Journal of Critical Care

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Eclamptic seizures are a known complication of pregnancy; less well publicized is the patient with late postpartum eclampsia. Late postpartum eclamptic seizures are convulsions that occur more then 48 hours after delivery. Because 40% of patients who have late postpartum eclampsia do not experience preeclampsia, clinical awareness is essential for early treatment and care. (American Journal of Critical Care. 2010;19:307,305-306) E clamptic seizures are a known complication of the final trimester of pregnancy, but less recognized is late postpartum eclampsia (LPPE), also called delayed postpartum eclampsia. Late postpartum eclamptic seizures are convulsions that occur between 48 hours and 4 weeks after delivery. 1-3 Forty percent of patients who have LPPE do not experience preeclampsia 1 and may have been asymptomatic before the convulsion. More than 20% of all eclamptic seizures occur more then 48 hours after delivery. 2 The etiology of late LPPE is believed to be similar to that for preeclampsia; however, both are not fully understood, and studies to clarify the etiology of both preeclampsia and LPPE are ongoing.Kathy (not the patient's actual name), a 28-yearold woman, came to the emergency department at our community hospital 6 days postpartum (para 1, gravida 1) after having 2 tonic-clonic seizures. The first was witnessed by her husband, and the second occurred en route to the hospital in the ambulance and required intubation. Kathy's uneventful pregnancy was followed by staff at a tertiary care center because of her history of idiopathic panhypopituitarism. She delivered via cesarean section after a failed induction. She had an epidural during her prolonged labor, but had no headaches while in the hospital. She was discharged with an appointment for 6-week follow-up. No additional blood work or blood pressure checks were required.While Kathy was in the emergency department, the initial physical examination showed an obtunded woman who gradually woke up. She was extubated and had normal findings on a neurological examination except for unequal pupils. Kathy reported a headache and her blood pressure was elevated Continued on page 305Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient's experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc@aacn.org. ©2010 American Association of Critical-Care Nurses doi: 10.4037/ajcc2010668by AACN on May 10, 2018 http://ajcc.aacnjournals.org/ Downloaded from (170s/90s) from her baseline (100s/60s). Despite her history of panhypopituitarism, she had normal results on a comprehensive metabolic panel. The urinalysis showed proteinuria but findings were otherwise negative. Computed tomography of her head showed normal findings. Magnet...

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Section: Continued On Page 305mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Tonic-Clonic Seizures in a Postpartum Patient: Case Report

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Cannava

Casey

et al. 2010

American Journal of Critical Care

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“…There are few data regarding the incidence, risk factors, optimal treatment and outcome of hypertensive disorders that are diagnosed in the postpartum period [14][15][16] . It is recognized that the immediate postpartum period continues to be a period of risk in patients with preeclampsia, with up to 44% of the total eclamptic seizures occurring in this period; 44% of the cases of eclampsia developed antenatal, 33% intrapartum and 23% postpartum 9,[14][15][16] ; while 26% of seizures develop 0-48 hours after delivery [14][15][16] . During the past decades, there has been extensive research regarding the incidence, risk factors, antepartum treatment, and outcome of women with preeclampsia; but there is little evidence on the management and the balance of fluids in the postpartum period.…”

Section: Introductionmentioning

confidence: 99%

The fluid balance observed postnatally on normal pregnancies, pregnancies with preeclampsia, and on pregnancies with oedema and proteinuria

Diamanti¹,

Κatsaounou²,

Vivilaki³

2017

Eur J Midwifery

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in arterial blood pressure and systemic vascular resistance. Mostly, all of these changes are generally reversed in weeks or months after delivery [1][2][3][4][5] . To be more specific, pregnancy is a volume-expanding state characterized by net sodium retention of 900 to 1000 mEq, as well water retention of 1.1 to 1.6 L, mediated by a balance between natriuretic and anti-natriuretic forces 1 . A rise in serum aldosterone is ABSTRACT INTRODUCTION It is observed that delivery does not completely eliminate the risk of developing symptoms of preeclampsia, as well as its impending complications. The postpartum period is often associated with a high risk of developing preeclampsia, eclampsia and HELLP syndrome. Yet, there is neither an established standard, nor specific guidelines for peripartum fluid management. Our purpose is to study during the first four days of the postpartum period the differences in fluid balance on: normal pregnancies, pregnancies with preeclampsia and pregnancies with oedema and proteinuria. METHODS The setting was the Gaia private maternity clinic in Athens, where 100 women in the postpartum period took part in the study and were requested to fill in a data collection-sheet, specially developed for the study. They were recruited between January 2014 and November 2014 and were divided into three groups. Group I consisted of all normal pregnancies, Group II those with oedema and proteinuria, and Group III those with preeclampsia. The demographic and clinical characteristics of the women and fetuses were initially recorded. Subsequently, daily records of fluid balance, as well as body weight, were kept for four days after labor. Descriptive statistics were used to analyze the demographic data of the sampled women. We compared the fluid balances among the three groups using t-test association and one-way Anova. RESULTS The mean age of the women was 32.48±4.38 years. Out of a total of 100 women, 59 of them had a normal pregnancy (Group I), 24 developed oedema and proteinuria (Group II) and 17 developed preeclampsia (Group III). All three groups had a positive fluid balance on the first day postpartum and only the first group had a negative cumulative fluid balance from the second day postpartum and onwards. The second group despite having started to discard a small volume of fluid, from the second day postpartum, the balance remained positive throughout the next two days. The third group however, had a negative fluid balance only during the fourth day after labor. CONCLUSIONS Our results indicate a difference in the kinetics of fluids in women with preeclampsia, compared to those that had a normal pregnancy and postpartum period. Consequently, there appears to be a need for more rational management and follow up on fluid balance throughout labor. INTRODUCTIONPregnancy involves remarkable changes in the anatomy and physiology that affect the renal and the cardiovascular system, in many aspects. These changes are in fact essential for the development and maintenance of a successful pregnancy, both ...

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