Late postpartum eclampsia as an obstetric complication seen in the ED

Graeber, Brendon; Vanderwal, Tamara; Stiller, Robert J.; Werdmann, Michael

doi:10.1016/j.ajem.2004.04.035

Cited by 20 publications

(14 citation statements)

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“…En effet, le cas clinique que nous rapportons décrit une éclampsie tardive, diagnostiquée avec retard dans le cadre d'une consultation en urgence pour céphalées. Une revue de la littérature montre qu'il est fréquent de constater que la plupart des patientes ayant présenté une éclampsie tardive du post-partum avaient été prises en charge dans des services de soins d'urgences ou de réanimation et non dans des services d'obstétrique [7]. Lubarsky et al [8] et Chames et al [9], rapportent que 44 et 79 % de leurs patientes respectives ayant fait une éclampsie retardée n'avaient aucun signe prémonitoire de prééclampsie.…”

Section: Discussionunclassified

Éclampsie retardée : leçons à tirer d’un cas survenu à j11 post-partum

Valentin

Ducarme

Wernet

et al. 2008

Gynécologie Obstétrique & Fertilité

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Section: Discussionunclassified

Éclampsie retardée : leçons à tirer d’un cas survenu à j11 post-partum

Valentin

Ducarme

Wernet

et al. 2008

Gynécologie Obstétrique & Fertilité

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“…Case reports and series in the emergency medicine and neurology literature indicate that the majority of these patients had no history of preeclampsia and/or had been asymptomatic before convulsion (8)(9)(10)16,17). Lubarsky et al (4), in particular, stress the need for increased awareness among emergency room physicians as well as timely resuscitation and treatment of complications, prompt consultation with the obstetric service, and the use of magnesium sulfate for initial antiseizure treatment.…”

Section: The Spectrum Of Eclampsia and Late Postpartum Eclampsiamentioning

confidence: 97%

“…The timely and correct diagnosis of late postpartum eclampsia is further complicated by the fact that many of these patients present to the emergency room (8)(9)(10), where the caregivers and consultants may not be well versed in obstetric medicine. Case reports and series in the emergency medicine and neurology literature indicate that the majority of these patients had no history of preeclampsia and/or had been asymptomatic before convulsion (8)(9)(10)16,17).…”

Section: The Spectrum Of Eclampsia and Late Postpartum Eclampsiamentioning

confidence: 98%

Late Postpartum Eclampsia: Examples and Review

Hirshfeld-Cytron

Lam²,

Karumanchi³

et al. 2006

Obstetrical & Gynecological Survey

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Eclampsia, defined as the occurrence of seizures in pregnant women, usually in the setting of preeclampsia and in the absence of other neurologic disorders, occurs mainly before, during , or within 48 hours after delivery. When convulsions occur later postpartum, diagnosis is difficult and treatment disputed. We review the entity of late postpartum eclampsia and report 2 examples in which the serum levels of antiangiogenic and angiogenic proteins were measured.

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“…Emergency clinicians must be aware of the symptoms of LPPE and should suspect it in women with those symptoms, even as long as 4 weeks postpartum, so that timely treatment can be initiated. 8 For our community hospital, interdisciplinary collaboration was the key to managing Kathy's care before she was transferred to a tertiary care center. In addition to managing her eclampsia, the nursing staff had to be attentive to her needs as a new mother and to her family's needs during this stressful and emotional event.…”

Section: Continued On Page 305mentioning

confidence: 99%

Tonic-Clonic Seizures in a Postpartum Patient: Case Report

Small

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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Late postpartum eclampsia as an obstetric complication seen in the ED

Cited by 20 publications

References 3 publications

Éclampsie retardée : leçons à tirer d’un cas survenu à j11 post-partum

Éclampsie retardée : leçons à tirer d’un cas survenu à j11 post-partum

Late Postpartum Eclampsia: Examples and Review

Tonic-Clonic Seizures in a Postpartum Patient: Case Report

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