Diagnosis and Management of Postpartum Eclampsia in the ED

Postpartum preeclampsia refers to hypertension and proteinuria after delivery, and the occurrence of a seizure within six weeks after delivery is called postpartum eclampsia. Etiology is unknown but theorized to involve abnormal placental formation. Major risk factors include preeclampsia, multiple gestations, obesity, and 1st pregnancy. First pregnancy was the only known risk factor in this case. A 24-year-old Hispanic female (Gravida 1, two weeks postpartum) presented to the ED after a tonic clonic seizure, witnessed by her husband. Except for acquiring ß-hemolytic strep, she had a normal pregnancy and full-term vaginal delivery. Past medical and family history of seizures were negative. Her preeclampsia during pregnancy was closely monitored and did not require medication. She reported feeling short of breath prior to the seizure, which led to consideration of other causes of the seizure. The differential included postpartum eclampsia, new onset seizure, head trauma, intracranial hemorrhage, PE, and syncope. Patient was placed in high acuity on a cardiac monitor to track her BP and kept on seizure precautions. A magnesium sulfate drip was started since eclampsia was the most likely differential. Upon attempting a 6 gm bolus, she developed tachycardia so the drip was reduced to 2 gm/hr. Head CT, chest CT, and EKG ruled out the head bleed, PE, and syncope, respectively. Patient had a BP of 140/99, elevated LFTs, and proteinuria. Based on the patient’s eclamptic episode within the six week window, she was diagnosed with postpartum eclampsia. While the overall prevalence of postpartum preeclampsia has remained steady, incidence of postpartum eclampsia has fallen due to improved prenatal care and identification of preeclampsia. Despite these improvements, this case highlights the importance of providing women additional counseling on postpartum preeclampsia and hypertension management as well as the challenges in early identification of postpartum eclampsia in the ED