Download PDF
Am J Perinatol 2007; 24(4): 257-266
DOI: 10.1055/s-2007-976548
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Late Postpartum Eclampsia: Report of Two Cases Managed by Uterine Curettage and Review of the Literature

Koji Matsuo1 , Shoreh Kooshesh1 , Mert Dinc1 , Chen-Chih J. Sun2 , Tadashi Kimura3 , Ahmet A. Baschat1
  • 1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
  • 2Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
  • 3Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Further Information

Publication History

Publication Date:
19 April 2007 (online)

Also available at
    Permissions and Reprints

ABSTRACT

The purpose of this study was describe two patients with rapid recovery of refractory late postpartum eclampsia (LPPE) following uterine curettage, and to evaluate the literature about supportive evidence for such a management in LPPE. A detailed literature search was performed focusing on studies reporting the clinical presentation, laboratory workup, imaging, and management of LPPE. Mean reported onset of LPPE was on postpartum day 7.0 ± 2.9. Only 35.3% had a history of preeclampsia: these had earlier onset of seizures compared with the subjects without history of preeclampsia (4.3 ± 1.4 versus 7.6 ± 2.9 days; p < 0.005). Onset of seizure was correlated with systolic blood pressure (Pearson's r = 0.34; p < 0.05). Major associated symptoms were headaches (71.4%), visual changes (46.0%), and nausea/vomiting (22.2%); 67.5% of patients were proteinuric. The remaining laboratory tests were usually normal. Among the patients with a normal head computed tomography, magnetic resonance imaging identified additional abnormalities in 53.8% (seven of 13). A total of 69.7% of patients developed multiple seizure episodes, some of these occurred while the patient was receiving magnesium sulfate treatment; 82.5% of patients underwent magnesium therapy and approximately half of those patients required multiple antiseizure drugs. The number of seizures was only correlated with the diastolic blood pressure (Pearson's r = 0.52; p < 0.01). Even remote from delivery, headaches, visual change, and nausea/vomiting are important symptoms of LPPE. Hypertension and/or proteinuria are important diagnostic findings. LPPE is often characterized by refractory seizures and controlling the diastolic blood pressure is important. Patients presented in our case report showed no seizures after uterine curettage. This potential useful management for LPPE requires additional investigation.

KEYWORDS

Late postpartum eclampsia - uterine curettage - review

REFERENCES

  • 1 Hirshfeld-Cytron J, Lam C, Karumanchi S A, Lindheimer M. Late postpartum eclampsia: examples and review.  Obstet Gynecol Surv. 2006;  61 471-480
    CrossrefPubMedGoogle Scholar
  • 2 Mattar F, Sibai B M. Eclampsia. VIII. Risk factors for maternal morbidity.  Am J Obstet Gynecol. 2000;  182 307-312
    CrossrefPubMedGoogle Scholar
  • 3 Leitch C R, Cameron A D, Walker J J. The changing pattern of eclampsia over a 60-year period.  Br J Obstet Gynaecol. 1997;  104 917-922
    PubMedGoogle Scholar
  • 4 Chames M C, Livingston J C, Ivester T S, Barton J R, Sibai B M. Late postpartum eclampsia: a preventable disease?.  Am J Obstet Gynecol. 2002;  186 1174-1177
    CrossrefPubMedGoogle Scholar
  • 5 Lubarsky S L, Barton J R, Friedman S A, Nasreddine S, Ramadan M K, Sibai B M. Late postpartum eclampsia revisited.  Obstet Gynecol. 1994;  83 502-505
    CrossrefPubMedGoogle Scholar
  • 6 Munjuluri N, Lipman M, Valentine A, Hardiman P, Maclean A B. Postpartum eclampsia of late onset.  BMJ. 2005;  331 1070-1071
    CrossrefPubMedGoogle Scholar
  • 7 Miles Jr J F, Martin Jr J N, Blake P G, Perry Jr K G, Martin R W, Meeks G R. Postpartum eclampsia: a recurring perinatal dilemma.  Obstet Gynecol. 1990;  76 328-331
    PubMedGoogle Scholar
  • 8 Matthys L A, Coppage K H, Lambers D S, Barton J R, Sibai B M. Delayed postpartum preeclampsia: an experience of 151 cases.  Am J Obstet Gynecol. 2004;  190 1464-1466
    CrossrefPubMedGoogle Scholar
  • 9 Harer Jr W B, McIndoe D W. Postpartum eclampsia treated by curettage.  Am J Obstet Gynecol. 1962;  84 1349-1350
    PubMedGoogle Scholar
  • 10 Magann E F, Martin Jr J N, Isaacs J D, Perry Jr K G, Martin R W, Meydrech E F. Immediate postpartum curettage: accelerated recovery from severe preeclampsia.  Obstet Gynecol. 1993;  81 502-506
    PubMedGoogle Scholar
  • 11 Magann E F, Bass J D, Chauhan S P, Perry Jr K G, Morrison J C, Martin Jr J N. Accelerated recovery from severe preeclampsia: uterine curettage versus nifedipine.  J Soc Gynecol Investig. 1994;  1 210-214
    PubMedGoogle Scholar
  • 12 Veltkamp R, Kupsch A, Polasek J, Yousry T A, Pfister H W. Late onset postpartum eclampsia without pre-eclamptic prodromi: clinical and neuroradiological presentation in two patients.  J Neurol Neurosurg Psychiatry. 2000;  69 824-827
    CrossrefPubMedGoogle Scholar
  • 13 Martin J, Sidman R. Late postpartum eclampsia: a common presentation of an uncommon diagnosis.  J Emerg Med. 2003;  25 387-390
    CrossrefPubMedGoogle Scholar
  • 14 Dziewas R, Stogbauer F, Freund M et al.. Late onset postpartum eclampsia: a rare and difficult diagnosis.  J Neurol. 2002;  249 1287-1291
    PubMedGoogle Scholar
  • 15 Hara N, Fujii T, Tsutsumi O. Postpartum eclampsia associated with cortical blindness.  Int J Gynaecol Obstet. 1994;  47 287-288
    CrossrefPubMedGoogle Scholar
  • 16 Hauswald M. Cortical blindness and late postpartum eclampsia.  Am J Emerg Med. 1987;  5 130-132
    CrossrefPubMedGoogle Scholar
  • 17 Hinchey J, Chaves C, Appignani B et al.. A reversible posterior leukoencephalopathy syndrome.  N Engl J Med. 1996;  334 494-500
    CrossrefPubMedGoogle Scholar
  • 18 Parisaei M, Derwig I, Yoon J, Erskine K J, Jarman P R. Posterior reversible leukoencephalopathy in a case of postpartum eclampsia.  Am J Obstet Gynecol. 2005;  193 885-886
    CrossrefPubMedGoogle Scholar
  • 19 Dziewas R, Stogbauer F, Freund M et al.. Late onset postpartum eclampsia a rare and difficult diagnosis.  J Neurol. 2002;  249 1287-1291
    PubMedGoogle Scholar
  • 20 Arkwright P D, Rademacher T W, Dwek R A, Redman C W. Pre-eclampsia is associated with an increase in trophoblast glycogen content and glycogen synthase activity, similar to that found in hydatidiform moles.  J Clin Invest. 1993;  91 2744-2753
    PubMedGoogle Scholar
  • 21 Nugent C E, Punch M R, Barr Jr M, LeBlanc L, Johnson M P, Evans M I. Persistence of partial molar placenta and severe preeclampsia after selective termination in a twin pregnancy.  Obstet Gynecol. 1996;  87 829-831
    PubMedGoogle Scholar
  • 22 Felz M W, Barnes D B, Figueroa R E. Late postpartum eclampsia 16 days after delivery: case report with clinical, radiologic, and pathophysiologic correlations.  J Am Board Fam Pract. 2000;  13 39-46
    PubMedGoogle Scholar
  • 23 Brady W J, DeBehnke D J, Carter C T. Postpartum toxemia: hypertension, edema, proteinuria and unresponsiveness in an unknown female.  J Emerg Med. 1995;  13 643-648
    CrossrefPubMedGoogle Scholar
  • 24 Alkan A, Tugrul S, Oral O, Uslu H, Kose D, Catakli F T. Effects of postpartum uterine curettage on maternal well-being in severe preeclamptic patients.  Clin Exp Obstet Gynecol. 2006;  33 55-58
    PubMedGoogle Scholar
  • 25 The Eclampsia Trial Collaborative Group . Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial.  Lancet. 1995;  245 1455-1463
    PubMedGoogle Scholar
  • 26 Belfort M A, Anthony J, Saade G R, Allen Jr J C. Nimodipine Study Group . A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia.  N Engl J Med. 2003;  348 304-311
    PubMedGoogle Scholar
  • 27 Ludmir J, Stubblefield P G. Surgical procedures in pregnancy. Gabbe SG, Niebyl JR, Simpson JL, et al Obstetrics: Normal and Problem Pregnancies. 4th ed. New York; Churchill Livingstone 2002: 607-650
    Google Scholar
  • 28 Belogolovkin V, Levine S R, Fields M C, Stone J L. Postpartum eclampsia complicated by reversible cerebral herniation.  Obstet Gynecol. 2006;  107 442-445
    PubMedGoogle Scholar
  • 29 Gold K J, Barnes C, Lalley J, Schwenk T L. Case report: late-onset eclampsia presents as bilateral cortical blindness.  Am Fam Physician. 2005;  71 856 , 858, 861
    PubMedGoogle Scholar
  • 30 Asaeda G, Ferreira R, Pierre-Louis A. Uncommon seizures: eclampsia in the postpartum patient.  JEMS. 2005;  30 36-38
    PubMedGoogle Scholar
  • 31 Azonobi I, McBride-Richter H, Patrick L. Late-onset postpartum eclampsia.  J Midwifery Womens Health. 2006;  51 51-53
    CrossrefPubMedGoogle Scholar
  • 32 Graeber B, Vanderwal T, Stiller R J, Werdmann M J. Late postpartum eclampsia as an obstetric complication seen in the ED.  Am J Emerg Med. 2005;  23 168-170
    CrossrefPubMedGoogle Scholar
  • 33 Chambers K A, Cain T W. Postpartum blindness: two cases.  Ann Emerg Med. 2004;  43 243-246
    CrossrefPubMedGoogle Scholar
  • 34 Mathew R, Raj R S, Sudha P. Late postpartum eclampsia without prodroma.  Neurol India. 2003;  51 539-540
    PubMedGoogle Scholar
  • 35 Martin J, Sidman R. Late postpartum eclampsia: a common presentation of an uncommon diagnosis.  J Emerg Med. 2003;  25 387-390
    CrossrefPubMedGoogle Scholar
  • 36 Winston A W, Norman D. Late postpartum eclampsia coincident with postdural puncture headache: a case report.  AANA J. 2003;  71 371-372
    PubMedGoogle Scholar
  • 37 Graves J C, Vandergriff J V. Atypical eclampsia: a case report and review.  Tenn Med. 2001;  94 173-175
    PubMedGoogle Scholar
  • 38 Newbould S. Postpartum eclampsia.  Am Fam Physician. 2002;  66 378
    PubMedGoogle Scholar
  • 39 Veltkamp R, Kupsch A, Polasek J, Yousry T A, Pfister H W. Late onset postpartum eclampsia without pre-eclamptic prodromi: clinical and neuroradiological presentation in two patients.  J Neurol Neurosurg Psychiatry. 2000;  69 824-827
    CrossrefPubMedGoogle Scholar
  • 40 Iffy L. Late postpartum eclampsia at 20 weeks' gestation.  Am J Perinatol. 1993;  10 95
    PubMedGoogle Scholar
  • 41 Mandelkern D, Burger A. Cortical blindness in postpartum preeclampsia progressing to eclampsia: case report.  Mt Sinai J Med. 1992;  59 72-74
    PubMedGoogle Scholar
  • 42 Michaeli J. Late appearance of postpartum eclampsia.  JAMA. 1985;  254 909
    CrossrefPubMedGoogle Scholar
  • 43 Sibai B M, Schneider J M, Morrison J C et al.. The late postpartum eclampsia controversy.  Obstet Gynecol. 1980;  55 74-78
    PubMedGoogle Scholar
  • 44 Steiner G J, Plasha M K. Late postpartum eclampsia: report of a case.  Obstet Gynecol. 1964;  24 594-596
    PubMedGoogle Scholar

Koji MatsuoM.D. 

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland Medical Center, University of Maryland School of Medicine

22 South Greene Street, P.O. Box 290, Baltimore, MD 21201