From the Guidelines
Eclampsia can occur up to 9 weeks postpartum, although it is rare, and healthcare providers should remain vigilant for its symptoms throughout the extended postpartum period. According to the International Society for the Study of Hypertension in Pregnancy (ISSHP) classification, diagnosis, and management recommendations for international practice 1, preeclampsia may develop de novo intra- or early postpartum, and eclampsia may occur postpartum. The guidelines recommend monitoring blood pressure at least 4 to 6 hourly during the day for at least 3 days postpartum and assessing general well-being and neurological status as per predelivery.
Key points to consider in the management of postpartum preeclampsia and eclampsia include:
- Monitoring blood pressure and neurological status closely
- Restarting antihypertensives after delivery and tapering slowly only after days 3 to 6 postpartum unless blood pressure becomes low or the woman becomes symptomatic
- Avoiding NSAIDs in women with preeclampsia if possible, especially in the setting of acute kidney injury (AKI)
- Using alternative pain relief methods
- Maintaining vigilance for symptoms such as severe headache, visual disturbances, upper abdominal pain, or significant swelling, which may indicate eclampsia or other complications.
The pathophysiology of postpartum eclampsia involves persistent endothelial dysfunction and inflammatory responses that can continue beyond delivery 1. Therefore, early recognition and treatment of preeclampsia symptoms are crucial for preventing serious complications, and women experiencing symptoms should seek immediate medical attention.
From the Research
Eclampsia Occurrence Postpartum
- Eclampsia is a serious complication of pregnancy, characterized by the combination of preeclampsia and seizures 2.
- Approximately one-half of all cases of eclampsia occur postpartum, with late onset postpartum eclampsia defined as occurring more than 48 hours after delivery 2.
Late Onset Postpartum Eclampsia
- There have been reported cases of late onset postpartum eclampsia occurring several weeks after delivery, with one case reported as late as 8 weeks postpartum 2.
- Another study found that convulsions can occur late, up to 4 weeks postpartum, and that late postpartum eclampsia without preceding pre-eclampsia is rare and poses a diagnostic challenge 3.
- Given this information, it is possible for eclampsia to occur 9 weeks postpartum, although it would be considered extremely rare.
Diagnosis and Treatment
- Early treatment initiation with magnesium sulphate and antihypertensive medication is crucial in preventing severe complications and reducing mortality in cases of eclampsia 2, 4, 5, 6.
- Magnesium sulphate is considered the drug of choice for women with eclampsia, due to its effectiveness in reducing the risk of recurrence of seizures and improving outcomes for both the mother and the baby 4, 5, 6.