Postpartum eclampsia care and atypical pre-eclampsia
THE CONTEXT
The passage covers postpartum anticonvulsant treatment, neurologic evaluation, follow-up and presentations that do not meet standard pre-eclampsia criteria.
Postpartum management
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Continue magnesium sulfate for 24 hours after delivery or the last seizure, whichever occurs later.
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Postpartum CT or MRI is indicated when there are signs of neurologic injury, focal deficits or prolonged coma.
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Care involves a multidisciplinary team including obstetricians, anesthetists and the critical care unit.
Follow-up and recurrence
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Postnatal clinic follow-up should occur by 6 weeks.
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The stated recurrence risk ranges from 2% to 25%. For the daughter of a woman with eclampsia, the stated risks of pre-eclampsia and eclampsia are approximately 25% and 3%, respectively.
Atypical pre-eclampsia
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Atypical pre-eclampsia includes pre-eclampsia or eclampsia developing without fulfilling the standard criteria involving hypertension or proteinuria.
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Presentations include pre-eclampsia or eclampsia before 20 weeks, and late postpartum pre-eclampsia or eclampsia more than 48 hours after delivery.
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Other presentations include women with gestational hypertension or gestational proteinuria who develop symptoms of pre-eclampsia, thrombocytopenia or elevated liver enzymes.
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Women with atypical pre-eclampsia who meet other diagnostic criteria for severe pre-eclampsia should be treated as having severe pre-eclampsia, including parenteral magnesium sulfate.