Postpartum eclampsia: a clinical study

Abstract

Background: Eclampsia, an enigmatic multisystem complication of pregnancy, is commonly defined as new onset of grand mal seizure activity and/or unexplained coma during pregnancy or postpartum. Eclampsia is associated with maternal deaths ranging from, 1.8% in developed to 14% in developing countries respectively. The worldwide incidence of delayed postpartum eclampsia is on an increasing trend, now at 16-18%, of all eclamptic seizures. Objective was to study the clinical findings and morbidity, associated with postpartum eclampsia and its correlation with neuroimaging- in our institute- SRIHER, Chennai.Methods: This is a retrospective study from a period of June 2016 to June 2021, in SRIHER, Chennai. Case records of all patients with postpartum eclampsia were analysed.Results: A total of 35 patients who satisfied the inclusion criteria were studied, out of which 55% of patients were diagnosed with hypertension or preeclampsia antenatally, and 45% presented as atypical eclampsia. In our institution, Postpartum eclampsia commonly occurred in the age group of 26-30 years of age (51.4%); was common after lower segment caesarean section (LSCS) (71.4%); most commonly occurred immediate postpartum (42.8%). Most common prodromal symptom was headache (77%), followed by blurring of vision (37%). Most common magnetic resonance imaging (MRI) finding was posterior reversible encephalopathy syndrome (PRES) (69%). 17% patients required intensive care unit (ICU) care. There was no mortality associated with postpartum eclampsia in the study period.Conclusions: This study emphasises that a high index of suspicion and a multidisciplinary approach effectively reduces mortality and morbidity associated with postpartum eclampsia. Neuroimaging is of robust help in the diagnosis and management of postpartum eclampsia.