The Fit

The postpartum period is one of the most critical stages in the life of a mother as a lot of complications associated with the pregnancy is manifest during labor, delivery and the postpartum period and if you are able to consistently navigate these 3 stages successfully then you can coast home repeatedly to a motherhood experience and life that is full of good health and freedom.

Postpartum eclampsia is the occurrence of seizures or convulsions after you have recently delivered in the presence of severe preeclamopsia.

Preeclampsia is the occurrence and combination of high blood pressure and high amounts of protein in the urine of pregnant mothers or postpartum mothers with associated edema and other organ dysfunctions.

In the postpartum period, we encounter women who having just delivered, start developing elevated blood pressure, edema and protein in urine. These types of complaints you noted may not previously have been present in your pregnancy or these may have in some cases been happening unnoticed and a postpartum period that was adjudged normal suddenly becomes life threatening with the development of sudden onset convulsions.

This is a rare but serious condition whether it occurs during pregnancy or postpartum. The incidence is about 1 in 2000-3000 pregnancies annually.

Causes

The things that can cause you to develop eclampsia have not been fully established but there are risk factors that have been strongly associated with the development of eclampsia in the postpartum period. Among these risk factors are

• First pregnancies
  

• Hypertension that predated the pregnancy
  

• Chronic vascular disease: Like Diabetes Mellitus and renal problems these vascular problems are associated with chronic hypertension

• Multiple pregnancies: This is as a result of the large placenta size, also common in molar pregnancies

• Extremes of maternal age: The teenage years and those over the age of 35

• Obesity
  

• Previous history of eclampsia
  

• Genetic predisposition: Being higher in Africans and African American than Hispanics or Caucasians

Symptoms

Eclampsia especially in the postpartum period may not show you any symptoms before it presents as grand mal seizures. Originally the symptoms of preeclampsia that you have may have been the reason why delivery of the baby was initiated and in most instances as the baby is delivered most people will become relieved and the index of suspicion for eclampsia will become lowered.

With the belief and impression that because it is the placenta and its impact on the pregnancy that causes this condition and with the baby having been born and the placenta removed, everything should be normal.

Unfortunately this is not so making postpartum eclampsia to become occasionally insidious in onset and terrifying.

In some occasions eclampsia presents with symptoms and warning signs that you should observe as pointers to the impending fit. These common symptoms are usually the symptoms of the preexisting preeclampsia

• Elevated blood pressure
  

• Swelling and edema of the face, hands legs
  

• Headaches
  

• Visual problems like flashes of light, blurry vision and sometimes temporary blindness
  

• Excessive weight gain
  

• Nausea and occasionally vomiting
  

• Passing of small volumes of urine
  

• Abdominal pain
  

• Muscle pains
  

• Agitation
  

• Seizures especially tonic clonic in nature
  

• Loss of consciousness
  

Prevention

The management of postpartum eclampsia will start with the prevention of the development of eclampsia by regularly checking your blood pressure even after delivery when you have had a history of preeclampsia antepartum .

Regular checkup also includes the checking of the level of protein in your urine and monitoring the degree of leg facial and hand swellings and noting if they are increasing or reducing after delivery and also you should ensure you rule out the development of symptoms suggestive of worsening preeclampsia like headaches, visual symptoms and abdominal pain.

The use of magnesium sulfate as a means of protecting against eclampsia is also highly recommended and in some cases low dose aspirin in late trimester of pregnancy has been found to be beneficial in reducing the risk of eclampsia both antepartum and postpartum.

Treatment

The 3 main goals of managing postpartum preeclampsia are

1 Control Fits and prevent further Fits

Once you have had an eclamptic fit, there is no further treatment that will suffice aside from controlling the fits as the more convulsions you have the worse is the prognosis for you and a full recovery as the main impact of the fits is in the brain with associated cerebral edema which can worsen.

The most effective medication for the treatment of convulsions to control further fits is with the use of magnesium sulfate. Magnesium sulfate has better outcome than other anticonvulsants like diazepam and phenytoin in the management of eclampsia.

2 Control Blood Pressure

Control of blood pressure in an eclamptic patient is very important as it helps to reduce the risk of development of Stroke. Stroke is a very bad complication in patients with eclampsia and it accounts for about 15 to 20% of deaths in eclampsia.

The most common medication for the control of blood pressure in patients with preeclampsia and eclampsia is hydralazine and labetalol because they are effective and has less side effects in this group of patients.

3 Prevent the development of complications

The goal of treatment is to enhance your prognosis and prompt and early treatment is essential in reducing the chance of development of complications. Both anticonvulsant therapy, blood pressure management and proper fluid therapy is helpful in reducing the risks of complications which can actually affect any organ in your body.

Complications of Eclampsia

HELLP Syndrome

This is a syndrome that consists of the following hemolysis, elevated liver enzymes and low platelet. It is a complication of eclampsia that can lead to bleeding disorder in the patient as the clotting factors are affected by the disease process.

Stroke

This is as a result of uncontrollable hypertension in a patient with eclampsia leading to a cerebrovascular accident (CVA).

Blindness

The blindness that you have here is mostly temporary and it is reversible

Heart failure

The heart fails from a combination of factors that include volume overload on the heart as a result of the edema, severe hypertension that may be uncontrollable and the pulmonary edema.

Death

A certain proportion of eclamptics may not survive especially if the diagnosis and treatment is delayed, if you have multiple seizures that is not amenable to treatment and those that go on to have stroke also have higher mortality rates when compared to others.

Long term outlook

Most of patients with eclampsia recover fully within days or weeks of the episode. You may not relapse in another pregnancy especially if there is no history of previous hypertension. You must be followed up with regular blood pressure checks throughout the 6-week postnatal period and once the BP remains stable you are safe from eclampsia and its sequelae

In the event of persistent blood pressure elevations or you have an underlying illness like Diabetes Mellitus or chronic hypertension, there is an increased risk of development of eclampsia in subsequent pregnancies.

Conclusion

Postpartum eclampsia is a disorder of pregnancy that can manifest in the postpartum period even though the causative factors have been removed .

This shows the importance of continuous monitoring of your system in the postpartum period as most complications of pregnancy, labor and delivery go on to manifest in the postpartum period making the postpartum period one of the most critical times in the life of a mother.

It is self limiting if managed carefully with the maintenance of high index of suspicion following delivery and prompt attention of your doctor and use of appropriate therapies so this minor hiccup in the postpartum does not completely derail your freedom and health in the postnatal life and beyond,

Dr mawa

To your postnatal health and freedom

mypostnatalmanagement.com

Please if you have any comments, suggestions, ideas or experiences you want to share with us concerning postpartum eclampsia kindly use the comments box below.