A 27-year-old second gravida had an uncomplicated pregnancy and normal blood pressures throughout. Five days after an uncomplicated vaginal delivery she presents to the emergency department with a generalised tonic-clonic seizure. Blood pressure is 168/108 mmHg and urine dipstick shows 3+ proteinuria. What is the correct diagnosis and initial management?

• A Epilepsy; start phenytoin and discharge home
• B Eclampsia; magnesium sulfate therapy and antihypertensives ✓
• C Cerebral venous thrombosis; start heparin immediately before any other drug
• D Gestational hypertension; observe and recheck blood pressure in 6 hours

Explanation

Postpartum eclampsia is well recognised and accounts for a substantial share of all eclamptic seizures; it typically occurs within 48 hours but can occur later, and it may be the first manifestation in a woman with entirely normal antenatal blood pressures. Management is identical to antepartum eclampsia: magnesium sulfate loading followed by maintenance infusion, with antihypertensive therapy for severe hypertension. Cerebral venous thrombosis is a differential but the hypertension and proteinuria make eclampsia the working diagnosis.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.