A 27-year-old woman had an uncomplicated vaginal delivery 12 days ago. She presents to the emergency department with two generalised tonic-clonic seizures. Blood pressure is 168/112 mmHg. She had normal blood pressures throughout pregnancy and immediately postpartum. What is the most appropriate next step?

• A CT head followed by observation without anticonvulsants
• B Intravenous magnesium sulfate and control of blood pressure ✓
• C Phenytoin loading and discharge on oral antiepileptics
• D Reassurance, as seizures beyond one week postpartum are never eclamptic

Explanation

Late postpartum eclampsia is defined as eclampsia occurring more than 48 hours after delivery, and it may present up to four weeks postpartum even in women who were normotensive during pregnancy. Management is identical to antepartum eclampsia: intravenous magnesium sulfate for seizure control plus antihypertensive therapy. Imaging is indicated only if the diagnosis is uncertain or response is atypical. Phenytoin is inferior to magnesium sulfate for eclamptic seizures, and dismissing the event as non-obstetric risks missing recurrent seizures and intracranial haemorrhage.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.