A 24-year-old woman has an uneventful vaginal delivery at term. On the 10th postpartum day she presents with a generalised tonic-clonic seizure. She had normal blood pressures recorded throughout pregnancy and the immediate postpartum period, and she was discharged home on day 3. What is the most appropriate immediate treatment?

• A Intravenous levetiracetam and outpatient neurology follow-up
• B Intravenous magnesium sulfate loading followed by maintenance infusion ✓
• C Immediate CT venography and systemic anticoagulation
• D Intravenous ceftriaxone and lumbar puncture

Explanation

Eclampsia can occur de novo in the postpartum period, classically within 48 hours of delivery but reported up to four weeks later, sometimes called late postpartum eclampsia. Seizure in this window is treated as eclampsia until proven otherwise, and magnesium sulfate is the anticonvulsant of choice. Cerebral venous thrombosis is a genuine differential that also presents with postpartum seizures, but it does not take precedence over treating the presenting convulsion first.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.