Late postpartum eclampsia: report of two cases managed by uterine curettage and review of the literature

The purpose of this study was describe two patients with rapid recovery of refractory late postpartum eclampsia (LPPE) following uterine curettage, and to evaluate the literature about supportive evidence for such a management in LPPE. A detailed literature search was performed focusing on studies reporting the clinical presentation, laboratory workup, imaging, and management of LPPE. Mean reported onset of LPPE was on postpartum day 7.0 +/- 2.9. Only 35.3% had a history of preeclampsia: these had earlier onset of seizures compared with the subjects without history of preeclampsia (4.3 +/- 1.4 versus 7.6 +/- 2.9 days; p < 0.005). Onset of seizure was correlated with systolic blood pressure (Pearson's r = 0.34; p < 0.05). Major associated symptoms were headaches (71.4%), visual changes (46.0%), and nausea/vomiting (22.2%); 67.5% of patients were proteinuric. The remaining laboratory tests were usually normal. Among the patients with a normal head computed tomography, magnetic resonance imaging identified additional abnormalities in 53.8% (seven of 13). A total of 69.7% of patients developed multiple seizure episodes, some of these occurred while the patient was receiving magnesium sulfate treatment; 82.5% of patients underwent magnesium therapy and approximately half of those patients required multiple antiseizure drugs. The number of seizures was only correlated with the diastolic blood pressure (Pearson's r = 0.52; p < 0.01). Even remote from delivery, headaches, visual change, and nausea/vomiting are important symptoms of LPPE. Hypertension and/or proteinuria are important diagnostic findings. LPPE is often characterized by refractory seizures and controlling the diastolic blood pressure is important. Patients presented in our case report showed no seizures after uterine curettage. This potential useful management for LPPE requires additional investigation.