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.