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Am Fam Physician. 2002;66(8):1527

Eclampsia is a major cause of perinatal morbidity and mortality and can present during the antepartum, intrapartum, or postpartum periods. Late postpartum eclampsia presents as convulsions, with onset occurring at more than 48 hours postpartum.

Chames and associates reviewed their clinical experience with eclampsia, looking at predictive factors for postpartum eclampsia and the effects of current treatments on outcomes. A retrospective review was done of the records of women who had eclamptic convulsions at three large medical centers. Of the 89 women with eclampsia during a five-year period, 23 had late-onset postpartum eclampsia; only five of the women had been diagnosed previously with preeclampsia. Headaches, visual symptoms, and at least one symptom of preeclampsia were more frequently present among women with late postpartum eclampsia than in other women with eclampsia, potentially making postpartum eclampsia more predictable.

The incidence of eclampsia has decreased with better prenatal care, earlier recognition of signs and symptoms, and prophylactic magnesium sulfate administration in women with preeclampsia. Women in the postpartum period need to be aware of the risk of eclampsia and the importance of reporting to their physicians any problems with severe headaches, blurred vision, mental status changes, or epigastric pain with nausea and vomiting.

The authors conclude that the rate of late postpartum eclampsia is increasing and that early management would be facilitated by improving patient and physician knowledge about the symptoms of preeclampsia. Early recognition of atrisk patients would allow for interventions, such as magnesium sulfate administration, that are likely to reduce the incidence of late postpartum eclampsia.

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