Garg Deepika, Rahaman Brad, Stein Evan G, Dickman Eitan
Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York.
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
J Emerg Med. 2015 Dec;49(6):e187-91. doi: 10.1016/j.jemermed.2015.07.019. Epub 2015 Sep 26.
Late postpartum eclampsia is defined as occurrence of eclampsia >48 h after delivery and is a rare clinical entity. The delayed onset and nonspecific symptoms at presentation make this entity a challenge to diagnose in patients presenting to the emergency department (ED); however, early recognition and timely interventions are the keys to reducing morbidity and mortality in patients with late postpartum eclampsia.
A 28-year-old woman presented to our ED with a chief complaint of headache of 4 days duration, 8 days after an uncomplicated, normal vaginal delivery. Her past medical history was unremarkable and her entire pregnancy was without medical incident. The patient's examination was within normal limits other than a blood pressure of 152/111 mm Hg and pulse of 54 beats/min. Given her undifferentiated headache and the possibility of preeclampsia, the patient was treated with magnesium sulfate, which was subsequently stopped due to worsening bradycardia. Hydralazine was administered for blood pressure control. Three hours after the magnesium was stopped, the patient reported blurry vision, which was immediately followed by a generalized tonic-clonic seizure. After the seizure, lorazepam was given for control of seizures, and the patient was admitted to the medical intensive care unit. The patient was transferred to the postpartum floor 6 days later in stable condition and without any further seizure activity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients with late postpartum eclampsia are infrequently encountered in the ED due to the rarity of this condition. Increased awareness of this entity among emergency physicians will lead to early interventions, which are crucial in decreasing morbidity and mortality in these patients.
晚发型产后子痫被定义为产后48小时后发生的子痫，是一种罕见的临床病症。其发病延迟且临床表现缺乏特异性，这使得急诊科（ED）的医生在诊断此类患者时面临挑战；然而，早期识别和及时干预是降低晚发型产后子痫患者发病率和死亡率的关键。
一名28岁女性在顺产无并发症8天后因头痛4天前来我院急诊科就诊。她既往病史无异常，整个孕期也无任何医疗事件。除血压为152/111 mmHg和脉搏为54次/分钟外，患者的检查结果均在正常范围内。鉴于其原因不明的头痛以及子痫前期的可能性，患者接受了硫酸镁治疗，但随后因心动过缓加重而停药。给予肼屈嗪控制血压。停用硫酸镁3小时后，患者报告视物模糊，随后立即发生全身性强直阵挛性癫痫发作。癫痫发作后，给予劳拉西泮控制癫痫发作，患者被收入医学重症监护病房。6天后患者病情稳定，无进一步癫痫发作活动，被转至产后病房。急诊科医生为何应了解此病症？：由于晚发型产后子痫较为罕见，急诊科很少遇到此类患者。急诊科医生对此病症的认识提高将有助于早期干预，这对于降低这些患者的发病率和死亡率至关重要。
