Complicated postpartum preeclampsia-eclampsia.

Infrequently, severe preeclampsia-eclampsia with or without HELLP syndrome persists more than 24 to 48 hours into the postpartum period. Maternal morbidity and mortality is increased in these women who persist in their disease and do not rapidly resolve their hypertension, decreased urinary output, depressed platelet count, and other related abnormalities within 72 to 96 hours postpartum. When these worsen to include multiple system organ failure, infection, and fibrin consumption coagulation disorders, emergent and aggressive intervention is needed. Prophylactic treatment options to accelerate postpartum recovery include ultrasound-directed postpartum curettage and oral nifedipine therapy. In pregnancies complicated by HELLP syndrome, postpartum corticosteroids can be used to hasten the recovery from this disease. Delayed ultrasound-directed curettage and exchange plasmapheresis with fresh-frozen plasma can be used in pregnancies when evidence of recovery is absent or further deterioration is evident by 96 hours postpartum. Other specific system involvement, such as central nervous system or renal system, requires directed therapy unique to the individual condition and patient that is undertaken in association with consultants.