Puerperal eclampsia in the immediate postoperative period of cesarean section: a critical obstetric emergency

Abstract

Eclampsia is a serious and potentially life-threatening complication of hypertensive disorders of pregnancy, characterized by the onset of new-onset seizures (tonic-clonic, focal, or multifocal) in the absence of other identifiable neurological causes. Most cases of eclampsia manifest postpartum, with the first 48 hours being the highest risk period. Recent literature has documented the emergence of atypical forms of eclampsia, in which seizures can occur in the absence of hypertension or proteinuria. The unpredictable nature of these cases makes timely diagnosis and management difficult. A 29-year-old female patient at approximately 40.6 weeks presented to the emergency department with prodromes of labor. An obstetric ultrasound was performed, and given the diagnosis of risk of loss of fetal well-being, an emergency segmental cesarean section was performed. Approximately four hours after the cesarean section, the patient presented two generalized tonic-clonic seizures. Anticonvulsant treatment was administered, a diagnosis of puerperal eclampsia was established, and her transfer to the Intensive Care Unit (ICU) was coordinated. The therapeutic plan in the ICU included an infusion of phenytoin as an anticonvulsant, antihypertensive management with alpha-methyldopa, hemodynamic support, correction of fluid and electrolyte imbalance, and empirical antibiotic therapy due to suspected urinary tract infection. Her subsequent evolution was favorable, remaining afebrile, hemodynamically stable, and without recurrence of seizures. The unusual presentation of puerperal eclampsia in the immediate postoperative period, in the initial absence of the classic diagnostic criteria of hypertension and proteinuria, is significant and of academic value. This case underscores the importance of maintaining a high level of clinical suspicion for eclampsia in the immediate postpartum period, even without prior criteria for preeclampsia. Early recognition and the timely use of magnesium sulfate are essential to reduce maternal morbidity and mortality.