Clinical Review Lesson of the week

Postpartum eclampsia of late onset

BMJ 2005; 331 doi: (Published 03 November 2005) Cite this as: BMJ 2005;331:1070
  1. Nalini Munjuluri, specialist registrar ([email protected])1,
  2. Marc Lipman, consultant physician2,
  3. Alan Valentine, consultant neuroradiologist2,
  4. Paul Hardiman, consultant obstetrician and gynaecologist2,
  5. Allan B Maclean, professor in obstetrics and gynaecology2
  1. 1North Middlesex University Hospital, London N18 1QF
  2. 2Royal Free Hospital, London NW3 2QG
  1. Correspondence to: N Munjuluri, 71 Lulworth Avenue, Goffs Oak EN7 5LB
  • Accepted 21 June 2005


Pre-eclampsia and eclampsia occur in 6% to 8% of all pregnancies.1 The British eclampsia study confirmed 383 cases of eclampsia during 1992 and warned of the severe consequences of the condition.2 In 1997 Leitch and colleagues showed that over a 60 year period the incidence of eclampsia had fallen from 74/10 000 to 7.4/10 000, although the incidence of postpartum eclampsia had increased.3

A US study identified 229 cases of postpartum preeclampsia or eclampsia between 1992 and 20024; 151 of these cases were diagnosed after readmission to hospital with new symptoms and signs after delivery, and 16% (24/151) of these had eclampsia. Other work from the United States identified 89 cases of eclampsia during 1996 to 20015; 29 cases (33%) presented in the postpartum period. In both these US studies most cases developed symptoms more than 48 hours post partum.

Most antenatal and intrapartum cases of eclampsia present to obstetricians, but postpartum cases are more likely to be encountered by non-obstetricians. We present a case of postpartum eclampsia.

Case report

A 27 year old woman in her second pregnancy delivered a healthy male baby weighing 3690 g at 38 weeks by elective caesarean section. Clinically significant proteinuria was present from 30 weeks onwards. In her …

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