Late Post Partum Pre-eclampsia

This case was written by Katerina Meassick with support from Dr. Steven Butler and Dr. Shani Italiya. Katerina Meassick is a fourth-year medical student attending the Arizona College of Osteopathic Medicine. She is currently pursuing a residency in emergency medicine. Dr. Steven Butler, PhD is the clinical simulation education specialist who operates and manages the Christus Spohn Shoreline Simulation Center (Texas A&M). Dr. Shani Italiya, DO is an emergency medicine physician and the medical director at the Christus Spohn Shoreline Simulation Center.

Why it Matters

Pre-eclampsia complicates between 2-10% of pregnancies and remains an important cause of maternal mortality accounting for approximately 15% of maternal deaths in the United States of America. Of those, approximate half of all cases occur during the postpartum period. Traditional education has taught learners to look for and recognize the signs and symptoms of preeclampsia in patients who are pregnant or in the immediate peripartum period. This has caused missed diagnosis of late-presenting pre-eclampsia until the patient has had a seizure or other end severe organ dysfunction. Better recognition and training on the full spectrum of this condition is needed.

Clinical Vignette

Alice, a 20-year old female with no significant past medical history is brought in by ambulance with worsening upper abdominal pain onset 1 week ago when she woke up. She has felt nauseous and has vomited one time this morning. Two days ago, she began to feel short of breath. She states that it has been getting worse and she is now having trouble lying flat. She was hypertensive with EMS.

Case Summary

A 20-year old female 5 weeks postpartum (G1T1A0) after a cesarean section is brought in by ambulance with worsening upper abdominal pain onset 1 week ago, 2 days of worsening dyspnea and a new severe headache. The patient is found to be increasingly hypertensive and eventually has a seizure. As the patient’s condition deteriorates the team must determine the cause of this patient’s symptoms (pre-eclampsia) and aggressively treatment her symptoms with IV magnesium, IV anti-hypertensives, IV anti-epileptics and eventually, intubation.

Download the Case Here: Late Post Partum Pre-eclampsia

From: Rua et al. 2018

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