Eclampsia following cesarean section with HELLP syndrome and multiple organ failure

We present a rare case of postpartum eclampsia with overt acute heart and renal failure, in the absence of any precursive signs of preeclampsia. A 41-year-old parturient underwent elective cesarean section for the delivery of twins under spinal anesthesia. Prior to the procedure, preoperative laboratory examination revealed only traceable proteinuria but she had hypertension perioperatively. Approximately 8 hours after the cesarean section, she developed seizures, followed by evident acute heart and renal failure. The diagnosis of postpartum eclampsia with HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome was established and she was admitted to the surgical intensive care unit for close care. Fortunately, the patient recovered fully and was discharged 26 days later. From this illustrative example, unexplainable and sustained hypertension following cesarean section should serve as a signal to warn the health care staff concerned about the possibility of impending life-threatening postpartum eclampsia.