Exploring Underrecognized Risk Factors and Diagnosis of Postpartum Eclampsia: A Case Report

Eclampsia occurring beyond 48 hours postpartum is termed "late postpartum eclampsia" (LPPE), which is a clinically challenging condition. It has an occurrence of approximately 15% of all eclampsia cases and often presents in women with no documented antenatal hypertension. We report a case of LPPE manifesting on postoperative day (POD) 7 following elective lower-segment cesarean section (LSCS) in a primigravida with pre-existing hypothyroidism in the complete absence of hypertensive recordings prior to and during the antenatal or immediate postoperative period. This case adds to the limited literature by highlighting potential risk factors and the need for a high index of suspicion. A 21-year-old primigravida woman (P1L1), POD 7 after elective LSCS for cephalopelvic disproportion, presented to the emergency department with a six-hour prodrome of severe occipital headache, blurring of vision, and two witnessed generalized tonic-clonic seizures. She had a background history of hypothyroidism managed with levothyroxine 25 µg once daily with no recorded hypertension prior to or during antenatal visits or during her initial postoperative hospital stay. Vital parameters recorded during the post-ictal phase were BP 140/92 mmHg, pulse 90 per minute, saturation 98% on room air, and random blood sugar level 92 mg/dl. She was administered intravenous levetiracetam and shifted for a CT brain, which showed no abnormality. Investigations revealed a spot urine protein-to-creatinine ratio of 308 mg/g with normal hepatic and renal parameters. She was diagnosed with LPPE based on new-onset hypertension, significant proteinuria, and neurological involvement. She was later managed with intravenous magnesium sulfate (MgSO₄) and antihypertensive therapy. After clinical stabilization, she was discharged on POD 13. This case underscores that LPPE can occur as late as POD 7 in the absence of documented hypertension, which makes anticipatory management difficult. It also highlights the need for structured postpartum surveillance protocols and explicit patient and family education regarding warning symptoms.