Postpartum Seizures Research Articles

Tranexamic acid-induced seizures in postpartum patients

Introduction: Tranexamic acid has found extensive application in obstetrics to prevent and treat postpartum hemorrhage (PPH). This case report investigated an infrequent incidence in which seizures were caused by the administration of tranexamic acid. Even though tranexamic acid is generally regarded as safe, it has been associated with the infrequent yet serious side effects of tranexamic acid-induced seizures. This case report was aimed at investigating the infrequent incidence of tranexamic acid-induced seizures in postpartum patients. Case: It was reported that a woman who was 40 weeks pregnant suffered from postpartum seizures after delivery via cesarean section. These seizures occurred after tranexamic acid was administered to treat postpartum hemorrhage (PPH) caused by uterine rupture, which was accompanied by hypocalcemia. Despite not having a history of epilepsy, preeclampsia, or hypertension, the electrocardiogram (EKG) showed a prolongation of the QT interval. A comprehensive diagnostic evaluation, which involved a CT scan of the head and a D-dimer examination, was conducted, revealing no abnormalities. Discussion: Tranexamic acid, a synthetic derivative of lysine, acts as a competitive inhibitor of plasminogen activation, thereby inhibiting the breakdown of fibrin clots.

Major Causes of Cerebral Palsy among the Children of Bangladesh

The most prevalent physical impairment in children is cerebral palsy (CP), although the exact etiology is frequently still a mystery. CP is a diverse collection of clinical symptoms that characterize long-term problems with posture and movement. It is typified by aberrant posture, mobility, and muscular tone, which restricts the affected person's range of activities. The current investigation was conducted to determine the sociodemographic characteristics linked to individuals with cerebral palsy, to investigate the age range most susceptible to the condition, to pinpoint the gender most impacted, and to ascertain the causes and prevalent forms of cerebral palsy in Bangladesh. A total of 100 children with cerebral palsy were selected from the Center for The Rehabilitation of the Paralyzed (CRP) and the outdoor and indoor departments of the Bangladesh Council for Children Welfare (BCCW), Dhaka, for a descriptive cross-sectional study. Out of the 100 children with cerebral palsy, the majority were male. The age range of the maximum percentage of children was 1 to 8 years. The majority of mothers (78%) of children with cerebral palsy had good health. 37% of the children's fathers and 28% of mothers had completed their bachelor's degrees. The majority of mothers, or 93% of them, were housewives. The siblings of the maximum children were all normal or had no disabilities. A maximum of 55% of children had normal deliveries, with no complications occurring during the child's birth. A maximum of 42% of children with cerebral palsy experience postpartum seizures due to birth damage. 45% of newborns suffer from asphyxia. The youngsters had ataxic cerebral palsy, which was the most prevalent kind of the condition. According to the study's findings, the main risk factors in Bangladesh are still infant convulsions, hospital deliveries, birth injuries, and hypoxia.

Postpartum seizure as a complication of dural puncture and intracranial hypotension.

Postpartum seizure as a complication of dural puncture and intracranial hypotension.

Self-Discontinuation of Antiseizure Medication During Pregnancy Increases Postpartum Seizure Frequency

Objectives: The study aimed to investigate the rate of unplanned pregnancies, changes in seizure frequencies during the 6 months before the pregnancy, during the pregnancy, and the 6 months after the pregnancy, and antiseizure medication (ASM) compliances in women with epilepsy (WWEs). Materials and Methods: The study retrospectively evaluated WWEs who were followed up in the epilepsy outpatient clinic of a training and research hospital between 1997-2021 and had used ASMs for at least 6 months prior to their pregnancy. Results: The study assessed a total of 158 pregnancies for 77 WWEs, with 112 pregnancies resulting in live births, 71.4% of which were unplanned pregnancies. Unplanned pregnancies are more common in less educated women (p = 0.02). Of the women, 35 self-discontinued their ASMs during pregnancy, and these women were younger than the WWEs who continued taking their ASMs (p = 0.003). In addition, folic acid supplement use was lower in women who self-discontinued their ASMs (p = 0.031). The rate of increase in seizure frequency during postpartum period compared to pregnancy was higher in women who self -discontinued ASMs (p = 0.032). Conclusion: Self–discontinuation of ASM during pregnancy is related to an increase in postpartum seizure frequency. WWEs should be given advice on how to minimize the risk of seizure during the postpartum period.

A diagnostic challenge of a patient with postpartum seizures and thrombocytopenia: A case report of posterior reversible encephalopathy syndrome with immune thrombocytopenia

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Factors affecting breastfeeding in women with epilepsy.

This study aimed to compare rates of breastfeeding initiation and maintenance in women with epilepsy (WWE) with those of the general population and to identify factors affecting breastfeeding patterns in WWE. We retrospectively reviewed data for the following variables in pregnant WWE (n=102) and healthy women without epilepsy (n=112): demographic characteristics (age, race, ethnicity), epilepsy type (focal or generalized onset), antiseizure medication(s), psychiatric comorbidities, postpartum seizure control, breastfeeding counseling, and lactation consultation. Fisher exact test and logistic regression analyses were performed to compare the rates of breastfeeding initiation and continuation in pregnant WWE with those of healthy pregnant women and to determine factors associated with rates of breastfeeding initiation and maintenance. The rate of breastfeeding initiation in WWE was significantly lower than in healthy women without epilepsy (50.9% vs. 87.6%), and WWE were less likely to maintain breastfeeding at 6weeks (38.2%) and 3months (36%) postpartum. Nearly half (53%) of WWE received antepartum breastfeeding counseling by their neurologists, and these women had higher odds of breastfeeding initiation and continuation (odds ratio [OR]=2.53, 95% confidence interval [CI] = 1.14-5.72, p=.02). Postpartum consultation with a board-certified lactation consultant was associated with higher odds of breastfeeding continuation at 6weeks (OR=5.43, 95% CI = 1.39-27.23, p=.02) and at 3months (OR=4.9, 95% CI = 1.34-20.87, p=.019). Women taking levetiracetam were more likely to initiate and continue breastfeeding than those taking lamotrigine (OR=6.22, 95% CI = 2.15-20.20, p=.001). The initiation rate and duration of breastfeeding were significantly lower in WWE than in healthy women without epilepsy and were significantly associated with several factors. Identification of potential barriers to breastfeeding in WWE may lead to development of intervention strategies that can improve breastfeeding rates in WWE to maximize positive health outcomes for WWE and their infants.

Good Management of an Ischemic Stroke on Postpartum Complicated Gestational Hypertension and Uterine Rupture

We present a case of postpartum ischemic stroke due to hypertension of pregnancy complicated by uterine rupture. Thanks to the clinical elements, in particular postpartum seizures, disturbances of consciousness and an immediate CT scan confirmed the diagnosis. The patient was resuscitated and transferred to neurology with hemiparesis as a sequel. We hope that the treatment of these patients can be improved thanks to our experience in this case management.

An unusual presentation of posterior reversible encephalopathy syndrome\u2014a case report

BackgroundAcute neurological emergencies in pregnant and postpartum women presenting as headache, visual disturbances, seizures, and elevated blood pressure are usually attributed to preeclampsia and eclampsia. However cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two important, rare conditions which should be considered. PRES is a rare neuroradiological syndrome characterised by vasogenic oedema of subcortical white matter, commonly involving posterior cerebral hemispheres. Preeclampsia and eclampsia are the common causes of PRES. However, late postpartum eclampsia concurrent to PRES is rare. Here, we report a rare case of PRES secondary to late postpartum eclampsia with atypical radiological findings.Case presentationA 25-year-old married woman with prior history of two spontaneous abortions presented to us on day 5 postpartum, post lower segment caesarean section (LSCS) with complaints of headache followed by one episode of new onset generalised tonic-clonic seizures. There was no history of seizures prior to the pregnancy and no history of hypertension or diabetes during any of her pregnancies. On examination, BP was 140/90 mm Hg and PR 98 bpm. Systemic examination revealed GCS 15/15, no focal neurological deficits, and bilateral flexor plantar response. Fundus examination was normal with no evidence of hypertensive retinopathy. Preliminary haematological and biochemical tests including antiphospholipid antibody (APLA) profile were done in view of prior abortions and were within normal limits. Lumbar puncture was done—normal study. EEG was normal. MRI with MRV was suggestive of atypical posterior encephalopathy. In view of late onset postpartum seizure, the patient was started on injection of magnesium sulphate, anti-hypertensives, and antiepileptics; following which, she improved and was discharged.ConclusionThough preeclampsia and eclampsia are usually screened entities, we should also follow women in puerperium for late postpartum eclampsia which is defined as seizures beyond 48 h of delivery up to 4 weeks postpartum. So it is important to follow-up postpartum women for complications like PRES because early detection and treatment can lessen the morbidity and mortality as they are completely reversible. Thus, health care professionals should be educated about the same. Apart from antenatal and intrapartum care, postpartum care should also be given equal importance.

Pregnancy with epilepsy and antiepileptic drug therapy on fetomaternal outcome

Background: Pregnancy women with epilepsy may have higher chances of obstetric complications, aggregative seizures, major congenital malformations, and abnormal deliveries. Monotherapy or polytherapy of anti-epileptic drugs are usually associated with adverse outcomes in pregnant women with epilepsy. Aim and Objectives: The aim of the study was to evaluate the effect of epilepsy and antiepileptic drug (AED) therapy on the fetomaternal outcome in pregnant women. Material and Methods: A total of 46 pregnant women with epileptic seizures between 18 and 35 years with mean age of 26.46 years were included in the study. The demographic, clinical, and obstetrical data were collected from the medical records. The AED monotherapy and polytherapy with drug dosage details were noted. The details of mode of delivery, outcome of seizures in post-natal period and fetal outcome were gathered. Results: About 65.21% cases were under AED polytherapy and 34.78% cases were under AED monotherapy. Majority cases had carbamazepine (CBZ) and sodium valproate mono and polytherapy. Majority had normal vaginal delivery (65.11%). Single or in combination use of sodium valproate, CBZ, and phenytoin are associated with major congenital malformations (9%). Postpartum hemorrhage was observed in 6.52% cases and postpartum seizure occurrence was observed in 8.69% cases. Conclusion: A well planned pregnancy, continuous monitoring for congenital malformations and fetal growth restriction is necessary in pregnant women under AED therapy for better maternal and fetal outcome.

Pregnancy-related complications and risk of postpartum readmission for seizures and epilepsy: A national study.

Peripartum seizures remain a leading cause of maternal morbidity and mortality worldwide. Therefore, recognition of high-risk individuals is essential. We aimed to determine the rate and identify risk factors for postpartum seizure/epilepsy readmissions. In this retrospective cohort study, the Nationwide Readmissions Database was used to identify index admissions for delivery and readmissions for seizures in the year 2013, defined by International Classification of Disease, Ninth Revision, Clinical Modification codes for epilepsy, convulsions, and eclampsia in the primary diagnostic position. Logistic regression analysis was used to examine 30-day readmission for seizures as well as associations between demographic, medical, psychiatric, and pregnancy-related factors. There were 1633714 index admissions for delivery, with a 30-day readmission rate for seizures/epilepsy of 19.69 per 100000 index admissions. The mean age of index participants was 28.6 years (SD = 5.8). Postpartum 30-day readmissions for eclampsia represented 80% of seizure/epilepsy readmissions. Higher income was associated with lower odds of seizure/epilepsy readmission (odds ratio [OR] = 0.50, 95% confidence interval [CI] = 0.34-0.72, P=.03) for the highest income group. Eclampsia (OR = 19.9, 95% CI = 9.38-42.2, P<.001), preexisting epilepsy (OR = 10.63, 95% CI = 6.43-17.56, P<.001), pre-eclampsia (OR = 3.23, 95% CI = 2.31-4.51, P<.001), and gestational hypertension (OR = 2.78, 95% CI = 1.94-3.98, P<.001) were associated with readmission for seizures. Readmissions for seizures are fortunately rare, but are important to minimize given morbidity and mortality. Most seizure readmissions occurring within 30days postpartum were coded as eclampsia rather than convulsions or pre-existing epilepsy. These findings suggest that early identification of women with pre-eclampsia and eclampsia may play a role in the prevention of postpartum seizures. Women with these risk factors should be identified to optimize care and monitored closely for seizure-associated complications.

To compare abbreviated regimens of single dose and 12 hours magnesium sulphate administration with the conventional 24 hours postpartum in severe preeclampsia: A randomized clinical trial

Introduction: Preeclampsia and eclampsia have remained a major global public health threat in contributing significantly to maternal and perinatal morbidity and mortality with incidence of 2.16% and 0.28% respectively. The treatment modalities of eclampsia and severe pre-eclampsia include initial stabilization, rational use of antihypertensives, anticonvulsants and planning for delivery. Magnesium Sulphate, as anticonvulsant is drug of choice for convulsion prophylaxis but its benefit should always outweigh its adverse effects. Traditionally the use of magnesium sulphate has been recommended for 24 hour postpartum. By reducing the duration of therapy, the frequency of postpartum maternal monitoring may be curtailed and the possibility for the women to ambulate early and care for her newborn may be increased. The purpose of present study is to compare the effectiveness, side effects and maternal outcome of magnesium sulphate administration as single dose and 12 hours postpartum with the conventional 24 hours in the cases of severe preeclampsia. Aims and Objectives: To compare abbreviated regimens of single dose and 12 hours magnesium sulphate administration with the conventional 24 hours postpartum in severe preeclampsia.Material and Methods: A randomized prospective clinical trial was conducted on pregnant women presenting with severe preeclampsia. The patients were randomly allocated into group I (single dose), group II (12hour) and group III (24hour) postpartum MgSO4. The dosage and the route of administration of magnesium sulphate was similar in all three groups before delivery as per Prichard regimen. After delivery, a single maintenance dose of magnesium sulphate was given in group I, 12 hours group II and for 24 hours postpartum in group III. During the study period, the patients were assessed for various outcome parameters such as seizures, clinical outcomes such as time to return to ambulation in hours, duration of indwelling urinary catheter in hours, time until contact with the newborn infant in hour, urine output, adverse effects and evidence of toxicity in mother.Results: All patients in three groups were comparable with regards to demographic as well as obstetric characteristics. None of the patient in group I had any of the signs of MgSO4 toxicity, however in group II, one patient had loss of patellar reflex and in group III, two patients had loss of patellar reflexes and another two had oliguria. None of the patient had respiratory depression or convulsion in any of the three groups. The patients in group I and group II, ambulated much earlier as and had less duration of catheter as compared to group III. However there was no significant difference in the average time until contact with the newborn between the three groups. Conclusion: Magnesium sulphate for 24hrs is the drug of choice for seizure prophylaxis in patients with severe preeclampsia and eclampsia but benefits of magnesium sulphate should outweigh its adverse effects. But there was increase in the feeling of wellbeing in shorter regimens with early ambulation, lesser duration of indwelling catheter and early breastfeeding leading to better capability of the mother to take care of newborn. The present study suggests that the abbreviated postpartum MgSO4 regimens can be effective alternatives to the conventional 24 hours regimen for postpartum seizure prophylaxis in severe preeclampsia.

Post-partum Seizure from Subdural Hematoma Secondary to Cerebrospinal Fluid Leak Following Epidural Anesthesia

ABSTRACTHeadaches in the post-partum period are common, while new seizures are not. While many causes of post-partum headache are benign, it can be difficult to determine which patients warrant a more comprehensive workup to investigate for serious causes, which may only present later with neurologic sequelae such as new seizures. We suggest that persistent post-dural puncture headaches in the context of intrapartum epidural anesthesia can be suggestive of a serious cause such as intracranial hypotension or subdural hematoma. We describe a case of a 28-year-old G1P1 female presenting with a first-time seizure at 19 days post-partum caused by subdural hematoma from a persistent cerebrospinal fluid leak. This was in the context of a history of typical post-dural puncture headache following delivery.&#x0D; RÉSUMÉLes maux de tête dans la période post-partum sont fréquents, alors que les nouvelles crises ne le sont pas. Bien que de nombreuses causes de céphalées post-partum soient bénignes, il peut être difficile de déterminer quels patients justifient un bilan plus complet pour rechercher les causes graves, qui peuvent ne se présenter que plus tard avec des séquelles neurologiques comme de nouvelles crises. Nous suggérons que les maux de tête persistants post-ponctionnels dans le contexte de l’anesthésie épidurale intra-partum peuvent suggérer une cause grave comme l’hypotension intracrânienne ou un hématome sous-dural. Nous décrivons le cas d’une femme G1P1 de 28 ans qui présente une première crise d’épilepsie 19 jours après l’accouchement causée par un hématome sous-dural causé par une fuite persistante de liquide céphalorachidien. C’était dans le contexte d’une histoire de céphalées typiques après une ponction post-durale après l’accouchement.

Postpartum Seizure Due to Neurocysticercosis: A Case of Diagnostic Dilemma

Seizure in early postoperative period in a postpartum female always poses diagnostic dilemma for both the anesthetist and the surgeon. We are reporting a 30-year-old primigravida with unremarkable history, except for few readings of high blood pressure during antenatal period who developed convulsions within 1 hour of delivery performed by lower segment cesarean section under spinal anesthesia. All relevant causes of postpartum seizure were ruled out and surprisingly magnetic resonance imaging of brain revealed cerebral neurocysticercosis; appropriate management and timely intervention resulted in uneventful recovery. The clinical manifestations of neurocysticercosis are variable and depend on the number, size, and location of cysts and the immune response of the host.

Posterior reversible encephalopathy syndrome – unusual manifestation of late postpartum eclampsia

Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological syndrome associated with headache, convulsions, visual disturbance and encephalopathy. Cerebral imaging of the condition is dominated by parieto-occipital white matter changes. We report a case of a 33-year-old multiparous woman with late postpartum seizures preceded by severe headache and visual disturbances. She was initially diagnosed with post-spinal headache but developed seizures. She was then diagnosed as having eclamptic fits and magnetic resonance venography revealed lesions suggestive of PRES. With prompt management the patient improved. This emphasizes the importance of early diagnosis of postpartum eclampsia to allow prompt management and prevent neurological sequelae.

Postpartum Woman With Seizures

A 27-year-old woman, postpartum day 9, presented with sudden onset of headache, vomiting, visual blurring, and 3 episodes of generalized tonic-clonic seizures. She had had an uneventful cesarean delivery 9 days previously and was discharged home. Her antenatal period was uneventful, and she did not have gestational hypertension. On examination, she was alert, oriented, and afebrile. Her blood pressure was 150/100 mm Hg, which had increased from her mean antenatal recording of 130/80 mm Hg. Fundus examination result was normal, and there were no focal neurologic deficits. Magnetic resonance imaging (MRI) of the brain showed T2 and T2 fluid-attenuated inversion recovery (FLAIR) hyperintense signals in bilateral parietooccipital lobes (Figures 1 and 2) and bilateral cerebellar hemispheres (Figure 3), without any diffusion restriction. She was treated with intravenous labetalol, nifedipine, and fosphenytoin. Her blood pressure normalized and her symptoms subsided, and she was later discharged.Figure 2Axial MRI showing T2 FLAIR hyperintensity of bilateral parietal lobes (arrows).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Axial MRI showing T2 FLAIR hyperintensity of bilateral cerebellar hemispheres (arrows).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome is a clinicoradiologic entity, characterized by the clinical triad of headache, visual blurring, and seizures. The classic neuroimaging feature is parietooccipital lobe edema, observed as T2 hyperintense lesions in the MRI.1Bartynski W.S. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features.AJNR Am J Neuroradiol. 2008; 29: 1036-1042Crossref PubMed Scopus (796) Google Scholar Cerebellar involvement as observed in this case is much rarer, and such atypical presentations are also possible.2McKinney A.M. Short J. Truwit C.L. et al.Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings.AJR Am J Roentgenol. 2007; 189: 904-912Crossref PubMed Scopus (519) Google Scholar Posterior reversible encephalopathy syndrome is usually accompanied by hypertension. Other causes include chronic kidney disease and immunosuppressive therapy.3Garg R.K. Posterior leukoencephalopathy syndrome.Postgrad Med J. 2001; 77: 24-28Crossref PubMed Scopus (236) Google Scholar Patients with blood pressure fluctuations in the antepartum and postpartum period are particularly vulnerable for the syndrome. In the setting of postpartum seizures, the differential diagnosis includes postpartum eclampsia, cerebral venous thrombosis, and intracerebral hemorrhage.

Posterior Reversible Encephalopathy Syndrome: A case report with review of literature

Posterior Reversible Encephalopathy Syndrome (PRES) refers to a clinico-radiologic entity with characteristic features on neuroimaging and non-specific symptoms comprising headache, confusion, visual disturbances and seizures. The lesions in PRES are thought to be due to vasogenic oedema. Here we are reporting a postpartum case of 18 year old primi with PIH who presented to our emergency department with detorioration of consciousness, headache and respiratory distress. Patient also had an episode of GTCS (Generalised Tonic Clonic Seizure) on admission. However, on the basis of MRI finding PRES was diagnosed and treated successfully in critical Care. Due to timely intervention patient had recovered without any neurological deficit. Keywords: Posterior reversible encephalopathy syndrome, Preeclampsia, Postpartum seizure

The impact of uterine curettage postpartum on maternal sFlt-1 concentration.

Our purpose was to investigate the influence of a uterine curettage on the immediate maternal sFlt-1 concentration post partum. Forty-six patients booked for delivery via primary caesarean section were included in a prospective open, case control study. Eighteen of them achieved an intraoperative curettage and formed the treatment group, 28 patients without curettage were enrolled in the control group. Maternal sFlt-1 serum values were measured immediately before and 24 h after delivery. Patients who underwent a uterine curettage showed a relative decrease of 70% (median 3670±1110 pg/mL-1143±270 pg/mL) in comparison to the control group with 65% (median 3132±636 pg/mL-1098±611 pg/mL; P=0.558). Additionally, three patients with preeclampsia and curettage were included, who showed a relative decrease of 76%. A uterine curettage may slightly accelerate the fall of the postpartal sFlt-1 concentration. The previously described benefit of curettage in patients with preeclampsia regarding faster recovery or treatment of postpartum seizures may be partly explained as mediated by anti-angiogenic factors.

O81. The impact of uterine curettage post partum on maternal sFlt-1 concentration

Introduction The anti-angiogenic biomarker sFlt-1 is closely related to the pathobiology and the clinical presentation of preeclampsia. A uterine curettage post partum is a known therapeutic option for eclamptic seizures or HELLP syndrome after delivery. Objectives Our purpose was to investigate the influence of a uterine curettage on the immediate maternal sFlt-1 concentration post partum. Methods Forty six patients booked for delivery via primary caesarean section were included in a prospective open, case control study. Eighteen of them achieved an intraoperative curettage and formed the treatment group, 28 patients without curettage were enrolled in the control group. Maternal sFlt-1 serum values were measured immediately before and 24 h after delivery. Results Patients who underwent a uterine curettage showed a relative decrease of 70% (from median 3670 ± 1110 pg/ml to 1143 ± 270 pg/ml) in comparison to the control group with 65% (from median 3132 ± 636 pg/ml to 1098 ± 611 pg/ml; p = 0.558). Additionally, three patients with preeclampsia and curettage were included, who showed a relative decrease of 76%. Conclusions A uterine curettage may slightly accelerate the fall of the postpartal sFlt-1 concentration. The previously described benefit of curettage in preeclamptic patients regarding faster recovery or treatment of post partum seizures may be partly explained as mediated by anti-angiogenic factors.

Importance of cardiological evaluation for first seizures

This paper reports two cases of long QT syndrome (LQTS) which presented with seizures as their initial feature. Case 1, AB was seen in emergency department with post-partum seizure, discharged and re-presented following cardiac arrest associated with LQTS. Case 2, CD presented initially with tonic-clonic seizure and because of experience with AB, CD was assessed for LQTS which was subsequently confirmed. The legal medicine experience re Dobler v Halverson, which involved a young boy with LQTS, who suffered cardiac arrest without prior diagnosis of LQTS, has reinforced the requirement to seriously consider LQTS as an aetiological factor in first seizure presentations.

Postpartum seizures due to tuberculoma in brain.

Postpartum seizures due to tuberculoma in brain.