Postpartum eclampsia of late onset: a complicated case

Editor—The message of the lesson of the week on postpartum eclampsia of late onset, that such eclampsia can occur in women with uncomplicated pregnancies, is undoubtedly important.¹ However, this case does not illustrate an uncomplicated pregnancy because “clinically significant proteinuria” was present from 30 weeks onwards in a woman who was already at an increased risk of pre-eclampsia because of her obstetric history.² Proteinuria can precede hypertension in the development of pre-eclampsia, and had her proteinuria been quantified, it may have alerted her obstetricians to the possibility of postpartum pre-eclampsia.

Hypertension often does not become evident until the fourth or fifth postpartum day, and women with antenatal preeclampsia or at increased risk should continue to have their blood pressure measured past the usual rather short postpartum stays increasingly seen in hospitals in the United Kingdom and Canada.