Gynecology World Conference 2026

Background: Puerperal eclampsia is a severe and potentially life-threatening complication of preeclampsia that can occur even after delivery. Although commonly associated with the antepartum period, a significant proportion of cases arise in the postpartum phase, sometimes with atypical and multisystem manifestations. Delayed recognition remains a major contributor to maternal morbidity and mortality, particularly in low-resource settings. We report a case of late postpartum eclampsia presenting with altered consciousness and to emphasize the importance of recognizing atypical clinical features and multisystem involvement in order to prevent severe maternal complications.

Case Presentation: A 39-year-old multiparous woman (P5A0) presented on postoperative day 13 following cesarean section with complaints of worsening headache, blurred vision, dizziness, neck pain, and nausea. One day prior, she had been evaluated at a primary healthcare facility with a systolic blood pressure of 160 mmHg and treated symptomatically. On admission, her blood pressure was 190/110 mmHg with an initial Glasgow Coma Scale (GCS) of E4M6V5. Shortly after admission, she developed a generalized tonic–clonic seizure followed by decreased consciousness (GCS E1M1V1), requiring emergency resuscitation.

Electrocardiography revealed ventricular extrasystoles.

Laboratory evaluation showed hypokalemia (2.7 mEq/L), mild leukocytosis (11,350/µL) with neutrophilia, and normal hemoglobin, platelet count, and glucose levels. Chest X-ray demonstrated infiltrates with fibrotic changes in the right upper lung suggestive of pneumonia, as well as cardiomegaly (cardiothoracic ratio 0.58) and aortic elongation. The patient was diagnosed with puerperal eclampsia complicated by decreased consciousness and cardiac arrhythmia. Management included intravenous magnesium sulfate, antihypertensive therapy (nifedipine and methyldopa), airway stabilization, and planned ICU admission.

Discussion: This case highlights late postpartum eclampsia with multisystem involvement and underscores the importance of early recognition of severe hypertension to prevent disease progression. Hypokalemia may have contributed to cardiac arrhythmia, while pulmonary findings suggest a concurrent condition that may worsen clinical status. Prompt management with magnesium sulfate, antihypertensive therapy, and supportive care resulted in clinical stabilization without recurrent seizures. Early recognition and comprehensive management are essential to reduce the risk of further complications.