2024 Volume 60 Issue 1 Pages 182-186
A 31-year-old pregnant woman, gravida 1 para 0, was treated with levetiracetam for epilepsy. Her last seizure was 8 years ago.
At the first day of the 38th week of gestation, she had induced delivery due to preeclampsia. She delivered a baby weighed 2,920g by vacuum extraction because of NRFS.
The postpartum hemorrhage was massive, she went into hemorrhagic shock. She got massive blood transfusion, intubated and an aortic occlusion balloon catheter. Contrast-enhanced CT showed no bleeding points outside the uterus, and blood tests revealed an obstetric DIC score of 19. We diagnosed that she had uterine-type amniotic fluid embolism and decided to do hysterectomy. Her status was improved after the operation. The total blood loss was 4,941g.
On the second postpartum day, she began to have epileptic seizures, which were difficult to control despite resumption of antiepileptic drugs. She got a tracheotomy for long term ventilation. We diagnosed that she had a status epilepticus with MRI, electroencephalographic examination, and blood tests.
To the best of our knowledge, this is the first case of a status epilepticus after postpartum hemorrhage shock in a pregnant woman with epilepsy. The causes of the status epilepticus were considered the decreased blood concentration of antiepileptic drugs and the lowered epileptic threshold by the sever invasion.
We should note that a pregnant woman with epilepsy could be a status epilepticus after postpartum hemorrhagic shock.
