seizures after delivery in mom with PIH

BETSRN · Apr 7, 2005

How common is it that a mom with pre-eclampsia/PIH has seizures after delivery? This is more of a question out of curiosity (my daughter is now 7), but when she was born, I had seizures from my eclampsia. The doc even spoke of putting me on phenobarb. OB/GYN made neuro come check me out before discharge.
Another thing, my feet were so swollen that it was hard to keep my balance when I walked . I got lasix for about 2-3 days after delivery. THAT was fun after a C-section... having to get up to pee every hour! (and no foley)
Also, if you have PIH with your first baby, are you at higher risk for developing it with your second baby? Although I would really like to have another child, I am OLD now (and I have a few years of school in front of me, so I would be even OLDER when I could plan on having another child). I had many bad experiences with that delivery (they started my induction on Friday, but I did not deliver until Sunday afternoon), so I think I am just scared now.
lifeLONGstudent

I have never seen a seizure after delivery. We often do NOT even continue the mag after delivery, but we are a very laid back place.

We see swollen feet (terrible swelling) after delivery (often just from IV's) and I have NEVER seen Lasix given either. Drinking lots of water usually resolves that. You don't ahve to have pre-eclampsia to have swelling.

The more IV fluid a mom gets the more she will swell. In general places give way too much IV fluid. You can have a baby and never have an IV at all, you know.

There is such a thing as overdoing it in all areas of medicine. I think some places do way too mcuh intervention and make people thick they are sicker than they are.

Jolie, BSN · Apr 7, 2005

In my experience, the moms who seize after delivery are among the sickest of the sick. Remember that the most effective treatment for PIH is delivery of the baby. Those moms who remain hypertensive and at risk for seizures even AFTER delivery have not responded adequately to the most effective treatment available.

While it is not a pleasant medication (and I speak from experience receiving the drug), MgSO4, along with anti-hypertensives can be very effective in preventing seizures, and our docs have not hesitated to use it post partum.

No one can say for sure whether or not you will experience PIH with a future pregnancy. My best advice is to seek out a consultation with your OB/GYN or a perinatologist prior to attempting another pregnancy. Learn what your risks are, and how they can be minimized. Learn what treatment options exist should you develop PIH again.

This is just anecdotal information based on my experience caring for patients, but the 3 sickest PIH/eclampsia patients I can recall all went on to have healthy subsequent pregnancies.

SmilingBluEyes · Apr 7, 2005

Prior history is one of the strongest things we take under consideration for future risk of complications. I would strongly urge you to discuss this at length with your primary physician and weigh the risks in YOUR case carefully. It's not "terribly common" to see a mom seize after delivery, but it does happen, and yes I have seen it. It must have been so frightening for you. My best wishes to you in any future decisions you make regarding having more children and your health. It must be tough to worry like you are.

babynursewannab · Apr 7, 2005

I did my preceptorship inservice on Mag pts. The majority of those who end up seizing do it post-partum and it can happen MONTHS after delivery. My best friend seized 7 months post partum and it was diagnosed eclampsia. The research freaked me out (having had three kids). Who the heck gets watched closely for months after delivery???? Nobody!!!

Be sure to watch for a sudden 10mm Hg change up or down in Mom after delivery. It is a pretty consistant sign of pending issues.

SmilingBluEyes · Apr 7, 2005

also watch for reflex excitibility. this is as big an indicator as any NUMBER is as to assess the risk someone will seize, either ante or post-partum.

babyktchr, BSN, RN · Apr 8, 2005

I have never seen a seizure after delivery. We often do NOT even continue the mag after delivery, but we are a very laid back place.
We see swollen feet (terrible swelling) after delivery (often just from IV's) and I have NEVER seen Lasix given either. Drinking lots of water usually resolves that. You don't ahve to have pre-eclampsia to have swelling.
The more IV fluid a mom gets the more she will swell. In general places give way too much IV fluid. You can have a baby and never have an IV at all, you know.
There is such a thing as overdoing it in all areas of medicine. I think some places do way too mcuh intervention and make people thick they are sicker than they are.[/quote
I know it is our hospital policy to continue mag for 24 hours after delivery..and of course longer if necessary. I am pretty sure that is a standard of care. I am going to have to look up ACOG and make sure, but I am thinking it is. Anyone else know???

palesarah · Apr 9, 2005

I know it is our hospital policy to continue mag for 24 hours after delivery..and of course longer if necessary. I am pretty sure that is a standard of care. I am going to have to look up ACOG and make sure, but I am thinking it is. Anyone else know

I don't know if that's the national SOC, but that is also what we do.

Actually, some pts will ONLY get mag for 24hours after delivery (none during labor).

The only eclamptic seizure I have seen was I think on the second or third day postpartum, in a pt who had been on mag, who had gone to the ICU after her section... she came back to us the next day or so, and seized about 12 hours after the mag had been dc'd. Poor girl, she had a long stay.

nurse_wannabe · Apr 9, 2005

I'm just wondering if PIH is grounds for a C/S, and if that would have a better outcome and less chance of PIH complications than a lady partsl delivery? If so, why would the OBGYN *not* schedule a c/s for a PIH mom?

PegRNBSN · Apr 9, 2005

I'm just wondering if PIH is grounds for a C/S, and if that would have a better outcome and less chance of PIH complications than a lady partsl delivery? If so, why would the OBGYN *not* schedule a c/s for a PIH mom?

Mode of delivery with preeclampsia is dependent upon the condition of the mother. Often it is a race against the disease. The only way to cure the mom is through delivery. The OB must decide if he can try to induce the mom (does he have enough time?) If not then a c/s is the best option. The other factor is whether there is HELLP involved. If low platelets are an issue then lady partsl delivery is preferred if enough time to deliver

lauriesalRNC · Apr 10, 2005

Yes you can seize after delivery. Actually I've seen moms get PIH AFTER delivering. Remember, not all the hormones of pregnancy are gone. We often keep moms on mag for 24 hrs after delivery when they are being treated for PIH.

Yes you are at higher risk of getting PIH next time !

jennobrn01 · Apr 10, 2005

I have only been in OB for four years and have seen a pt. 5 or 6 days post partum seize. She was feeling "bad", came to the ED, and while being registered seized right in the waiting area.

Adequately treating pt.'s with PIH according to standard is not "over doing" it.

Jenn