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15thWorldCongressinFetalMedicine Seizuresinearlypostpartumperiod:adiagnosticchallenge MarinhoM,SoaresC,TorraoA,FerreiraC,BarbosaM CentroHospitalarVilaNovadeGaia/Espinho,VilaNovadeGaia,Portugal Objective Toreportacaseofapreviouslyhealthywomanwithanuneventfulpregnancythatpresentedseizureepisodes3daysafterdelivery. Methods Acasereportofinauguralseizuresinthepostpartumperiodwithitschallengedifferentialdiagnosisdiscussionandmanagement. Results G2P0previouslyhealthywomanwithanuneventfulpregnancyfollowedatourinstitutionbecauseofmaternalage(38yearsold).Shereceivedalumbarepiduralduringlabor and delivered a healthy baby boy via cesarean section after nonreassuring fetal status. At the 3rd day after delivery she started paroxysmal episodes of involuntary contraction of the last three fingers of left hand and afterwards of left superior limb, lasting seconds with spontaneous cessation and then a stronger seizure with loss of consciousness.Afterthisepisode,therewasnoalteredstateofconsciousness.Thepatientdidnotpresentedhypertension,headache,nausea,visualdisturbancesorfever. She had 3 more partial seizure episodes after the inaugural one. Laboratory tests showed no thrombocytopenia, liver or renal impairment or other relevant alteration. Magnesium sulphate was administrated until eclampsia was safely excluded. Lumbar puncture, head CT scan, EEC and ECG did not reveal any abnormality as well as cerebralMRIandmagneticresonanceangiography.Afterbeingstudiedthesepartial(focal)seizureswereinterpretedasinauguralepilepsy. Conclusion Seizuresinthepostpartumperiodposesaclinicalchallengesincethereareseveralcauses.Evaluationandmanagementshouldbeperformedinastepwisefashionandmay require a multidisciplinary approach with other specialties such as neurology. Differential diagnosis includes eclampsia, epilepsy, cerebrovascular accidents (ex. cerebral venousthrombosis),infectiousencephalitis,braintumors,liver/renalfailure,metabolicderangement,thrombophilia,posteriorreversibleencephalopathysyndrome,thrombotic thrombocytopenicpurpura,etc.Theremayalsobeconsiderableoverlapinthepresentationoftheseconditions,makingdiagnosisandtreatmentdifficult.Thedistinctionof etiology is critical, because therapy must be directed at the underlying disorder in order to achieve seizure control. Inaugural epilepsy in the postpartum period is an uncommonexclusiondiagnosisthatmustbeconsidered.
