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Late postpartum preeclampsia induced acute pulmonary edema, a rare presentation of a common disease: A case report

João Rua, Joana Costa, José Leite, Ricardo Marques, Joana Queiró, Jorge Fortuna, Adriano Rodrigues
  • João Rua
    Internal Medicine Department B, General Hospital, University of Coimbra, Coimbra, Portugal | Joaomfrua@gmail.com
  • Joana Costa
    Internal Medicine Department B, General Hospital, University of Coimbra, Coimbra, Portugal
  • José Leite
    Internal Medicine Department B, General Hospital, University of Coimbra, Coimbra, Portugal
  • Ricardo Marques
    Internal Medicine Department B, General Hospital, University of Coimbra, Coimbra, Portugal
  • Joana Queiró
    Medical Emergency Unit, S. José Hospital, Central Lisboa Hospital Centre, Lisboa, Portugal
  • Jorge Fortuna
    Internal Medicine Department B, General Hospital, University of Coimbra, Coimbra, Portugal
  • Adriano Rodrigues
    Internal Medicine Department B, General Hospital, University of Coimbra, Coimbra, Portugal

Abstract

Preeclampsia is a disorder of widespread vascular endothelial dysfunction and vasospasm associated with pregnancy. It can occur from the 20th week to 4-6 weeks postpartum, resulting in hypertension, proteinuria and, in severe cases, end-organ damage and death. A 31-year-old puerpera enters the emergency room with complaints of dyspnea and leg edema, two weeks after the delivery. She was polipneic and hypertensive, had vascular congestion on thorax x-ray, elevated d-dimers and NT-proBNP. Meanwhile pulmonary embolism was suspected, she developed an acute pulmonary edema. Exams excluded embolism and cardiac abnormalities. New onset proteinuria allowed to diagnose a severe postpartum preeclampsia. About 5.7% of preeclampsia occurs in the postpartum but this is sometimes neglected. As progression to eclampsia isn’t influenced by control of hypertension or severe symptoms and seizure complications are a major cause of morbimortality, its recognition and institution of prophylaxis with magnesium sulphate is crucial.

Keywords

Postpartum preeclampsia; Severe preeclampsia; Pulmonary edema.

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Submitted: 2017-12-18 02:41:23
Published: 2018-05-28 15:43:19
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Copyright (c) 2018 João Rua, Joana Costa, José Leite, Ricardo Marques, Joana Queiró, Jorge Fortuna, Adriano Rodrigues

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