A case of Pregnancy Complicated by Epilepsy with status epilepticus after Hemorrhagic Shock due to Uterine-Type Amniotic Fluid Embolism

<p> A 31-year-old pregnant woman, gravida 1 para 0, was treated with levetiracetam for epilepsy. Her last seizure was 8 years ago.</p><p> 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.</p><p> 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.</p><p> 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.</p><p> 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.</p><p> We should note that a pregnant woman with epilepsy could be a status epilepticus after postpartum hemorrhagic shock.</p>