Transient osteoporosis of pregnancy (TOP) is a rare and often misdiagnosed disease during pregnancy. The postpartum fatigue or stress fracture is a recognized cause of pain, the diagnosis of postpartum osteoporosis (PPO) should be considered in the differential diagnosis of disabling lumbalgia occurring either during pregnancy (especially in the third trimester) or immediately after delivery. We report here the case of a 31-year-old patient, primiparous with no particular history, who presented disabling radiating pubic pain on the fourth day of postpartum after her caesarean section, that pelvic MRI had shown a fracture of the left sacral fin, associated with osteopenia of the hip. Her phosphocalcic assessment had objectified a vitamin D deficiency.
Thrombocytopenia occurs in about 10% of pregnant women. This could be due to a normal variant of pregnancy (gestational thrombocytopenia), a pregnancy-specific condition (preeclampsia and HELLP syndrome) or a condition exacerbated by pregnancy (ITP, vasculitis, PTT). The prognosis and treatment vary enormously, based on the underlying cause. Gestational thrombocytopenia (accidental thrombocytopenia of pregnancy) is a mild, asymptomatic thrombocytopenia that usually occurs late in pregnancy. There is no association with fetal thrombocytopenia, and maternal thrombocytopenia disappears spontaneously after delivery.
The primum movens of pre-eclampsia is a systemic maternal endothelial dysfunction. Choroidal and retinal vessels are rarely affected or rarely explored, and their involvement is usually reversible in pre-eclampsia if the diagnosis is made in time to establish adequate surveillance and treatment for each situation. The underlying lesions to ocular disorders are retinal serous detachment (RSD), optic neuropathy and finally the most serious involvement is cortical blindness. The pathophysiological hypothesis is clearly proven by the various complementary examinations such as fundus examination, OCT (Optic Coherence Tomography), and fluorescein angiography. Clinically, there appears to be a parallelism between the clinical importance of edema and that of RSD.
We report the case of a patient who presented, during a severe pre-eclampsia (in an edematous form) on twin pregnancy, a favorable postpartum DSR with suspicion of optic neuropathy. A follow-up by internists was recommended.
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