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| <h2>Late Postpartum Pre/E<a href="http://www.example.com">link title</a>clampsia</h2>
| | ==Types== |
| <h3> Background </h3>
| | {{Postpartum emergencies DDX}} |
| <ul><li>15% of all cases of eclampsia
| | |
| </li><li>40% have no history of HTN or proteinuria
| | ==See Also== |
| </li></ul>
| | *[[Emergent delivery]] |
| <h3> Diagnosis </h3>
| | |
| <p>Hypertension
| | [[Category:OBGYN]] |
| </p>
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| <ul><li>Sys >140 or dia > 90 AND
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| </li><li> Proteinuria > 0.3g in 24-hr
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| <ul><li>Urine dipstick of 1+ is suggestive
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| <ul><li>Lack of proteinuria is not rule-out!
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| </li></ul>
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| </li></ul>
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| </li></ul>
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| <ul><li>History
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| <ul><li>Headache
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| </li><li>Confusion
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| </li><li>Visual disturbances
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| </li><li>Nausea/vomiting
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| </li><li>Epigastric pain
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| </li></ul>
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| </li></ul>
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| <ul><li>Physical
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| <ul><li>AMS
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| </li><li>Focal neurologic deficits
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| </li><li>Visual symptoms
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| </li><li>Hyperreflexia
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| </li><li>RUQ or diffuse abdominal tenderness
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| </li><li>Peripheral edema
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| </li></ul>
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| </li></ul>
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| <h3> Work-Up </h3>
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| <ul><li>UA
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| </li></ul>
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| <h3> Treatment </h3>
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| <ul><li>Control blood pressure
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| <ul><li>Lower to Sys 130-150, dia 80-100
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| </li></ul>
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| </li><li>Labetalol
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| <ul><li>Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
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| </li><li>Option 2: Initial 20mg; then IV infusion of 1-2mg/min
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| </li></ul>
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| </li><li>Hydralazine
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| <ul><li> 5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
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| </li></ul>
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| </li><li>Prevent eclampsia
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| <ul><li> Magnesium: Load 4-6g IV over 15min followed by 2-3g per hr
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| <ul><li>Observe for loss of reflexes, respiratory depression
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| </li></ul>
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| </li><li>If seizures recur:
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| <ul><li>Consider other anticonvulsant drugs
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| </li><li>Consider alternative diagnosis
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| </li></ul>
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| </li></ul>
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| </li></ul>
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| <h2> HELLP Syndrome </h2>
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| <h3> Background </h3>
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| <ul><li>Presents in postpartum period in 30%
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| <ul><li>Usually within 48 hr of delivery
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| </li></ul>
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| </li><li>80% had no evidence of preeclampsia before delivery
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| </li></ul>
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| <h3> Diagnosis </h3>
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| <ul><li>Signs/Symptoms
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| <ul><li>RUQ or epigastric pain - 40-90%
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| </li><li>Proteinuria - 86-100%
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| </li><li>Hypertension - 82-88%
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| </li></ul>
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| </li><li>Labs
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| <ul><li>CBC w/ diff
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| <ul><li>Microangiopathic hemolytic anemia
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| </li><li>Plt count <100
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| </li></ul>
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| </li><li>LFT
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| <ul><li>AST > 70, bilirubin > 1.2
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| </li></ul>
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| </li><li>LDH > 600
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| </li></ul>
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| </li></ul>
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| <h3> Work-Up </h3>
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| <ul><li>CBC w/ diff
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| </li><li>Chemistry
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| </li><li>LFT
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| </li><li>LDH
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| </li><li>PT/PTT/INR
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| </li><li>FDP, fibrinogen, D-Dimer
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| </li><li>CT to evaluate for hepatic hematoma (if needed)
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| </li></ul>
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| <h3> Treatment </h3>
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| <ul><li>Same as for eclampsia
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| </li></ul>
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| <h3> Complications </h3>
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| <ul><li> DIC
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| </li><li> Acute renal failure
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| </li><li> Subcapsular liver hematoma
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| <ul><li>Abdominal distention
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| </li><li>Mainttain adequate intravascular volume
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| <ul><li>If unstable consider embolization vs surgery
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| </li></ul>
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| </li></ul>
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| </li></ul>
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| <h2> Peripartum Cardiomyopathy </h2>
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| <h3> Background </h3>
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| <ul><li>Presentation similar to typical CHF
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| </li></ul>
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| <h3> Diagnosis </h3>
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| <ul><li>Development of heart failure in ast month of pregnancy or w/in 5 months of delivery
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| </li><li>Absence of an identifiable cause for the heart failure
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| </li><li>Absence of recognizable heart disease prior to the last month of
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| </li></ul>
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| <p>pregnancy
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| </p>
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| <ul><li>Left ventricular systolic dysfunction
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| </li></ul>
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| <h3> DDX </h3>
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| <ul><li>Respiratory tract infection
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| </li><li>PE
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| </li><li>MI
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| </li><li>Postpartum fluid overload
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| </li></ul>
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| <h3> Treatment </h3>
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| <ul><li>Treat like usual heart failure
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| </li></ul>
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| <h2> Source </h2>
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| <p>EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
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| </p><p><br /> <br /><br />
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| </p><span _fcknotitle="true" class="fck_mw_category" sort="OB/GYN">OB/GYN</span> <br/>
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