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