Postpartum emergencies: Difference between revisions
No edit summary |
No edit summary |
||
| Line 76: | Line 76: | ||
=== Treatment === | === Treatment === | ||
*Same as for eclampsia | *Same as for eclampsia | ||
=== Complications === | === Complications === | ||
| Line 86: | Line 85: | ||
***If unstable consider embolization vs surgery | ***If unstable consider embolization vs surgery | ||
== Peripartum Cardiomyopathy == | |||
=== Background === | |||
*Presentation similar to typical CHF | *Presentation similar to typical CHF | ||
Development of heart failure in | === Diagnosis === | ||
*Development of heart failure in ast month of pregnancy or w/in 5 months of delivery | |||
*Absence of an identifiable cause for the heart failure | |||
*Absence of recognizable heart disease prior to the last month of | |||
pregnancy | pregnancy | ||
*Left ventricular systolic dysfunction | |||
=== DDX === | |||
*Respiratory tract infection | *Respiratory tract infection | ||
*PE | *PE | ||
| Line 115: | Line 103: | ||
*Postpartum fluid overload | *Postpartum fluid overload | ||
== | === Treatment === | ||
*Treat like usual heart failure | |||
== | == Source == | ||
EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies | |||
<br/>[[Category:OBGYN]] <br/><br/> | <br/>[[Category:OBGYN]] <br/><br/> | ||
Revision as of 05:08, 27 March 2011
Late Postpartum Eclampsia
Background
- 15% of all cases of eclampsia
- 40% have no history of HTN or proteinuria
Diagnosis
Hypertension
- Sys >140 or dia > 90 AND
- Proteinuria > 0.3g in 24-hr
- Urine dipstick of 1+ is suggestive
- Lack of proteinuria is not rule-out!
- Urine dipstick of 1+ is suggestive
- History
- Headache
- Confusion
- Visual disturbances
- Nausea/vomiting
- Epigastric pain
- Physical
- AMS
- Focal neurologic deficits
- Visual symptoms
- Hyperreflexia
- RUQ or diffuse abdominal tenderness
- Peripheral edema
Work-Up
- UA
Treatment
- Control blood pressure
- Lower to Sys 130-150, dia 80-100
- Labetalol
- Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
- Option 2: Initial 20mg; then IV infusion of 1-2mg/min
- Hydralazine
- 5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
- Prevent eclampsia
- Magnesium: Load 4-6g IV over 15min followed by 2-3g per hr
- Observe for loss of reflexes, respiratory depression
- If seizures recur:
- Consider other anticonvulsant drugs
- Consider alternative diagnosis
- Magnesium: Load 4-6g IV over 15min followed by 2-3g per hr
HELLP Syndrome
Background
- Presents in postpartum period in 30%
- Usually within 48 hr of delivery
- 80% had no evidence of preeclampsia before delivery
Diagnosis
- Signs/Symptoms
- RUQ or epigastric pain - 40-90%
- Proteinuria - 86-100%
- Hypertension - 82-88%
- Labs
- CBC w/ diff
- Microangiopathic hemolytic anemia
- Plt count <100
- LFT
- AST > 70, bilirubin > 1.2
- LDH > 600
- CBC w/ diff
Work-Up
- CBC w/ diff
- Chemistry
- LFT
- LDH
- PT/PTT/INR
- FDP, fibrinogen, D-Dimer
- CT to evaluate for hepatic hematoma (if needed)
Treatment
- Same as for eclampsia
Complications
- DIC
- Acute renal failure
- Subcapsular liver hematoma
- Abdominal distention
- Mainttain adequate intravascular volume
- If unstable consider embolization vs surgery
Peripartum Cardiomyopathy
Background
- Presentation similar to typical CHF
Diagnosis
- Development of heart failure in ast month of pregnancy or w/in 5 months of delivery
- Absence of an identifiable cause for the heart failure
- Absence of recognizable heart disease prior to the last month of
pregnancy
- Left ventricular systolic dysfunction
DDX
- Respiratory tract infection
- PE
- MI
- Postpartum fluid overload
Treatment
- Treat like usual heart failure
Source
EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies