Postpartum emergencies: Difference between revisions
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== HELLP Syndrome == | == HELLP Syndrome == | ||
=== Background === | === Background === | ||
*Presents in postpartum period in 30% | *Presents in postpartum period in 30% | ||
**Usually within 48 hr of delivery | **Usually presents within 48 hr of delivery | ||
*80% had no evidence of preeclampsia before delivery | *80% had no evidence of preeclampsia before delivery | ||
=== Diagnosis === | === Diagnosis === | ||
*Signs/Symptoms | *Signs/Symptoms | ||
**RUQ or epigastric pain - 40-90% | **RUQ or epigastric pain - 40-90% | ||
| Line 73: | Line 70: | ||
=== Work-Up === | === Work-Up === | ||
*CBC | |||
*CBC | |||
*Chemistry | *Chemistry | ||
*LFT | *LFT | ||
| Line 83: | Line 79: | ||
=== Treatment === | === Treatment === | ||
*Same as for eclampsia | *Same as for eclampsia | ||
=== Complications === | === Complications === | ||
*DIC | *DIC | ||
*Acute renal failure | *Acute renal failure | ||
Revision as of 07:30, 1 August 2011
Late Postpartum Pre/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 presents 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
- 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