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

Revision as of 02:44, 7 April 2011

Late Postpartum Pre/E<a href="http://www.example.com">link title</a>clampsia

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!
  • 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

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

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




OB/GYN

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