Post-Partum Preeclampsia in ER

Today’s Morning Report is presented by Dr. Aldokhi!

Post-Partum Preeclampsia

30 year old female referred from GYN clinic one week post partum with BP 150/98 for Preeclampsia work up

Definitions

– Preeclampsia: HTN with proteinuria or end organ damage

– Eclampsia : Preeclampsia with seizure

– HELLP: Hemolysis, Elevated Liver enzymes, Low Platelets

– 5 % of preeclampsia is postpartum

S & S

High BP, Edema, headache, epigastric pain, N/V, AMS, blurry vision

Pregnant >20 wks or post-partum <6 weeks

BP 140/90 + proteinuria (300 mg /day or Pr/Cr ration of >0.3 mg/dl)

BP 140/90 + end organ damage (proteinuria not present)

Severity

– BP 160/110

– Plt <100,000

– LFT (AST, ALT >X2)

– Cr >1.1 or double the baseline

– Pulmonary edema

– Visual problem

– ? severe headache

What labs to send?

CBC ( hemolytic anemia, Plt count, peripheral smear )

LDH (marker of hemolysis and to less extend liver injury)

Coag (not useful)

CMP (Bili, Cr, LFT)

UA (proteinuria)

GYN usually ask for :

– Uric Acid (association with severity , may predict preeclampsia?)

– FDP , fibrinogen (marker of DIC)

– GYN consult

– Give Mg if severe preeclampsia

– Consider antihypertensive if BP >150/100

– Antihypertensive agents generally acceptable for use in breastfeeding include the following: nifedipine XL, labetalol, methyldopa, captopril, and enalapril.

References :

American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013.
Magee LA, Pels A, Helewa M, et al. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014; 36:416.