Postpartum Preecclampsia

Key Points:

--Postpartum preeclampsia = HTN and proteinuria after delivery

--can occur up to 4 weeks after delivery (median of 5 days in this study)

--33-69% of patient have no evidence of preeclampsia in the ante/peripartum period

--HPI: most common complaints (n=22):

• headache (82%, 18/22)
• visual changes (31 %)
• elevated BP at home (23%)
• nausea (18%)
• abdominal pain (14%)
• vomiting (14%)
• edema (9%)
• neck pain (9%)

--PHYSICAL EXAM & LABS: notable findings, some not as 'classic' as you think (n=22 unless indicated)

• elevated SBP (95%)
• elevated DBP (77%)
• hyperreflexia (47%, 10/21)
• edema (84%, 16/19)
• proteinuria (64%)
• elevated LFTs (41%)
• hyperuricemia (54%)

--TREATMENT:

• BP control (e.g. hydralazine, labetolol)
• magnesium, benzodiazepines if seizures

10-SECOND TAKEAWAY:
--Postpartum preecclampsia (classically) = HTN, proteinuria, <4wks postpartum
--Symptoms: high BP, HA, vision changes, nausea/vomiting, swelling
--Good to check (but all don't have to be abnormal): BP, reflexes, urine (proteinuria), LFTs, uric acid
--Treatment Toolbox: can't deliver postpartum, so BP control and magnesium/benzos if ecclamptic

Reference(s): Yancey et al. Postpartum Preeclampsia: Emergency Department Presentation and Management. JEmergMed 2008.

Submitted by T. Boyd.