Postpartum emergencies: Difference between revisions

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

Revision as of 16:44, 8 April 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!
  • 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



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