Postpartum Hypertension
Treat severe persistent hypertension (SBP ≥160, DBP ≥110) with labetalol or hydralazine - Derek Lubetkin
image by: Preeclampsia Foundation
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Postpartum hypertension
Gestational hypertension and preeclampsia (two common causes of persisting postpartum hypertension) usually resolve by 12 weeks. Beyond this period, clinicians should consider a secondary cause of hypertension, which can be found in up to 10% of cases, before establishing a diagnosis of essential chronic hypertension.
Although there are limited studies assessing neonatal effects of maternal antihypertensive treatment during breastfeeding, well-established understanding of pharmacokinetic principles has led to the acceptance of multiple antihypertensive drugs as safe for use. Diuretics and angiotensin II receptor blockers are not recommended.
Resources
Under Pressure – Postpartum Hypertensive Emergencies
In this 14-minute presentation from Rebellion in EM 2021, Dr. Jenny Beck-Esmay, MD discusses postpartum emergencies including hypertension, preeclampsia/eclampsia and HELLP syndrome.
A burst of light on postpartum seizure
Treat severe persistent hypertension (SBP ≥160, DBP ≥110) with labetalol or hydralazine.
Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period
When treatment for acute-onset, severe hypertension is needed and IV access has not yet been initiated, a 200-mg dose of labetalol can be administered orally if immediate release oral nifedipine is not available. This labetalol dose may be repeated in 30 minutes if appropriate improvement is not observed.
Focus on Delayed Postpartum Preeclampsia and Eclampsia
Hypertensive disorders including preeclampsia and eclampsia are one of the leading causes of maternal morbidity and mortality. While there has been an overall decrease in the frequency of eclampsia, the frequency of postpartum and delayed eclampsia has increased.
Management of hypertension in pregnancy
After delivery, hypertension typically resolves within 12 weeks for women with gestational hypertension or pre-eclampsia. If this does not occur, consideration should be given to investigation for primary or secondary hypertension. Regular monitoring of blood pressure postnatally should occur, with down titration of antihypertensive drugs when the systolic blood pressure drops below 120 mmHg. For women with chronic hypertension, the decision to return to their usual antihypertensive treatment will depend on its compatibility with breastfeeding, and their future pregnancy plans. It would be reasonable to transition them back to their usual treatment early, provided they remain aware of the importance of review before future pregnancies to ensure it will be safe to use.
Postpartum hypertension: When a new mom's blood pressure is too high
Maternal complications resulting from severe hypertension during or after pregnancy are largely preventable. However, severe hypertension, particularly in the postpartum period, often goes unrecognized and untreated because women are not receiving the tools, education, or empowerment they need to monitor and maintain their health after going home with their baby.
Postpartum management of hypertension and effect on readmission rates
Among the patients discharged with a prescription for antihypertensive medications, those discharged in a hypertensive state were almost 3 times more likely to be readmitted than their normotensive counterparts.
Postpartum Preeclampsia
Postpartum preeclampsia is a serious condition related to high blood pressure. It can happen to any woman who just had a baby. It has most of the same features of preeclampsia or other hypertensive disorders of pregnancy, without affecting the baby.
Postpartum Preeclampsia: A Rare Complication
Postpartum preeclampsia can result in severe long-term complications for a new mother. It is one of the most feared postpartum medical complications emergency physicians will encounter. Even more uncommon is the progression from seizures to intracranial hemorrhage. Early recognition of late onset eclampsia, defined as onset of seizures greater than 48 hours postpartum, is crucial in minimizing adverse outcomes.
Postpartum hypertension
Gestational hypertension and preeclampsia (two common causes of persisting postpartum hypertension) usually resolve by 12 weeks. Beyond this period, clinicians should consider a secondary cause of hypertension, which can be found in up to 10% of cases, before establishing a diagnosis of essential chronic hypertension. Initial investigations include serum creatinine, electrolytes and urinalysis.
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