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.