Key Points
- Preeclampsia can occur postpartum; seizures (eclampsia) may present de novo after delivery.
- Treat severe hypertension promptly and give magnesium sulfate for seizure prophylaxis/treatment.
- Evaluate for organ involvement (HELLP, renal, pulmonary edema) and manage complications.
Algorithm
- Recognize new-onset hypertension with end-organ signs postpartum; labs and urine protein.
- Administer magnesium sulfate; control BP (labetalol, hydralazine, or nifedipine).
- Admit for monitoring; evaluate for secondary causes if atypical.
Clinical Synopsis & Reasoning
For Postpartum Hypertension Recognition Treatment, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as BP/Urine protein (Diagnosis), CBC/CMP/Platelets (Organ involvement), CXR (if dyspnea) (Pulmonary edema). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include Magnesium sulfate, Labetalol/Hydralazine/Nifedipine. Use validated frameworks (e.g., Acute Antihypertensives) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Management Notes
Beware postpartum pulmonary edema. Educate on red‑flag symptoms (headache, vision changes, dyspnea).
Epidemiology / Risk Factors
- Prior preeclampsia, chronic HTN, multiple gestation, obesity
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| BP/Urine protein | Diagnosis | Elevated BP; proteinuria | — |
| CBC/CMP/Platelets | Organ involvement | Thrombocytopenia, ↑AST/ALT, ↑Cr | — |
| CXR (if dyspnea) | Pulmonary edema | Interstitial edema | — |
Acute Antihypertensives
| Drug | Dose |
|---|---|
| IV labetalol | 20 mg → 40 mg → 80 mg q10 min (max 220 mg) |
| IV hydralazine | 5–10 mg q20 min (max ~20–30 mg) |
| Oral nifedipine IR | 10 mg → 20 mg (repeat in 20 min) |
| Maintenance | Oral labetalol, nifedipine XL |
| Magnesium sulfate | 4 g load then 1–2 g/h infusion |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Acetaminophen | Analgesic/antipyretic | Hours | Symptom control as appropriate | Hepatotoxicity (overdose) |
| Ondansetron | 5-HT3 antagonism | Minutes | Antiemesis if needed | QT prolongation |
Prognosis / Complications
- Most improve postpartum; risk of recurrence and long-term CV disease
Patient Education / Counseling
- Warning signs (headache, vision changes, SOB); BP monitoring; contraception and future pregnancy planning
References
- ACOG Preeclampsia/PP HTN — Link