Postpartum patients may present to the emergency department with complaints ranging from minor issues, requiring only patient education and reassurance, to severe, life-threatening complications that require prompt diagnosis and multidisciplinary consultation and management. At times, vague presentations or overlapping conditions can make it difficult for the emergency clinician to recognize an emergent condition and initiate proper treatment.
Our recent issue Managing Postpartum Complications in the Emergency Department reviews the major common emergencies that present in postpartum patients, by chief complaint, including hemorrhage, infection, pre-eclampsia, eclampsia, headache, and cardiopulmonary conditions, and reviews the most recent evidence and guidelines.
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Here are a few key points:
- Postpartum patients can present, without prior history, with new-onset high blood pressure, pre-eclampsia, or HELLP syndrome up to 6 weeks after delivery. The diagnostic criteria for postpartum pre-eclampsia are noted in Table 1 in the issue.
- Blood pressure >160 mm Hg systolic or >110 diastolic is considered severe; recheck in 15 minutes. If it remains elevated, antihypertensive therapy should be initiated; first-line therapy is beta blockers.
- For eclamptic patients who are seizing, therapy includes a magnesium sulfate loading dose of 4-6 grams IV, followed by a maintenance dose of 1-2 grams/hr. Patients experiencing recurrent seizures may need additional doses or an infusion.
Last Updated on March 21, 2022