All postpartum women should be educated about the signs and symptoms of preeclampsia and severe hypertension.
Occasionally, severe FHR abnormalities or ominous patterns can be found in patients who are either unconscious after eclamptic convulsions, in shock from ruptured liver hematoma, or who have experienced severe abruptio placentae and possible coagulopathy. In such cases, emergency cesarean section performed due to fetal considerations may lead to a catastrophic outcome for both mother and infant. In eclamptic patients, fetal bradycardia and late decelerations are common findings during and immediately after a convulsion. These abnormalities are reversible following correction of maternal hypoxia and acidosis. These patients should be oriented to name, place, and time before being subjected to anesthesia and surgery.
Postpartum management
Hypertension or preeclampsia may first develop in the postpartum period or may worsen at this time. Thus, all postpartum women should be educated about the signs and symptoms of preeclampsia and severe hypertension. In addition, health-care providers and all personnel who answer patient phone calls should be educated about what information to report to physicians.10
It is important to remember that postpartum women—particularly those with chronic hypertension or with hypertension-preeclampsia in the current pregnancy—are at risk for HELLP syndrome, eclampsia, pulmonary edema, stroke, and thromboembolic disease. Women should be instructed to report any of the symptoms listed in TABLE 11.
In the immediate postpartum period, women with preeclampsia should have accurate intake and output of fluids. These women usually receive large amounts of fluids during labor as a result of prehydration prior to epidural anesthesia and IV administration of oxytocin or magnesium sulfate. They also receive fluids after delivery because of oxytocin and magnesium sulfate administration. As a result, some of these women may have abnormal renal function and capillary leakage, putting them at risk for pulmonary edema. These patients should be monitored closely for this complication.
In the late postpartum period (more than 48 hours after delivery), some women with hypertension or preeclampsia are at increased risk for complications such as severe preeclampsia, eclampsia, HELLP syndrome, congestive heart failure, and stroke.10,11 Because these women usually present to the emergency department, emergency room staff and physicians often are the first to evaluate them. It is vital that these health-care professionals are educated regarding prompt evaluation and recognition of signs and symptoms of preeclampsia in the postpartum period.
TABLE 11
Symptoms patients should report in the postpartum period
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Dr.Sibai reports no financial relationship with any companies whose products are mentioned in this article.