“Possible Postpartum Hypertension” … Case Conclusion August 5, 2010
Posted by ebmedicine in Obstetric Emergencies.add a comment
The Diagnosis Is…
On repeat measurement of her blood pressure, your patient had a reading of 155/90 mm Hg. You prescribed prochlorperazine for her headache and nausea and IV saline, and you ordered a CBC, metabolic profile, uric acid level, coagulation panel, and urinalysis. The bedside urine dipstick result for protein was 1+. You consulted obstetrics and anesthesia. The obstetrician evaluated the patient and called your attention to her hyperreflexia. The patient also seemed lethargic, which you concluded may be due to the prochlorperazine but may also be due to preeclampsia. You and the obstetrician decided to begin magnesium sulfate with a bolus of 4 g over 15 minutes followed by an infusion of 2 g per hour. The anesthesiologist arrived and concluded that this was not a postdural puncture headache, and your patient was moved to the ICU. You found out the following week that she had done well, with no progression to eclampsia and rapid resolution of her symptoms, and that she was discharged home 2 days later.
Congratulations to Dr. Fondy, Dr. Hawkins, Dr. Kosasih, Dr. Vander Knapp, and Dr. Williams — this week’s winners of Emergency Medicine Practice’s “Postpartum Emergencies: Headache, Hypertension, Eclampsia, And Cardiomyopathy”! For an evidence-based review of most commonly encountered postpartum emergencies (headache, LPPE, hypertension, and cardiomyopathy), read the August 2010 issue of Emergency Medicine Practice, “Postpartum Emergencies: Headache, Hypertension, Eclampsia, And Cardiomyopathy.”
Possible Postpartum Hypertension… July 15, 2010
Posted by ebmedicine in Obstetric Emergencies.30 comments
It is Friday evening in the ED, and your first patient is a 42-year-old woman whose chief complaint is headache that began at around 9 AM. She is a gravida 3, para 2-0-1-2 with a history of a previous C-section but no other significant past medical history. On further examination, you establish that 6 days earlier she had a C-section delivery with spinal anesthesia for a 36-week pregnancy because of premature rupture of membranes. Otherwise, this pregnancy and previous pregnancies were uneventful, and mother and baby went home on post-op day 4. Her headache has been severe and continuous for the past 6 hours, unrelieved with ibuprofen taken 3 hours earlier. Pain is now 10/10, and she had 2 episodes of vomiting shortly after her arrival in the ED. There are no visual symptoms, fever, chills, or focal weakness. Her triage blood pressure is 170/85. The ED is busy, and your focus is on throughput, but this patient has a concerning differential diagnosis that includes postdural puncture headache, subarachnoid hemorrhage, and venous sinus thrombosis. You are also concerned about the blood pressure, and though it may be elevated because of her pain, you wonder if you should consider postpartum hypertension.
What’s Your Diagnosis?
(Enter to win the latest issue of Emergency Medicine Practice, including CME, by submitting your answer in the comments box. The deadline to enter is August 6th.)
