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Postpartum preeclampsia: emergency department presentation and management
Lynne M Yancey1, Elizabeth Withers, Katherine Bakes
1Division of Emergency Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
The Journal of Emergency Medicine
|September 26, 2008
Summary
Postpartum preeclampsia/eclampsia often occurs without prior diagnosis. Emergency physicians should recognize symptoms like headache and hypertension up to four weeks postpartum.
Area of Science:
- Obstetrics and Gynecology
- Emergency Medicine
- Maternal-Fetal Medicine
Background:
- Postpartum preeclampsia/eclampsia is defined as hypertension and proteinuria, with or without seizures, occurring up to four weeks after delivery.
- This condition requires careful diagnosis and management in the postpartum period.
Purpose of the Study:
- To describe the Emergency Department (ED) presentation, signs, symptoms, diagnostic findings, management, and outcomes of postpartum preeclampsia/eclampsia.
- To review the diagnosis and management of this condition based on institutional data.
Main Methods:
- A retrospective chart review of 22 cases identified via ICD-9 codes over an 8-year period at two urban teaching hospitals.
- Inclusion criteria focused on patients presenting to the ED in the postpartum period after hospital discharge.
- Data extraction included demographics, signs/symptoms, ancillary studies, and admission outcomes.
Main Results:
- Over half (55%) of patients lacked a prior diagnosis of preeclampsia.
- Common postpartum symptoms included headache, visual changes, hypertension, edema, proteinuria, elevated uric acid, and liver function tests.
- Most women presented with elevated diastolic blood pressure (>90 mm Hg), with a median presentation of 5 days postpartum.
Conclusions:
- Postpartum preeclampsia/eclampsia frequently presents without a history of pregnancy-related preeclampsia.
- Classic signs like elevated blood pressure, edema, and proteinuria may not all be present.
- Emergency physicians must be aware of postpartum preeclampsia/eclampsia symptoms, including headache, vision changes, hypertension, or seizure, up to four weeks postpartum.
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