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. This issue 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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Following are the most informative references cited in this paper, as determined by the authors.
7. * Goldszmidt E, Kern R, Chaput A, et al. The incidence and etiology of postpartum headaches: a prospective cohort study. Can J Anaesth. 2005;52(9):971-977. (Prospective cohort study; 985 patients) DOI: 10.1007/BF03022061
11. * ACOG Committee Opinion no. 361: breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007;109(2, Part 1):479. (Practice bulletin) DOI: 10.1097/00006250-200702000-00064
13. * Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-e260. (Practice guidelines) DOI: 10.1097/AOG.0000000000003891
30. * American College of Obstetricians and Gynecologists’ Presidential Task Force on Pregnancy and Heart Disease and Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 212: pregnancy and heart disease. Obstet Gynecol. 2019;133(5):e320-e356. (Practice bulletin) DOI: 10.1097/AOG.0000000000003243
44. * Xu W, Gao L, Li T, et al. The performance of CT versus MRI in the differential diagnosis of cerebral venous thrombosis. Thromb Haemost. 2018;118(06):1067-1077. (Meta-analysis; 4595 patients) DOI: 10.1055/s-0038-1642636
51. * WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10084):2105-2116. (Randomized double-blind placebo-controlled trial; 20,021 patients) DOI: 10.1016/S0140-6736(17)30638-4
53. Swaminathan A. Post-partum hemorrhage. 2018. Accessed February 10, 2022. (Review blog)
59. * Misra UK, Kalita J, Chandra S, et al. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. Eur J Neurol. 2012;19(7):1030-1036. (Randomized controlled trial; 66 patients) DOI: 10.1111/j.1468-1331.2012.03690.x
72. Trimethoprim-sulfamethoxazole. Drugs and Lactation Database (LactMed). Accessed February 10, 2022. (Review article)
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Keywords: postpartum, hemorrhage, bleeding, pre-eclampsia, eclampsia, headache, peripartum cardiomyopathy, cerebral venous thrombosis, hypertension, mastitis, endometritis, HELLP
Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the March 2022 issue of Emergency Medicine Practice: Managing Postpartum Complications in the Emergency Department
Nicole Yuzuk, DO; Joseph Bove, DO; Riddhi Desai, DO
Jennifer Beck-Esmay, MD, FACEP; Elizabeth Leenellett, MD, FACEP
March 1, 2022
March 31, 2025
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credits
Date of Original Release: March 1, 2022. Date of most recent review: February 10, 2022. Termination date: March 1, 2025.
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