Managing Postpartum Complications in the Emergency Department

Points and Pearls Excerpt

• 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.
• 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.