Postpartum Preeclampsia Diagnosis and Management

• Postpartum preeclampsia is a condition that can affect women from the time after delivery and up to 6 weeks after.
• With postpartum preeclampsia, patients are now not seeing a health care provider regularly, delivery is not a solution, and access to care.
• When postpartum preeclampsia is not effectively managed and treated it can lead to seizures, strokes, organ damage, and even death.

Your patient has made it through the pregnancy, conquered labor, and had a successful delivery to a healthy newborn, and bleeding is normal.

Yay, we are in the clear, well not quite yet.

Postpartum preeclampsia is a condition that can affect women from the time after delivery and up to 6 weeks after. Many patients may have not even experienced any signs or symptoms to indicate postpartum preeclampsia, until after they deliver.

With little to no indications, it becomes crucial to continue to monitor, observe, and educate all patients throughout the postpartum phase. Unfortunately, the causes for this condition are unknown, but there is potential that this disease process initiates its development during pregnancy but does not show itself until after the fetus is delivered.

Dangers of Postpartum Preeclampsia

With postpartum pre-eclampsia, there can be multiple dangers associated with postpartum preeclampsia. With postpartum pre-eclampsia, patients are now not seeing a health care provider regularly, delivery is not a solution, and access to care.

Patients are no longer pregnant, so when they obtain care, they become viewed as an adult patient versus an obstetrical patient. Not to mention, the whole new life and routine changes of bringing home a newborn can create an uncontrolled overlooking of maternal symptoms or be downsized by maternal exhaustion or stress.

When postpartum preeclampsia is not effectively managed and treated it can lead to seizures, strokes, organ damage, and even death.

Postpartum Preeclampsia Signs and Symtpoms

Postpartum pre-eclampsia and pregnancy associated pre-eclampsia do have the same signs and symptoms.

Continuing to assess for the below symptoms after delivery through discharge, as well as educating patients and families to be alert for these when they go home. Educating on when to call the healthcare provider and when to go to the emergency room are important in obtaining prompt treatment of this condition.

• Epigastric Pain
• Nausea and Vomiting
• Facial and extremity edema
• Dyspnea
• Headaches
• Blurry vision
• Seeing spots
• Elevated blood pressure above 140/90

Postpartum Preeclampsia Diagnosis

Diagnosis can differ if the condition develops during the immediate postpartum period while the patient is still inpatient or after discharge, with a return visit to the clinic or emergency room. Blood pressure measurements will be taken anywhere from every 5-15 minutes to see trends or for evaluation medication effectiveness.

Gathering a full history intake of signs, symptoms, pregnancy, delivery, family, and medical history. Focused assessments on cardiac, respiratory, and neurological systems should be performed. Laboratory assessments should include a CBC, CMP, and a urinalysis or 24-hour urine collection to evaluate for protein. Prescence of protein in the urine and hypertension will require treatment.

Postpartum Preeclampsia Treatment

Patient may be readmitted to inpatient status or treated as an outpatient status depending on the severity of the condition.

Administration of antihypertensive medications while continuing to frequently monitor blood pressure to assess for effectiveness and continued trends should be performed. If the first line anti-hypertensive is not effective to stabilize blood pressure, moving to second- and third-line anti-hypertensives will be necessary. The three antihypertensive medications used are: labetalol, hydralazine, and nifedipine.

Depending on the severity of blood pressure and clinical indicators, antiseizure medication can be prescribed to maintain patient stability. If patients are inpatient, then transitioning patients to PO antihypertensives, home monitoring education, and setting up additional follow up appointments for continuation of disease management. Patients may even require referrals to specialists, depending on patient specific status and the scope of practice with providers in their area.

The Bottom Line

Postpartum preeclampsia is a condition in which both mothers and nurses should be aware.

Many mothers may miss signs and symptoms for a variety of reasons including they are now not seeing a health care provider regularly, delivery is not a solution, and access to care.

Patient education on postpartum preeclampsia signs and symptoms and treatment options can really make a difference in avoid adverse outcomes.

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