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When you see elevated blood pressure in a pregnant patient, the alarm bells go off. But what about post partum? Is there a problem with elevated blood pressure there as well? Yes! It turns out that pre-eclampsia (and by extension, eclampsia) can happen up to 6 weeks after delivery.
Bridget S. - May 10, 2018 8:08 AM
Hi! I was just reviewing this, and wanted to add a comment - symptoms of preeclampsia can make the diagnosis without lab abnormalities - this includes with liver dysfunction: ACOG guidelines note that severe epigastric or right upper quadrant pain without an alternative diagnosis that fails to respond to appropriate pain medication can be a sign of severe preeclampsia without the need for elevated LFT's. There's an excellent article on propublica (https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system-1) that describes one of these cases in detail. Thanks for sharing your story, every ER doc I've mentioned postpartum preeclampsia to said they weren't aware it existed!
Sam Ashoo, MD - May 11, 2018 10:04 AM
Thanks Bridget. You are absolutely correct. The ACOG guidelines from 2013 found here (https://www.acog.org/~/media/Task%20Force%20and%20Work%20Group%20Reports/public/HypertensioninPregnancy.pdf ) do indeed list severe persistent right upper quadrant or epigastric pain not explained by alternate diagnosis. That language can be found in Box E-1 on page 3 of the document. It was certainly present in this case !
Keep spreading the word...
Sam
PS- I build a pocket reference for this case at https://admin-em.com/samsnotes/preeclampsia/