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Postpartum Preeclampsia

Sam Ashoo, MD
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16:04
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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01:51

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EM:RAP 2017 June Written Summary 647 KB - PDF

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.

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Bridget S. -

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 -

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/

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Don’t Fear The Stink! Full episode audio for MD edition 245:23 min - 342 MB - M4AEM:RAP 2017 June Canadian Edition Canadian 24:49 min - 34 MB - MP3EM:RAP 2017 June German Edition Deutsche 68:28 min - 94 MB - MP3EM:RAP 2017 June French Français 29:35 min - 41 MB - MP3EMRAP 2017 June Resumen Español Español 94:49 min - 130 MB - MP3EM:RAP 2017 June Board Review Answers 187 KB - PDFEM:RAP 2017 June Board Review Questions 170 KB - PDFEM:RAP 2017 June MP3 328 MB - ZIPEM:RAP 2017 June Written Summary 647 KB - PDF

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