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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!
Sarmed (Sam) A., 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/