The Postpartum hypertension Is the high blood pressure that occurs in women after childbirth. It may exist since pregnancy or appear for the first time in the postpartum period, and may become a risk for maternal well-being.
Postpartum blood pressure increases three to six days after birth, when most women have been discharged home, so the risks are magnified because the mother is generally no longer under medical supervision.
Postpartum hypertension affects 1 in 12 women. Evidence suggests that it is the result of increased resistance of the utero-placental circulation, resulting in altered blood flow and, subsequently, poor placental perfusion.
A significant increase can be dangerous, especially in developing countries, for example, Stroke , And in some cases to death.
Values of postpartum hypertension
It is considered that there is postpartum hypertension when, upon taking the tension, the reading is as follows:
PAS> 140 mm Hg or PAD> 90 mm Hg without proteinuria, with readings preferably taken at least 2 times, with 6 hours of difference.
Definition of preeclampsia postpartum:
SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg and Proteinuria ≥ 0.3 g in a 24-hour urine sample.
PAD: diastolic blood pressure
SBP: systolic blood pressure
symptom
Postpartum hypertension can be difficult to detect since many women do not show symptoms, so it is recommended to check for tension from the day of delivery and up to several days later, when the mother is already at home.
When they do have symptoms, they are usually the most common:
- Severe headaches .
- Changes in vision (including temporary loss of vision, blurred vision, or sensitivity to light).
- Change in reflexes.
- Nausea or vomiting.
- Swelling of the face and limbs.
- Stains on the eyes.
- Upper abdominal pain, usually under the ribs on the right side.
- Sudden increase in weight, typically more than 2 pounds (0.9 kilograms) per week.
- Reduction of urine output.
- Blood in the urine.
- Excess protein in the urine (proteinuria).
- When you take the pressure, it is high.
Causes
Postpartum hypertension may be related to the persistence of gestational hypertension, Preeclampsia Or pre-existing chronic hypertension, among other causes.
Causes for which postpartum hypertension may occur:
- Women who have been diagnosed with preeclampsia during pregnancy (a condition of protein loss in the urine, severe swelling and hypertension) often have a higher blood pressure right after birth and lasting up to 12 weeks. Although there are cases of women that can last several months.
- Another cause of postpartum hypertension includes the accumulation of extra fluid in the body tissues, which may be the result of hormonal changes in the woman after childbirth, due to the administration of intravenous fluids during childbirth.
- There are also several medications that are frequently prescribed in the postpartum period, such as ibuprofen, ergonovine and anticongesticides, and the use of large or frequent doses of these agents may aggravate preexisting hypertension or cause postpartum hypertension. Therefore, all women with postpartum hypertension should be evaluated for receiving these medications, and are discontinued if they are being used. 4. A very uncommon cause may be the result of an adrenal gland tumor. Immediately after delivery, this tumor can cause the onset of hypertension, even if the woman maintained normal blood pressure during pregnancy.
Although the underlying causes and clinical presentation of these types of hypertension vary, patients can be investigated and treated in a similar way.
Diagnosis
The differential diagnosis is extensive and varies from benign (mild or essential hypertension) to life threatening, such as severe preeclampsia, eclampsia, pheochromocytoma and stroke.
While the woman is in the hospital, the attending medical staff should be instructed in the continuous monitoring of signs and symptoms, as well as warn and educate the mother about this risk before departing home.
Assessment and management should be done in a phased manner and may require a multidisciplinary approach that considers risk factors, time of onset, associated signs / symptoms and the results of selective laboratory and imaging findings.
The aim of this review is to raise awareness and provide a step-by-step approach to the diagnosis and treatment of women with persistent and / or recent-onset hypertension.
Treatment
If your blood pressure is high enough, doctors treat you with magnesium sulfate to stop the Convulsions .
Blood pressure medications may also be given. Labetolol and Hydralazine are the pillars in the treatment of postpartum hypertension.
Those women who continue to have persistent hypertension despite the use of the maximum doses of antihypertensive drugs require an evaluation to determine the presence of renal artery stenosis or primary hyperaldosteronism.
Women with hypertension along with shortness of breath, orthopnea, tachycardia, or palpitations should be evaluated to rule out pulmonary edema and / or postpartum cardiomyopathy, hyperthyroidism, or pheochromocytoma.
Complications
Complications depend on the following factors: severity and etiology of hypertension, maternal status (presence of organic dysfunction) and quality of treatment used.
Women with chronic hypertension during pregnancy have an increased risk of exacerbation of hypertension and / or overlapping of preeclampsia.
The risk depends on the severity of hypertension, the presence of associated medical conditions (obesity, type 2 diabetes, kidney disease), or whether antihypertensive medications were used during pregnancy.
Life-threatening complications include cerebral infarction or hemorrhage, congestive heart failure or pulmonary edema, renal failure, or death.
The outcome is usually good in those cases with isolated hypertension or preeclampsia, whereas in cases of late diagnosis and inadequate control of severe persistent hypertension, the consequences are severe.
References
- BMJ (2013). Postpartum management of hypertension. BMJ Publishing Group. Retrieved from: www.bmj.com.
- Farzanna S. Haffizulla, MD (2016). What causes postpartum hypertension?. Share Care. Retrieved from: sharecare.com.
- The Editors of Encyclopædia Britannica (2017). Postpartum hypertension. Encyclopædia Britannica, Inc. Retrieved from: global.britannica.com.
- Magee L. (2013). Prevention and treatment of postpartum hypertension. The Cochrane Collaboration. Retrieved from: cochrane.org.
- Manju C. (2007). Medical problems in pregnancy. Wiley Online Library. Retrieved from: onlinelibrary.wiley.com.
- Baha M. Sibai (2012). Etiology and management of postpartum hypertension-preeclampsia. American Journal Obstetrics Gynecology. Retrieved from: ajog.org.