Immediate postpartum management of patients with severe hypertensive disorders of pregnancy: pathophysiology guiding practice

Hogg, James P.; Szczepański, J; Collier, Charlene; Martin, James N.

doi:10.1080/14767058.2020.1776251

Cited by 7 publications

(6 citation statements)

References 92 publications

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“…Women consulted 4 to 7 days postpartum for their HDP on average, which is in line with the literature. 14 Hospitalization was more frequent in our center (45.3% of cases) than in studies in the United States 15 (mean of 22.9%), which could be explained by differences in hospitalization criteria between centers.…”

Section: Discussioncontrasting

confidence: 51%

“…Several common risk factors were reported to be associated with de novo postpartum HDP occurring after 48 h of delivery, such as gestational diabetes (adjusted odds ratio (aOR) 72.91; 95 CI 5.52-infinity, p < 0.001), obesity (aOR 13.38; 95 CI 1.87-infinity, p = 0.01) and maternal age > 40 years (aOR 24.83; 95 CI 1,43-infinity, p = 0.03). 12 Although we had a higher proportion of de novo postpartum HDP (43.9%) compared to the literature (0.3 to 27.5%) possibly due to our study design and rigorous approach for cases identification, 14 antepartum risk factors for HDP were present in more than 80% of cases. Unfortunately, adequate postpartum BP follow-up at discharge was achieved in less than one-third of these cases.…”

Section: Discussionmentioning

confidence: 70%

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Optimal management of post-discharge postpartum hypertensive disorders of pregnancy: a quality improvement initiative

et al. 2022

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Introduction: Postpartum hypertensive disorders of pregnancy occur in 2-5% of pregnancies. It is a major cause of urgent postpartum consultation and is associated with life-threatening complications. Our objective was to evaluate if local management of postpartum hypertensive disorders of pregnancy was congruent with expert recommendations. Methods: We conducted a quality improvement initiative through a retrospective single-centre cross-sectional study. All women over 18-year-old consulting emergently for hypertensive disorders of pregnancy in the first six weeks postpartum, from 2015 to 2020, were eligible. Results: We included 224 women. Optimal management of postpartum hypertensive disorders of pregnancy was observed in 65.0%. While diagnosis and laboratory work-up were excellent, adequate blood pressure surveillance and recommendations upon discharge of an outpatient postpartum episode (69.7%) did not meet expectations. Conclusion: Efforts should be targeted to improve discharge recommendations on optimal blood pressure surveillance after delivery for women at risk for hypertensive disorders of pregnancy and for postpartum hypertensive disorders of pregnancy in women treated as outpatients.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 70%

Optimal management of post-discharge postpartum hypertensive disorders of pregnancy: a quality improvement initiative

et al. 2022

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“…There was no statistically significant difference between the studied groups regarding age (pvalue >0.05) Table (1).…”

Section: Resultsmentioning

confidence: 87%

“…They affect 5-10% of all the pregnancies. They are the leading cause of maternal morbidity and mortality [1] add 16 percent of maternal deaths were attributed to hypertensive disorders. Hypertensive disorders in pregnancy are classified into chronic hypertension, pre-eclampsia, eclampsia, superimposed pre-eclampsiaeclampsia and gestational hypertension [2].…”

Section: Introductionmentioning

confidence: 99%

Study of Some Hematological Markers of Systemic Inflammatory Response in Preeclampsia

Abd-Elaziz

Elbasyuony

Mabrouk

et al. 2022

JAMMR

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Background: Preeclampsia is one of the major health problems during pregnancy, which is characterized by hypertension, proteinuria, and features of multi-organ disease, and it complicates about 2 to 8% of pregnancies with increased maternal and neonatal morbidity and mortality, aim of this study was to evaluate the following blood markers in preeclampsia; neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, red cell distribution width, mean platelet volume and platelet value. Subjects and Methods: This was diagnostic research, observational method and cross-sectional design that was conducted at Obstetrics and Gynecology Department, Tanta University Hospitals, from 1-7-2020 to 1-11-2021. After fulfilling the Research and Ethics Committee guidelines, pregnant women were counseled to be enrolled in this study. Results: There was significant decrease in PLR in severe preeclampsia group compared to control group (P<0.001) as well as mild preeclampsia group (P<0.001); while there was no statistically significant difference between control group and mild preeclampsia group (P>0.05). There was significant elevation in RDW in severe preeclampsia group compared to control group (P=0.005) as well as mild preeclampsia group (P<0.001); There was significant reduction in MPV in severe preeclampsia group compared to mild preeclampsia group (P<0.001) as well as control group (P<0.001); while there was no statistically significant difference between mild preeclampsia group and control group (P>0.05). There was significant decrease in PCT in severe preeclampsia group compared to control group (P=0.034) as well as mild preeclampsia group (P=0.009); while there was no statistically significant difference between control group and mild preeclampsia group (P>0.05). Conclusion: In differentiation of preeclampsia, the highest sensitivity was achieved with MPV, while the highest specificity was achieved with PLR. In the differentiation of severe preeclamptic cases, the highest sensitivity was achieved with lymphocytes and MPV, while the highest specificity was achieved with PLR.

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“…2,6 HELLP syndrome, characterized by a constellation of different clinical and laboratory findings, including hemolysis, elevated liver enzymes, and low platelets, 5 is a rare obstetric complication seen in pregnancy, and is life threatening to both mother and fetus. 7 While most cases of HELLP syndrome occur prior to delivery (mostly between weeks 27 and 37), approximately 30% occur in the postpartum period. 8 Preeclampsia is a hypertensive disorder seen in pregnancy that can cause end-organ damage 9 and is the single greatest risk factor for HELLP and is present in more than 80% of all HELLP syndrome cases.…”

Section: Introductionmentioning

confidence: 99%

Peripartum cardiomyopathy and HELLP syndrome in a previously healthy multiparous woman: A case report

Quevedo¹,

Bekele

Thompson

et al. 2020

SAGE Open Medical Case Reports

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Peripartum cardiomyopathy is a type of dilated cardiomyopathy in which the exact etiology is uncertain. HELLP syndrome is characterized by a constellation of different clinical and laboratory findings, including hemolysis, elevated liver enzymes, and low platelets. Few case reports exist detailing successful diagnosis and management of postpartum HELLP syndrome, peripartum cardiomyopathy, and multisystem organ failure in a previously healthy woman. We herein report the case of a 39-year-old multiparous female with mild gestational hypertension, who presented in the third trimester with vaginal bleeding and was subsequently suspected to have intrapartum placental abruption leading to immediate Cesarean section, complicated by massive postpartum hemorrhage, necessitating care in the intensive care unit. HELLP syndrome, disseminated intravascular coagulation, and acute kidney injury requiring hemodialysis subsequently developed along with respiratory failure and peripartum cardiomyopathy. After diagnosis and proper management, the patient made a full recovery. Peripartum cardiomyopathy should remain on the differential for women with heart failure symptoms.

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Immediate postpartum management of patients with severe hypertensive disorders of pregnancy: pathophysiology guiding practice

Cited by 7 publications

References 92 publications

Optimal management of post-discharge postpartum hypertensive disorders of pregnancy: a quality improvement initiative

Optimal management of post-discharge postpartum hypertensive disorders of pregnancy: a quality improvement initiative

Study of Some Hematological Markers of Systemic Inflammatory Response in Preeclampsia

Peripartum cardiomyopathy and HELLP syndrome in a previously healthy multiparous woman: A case report

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