Discuss your therapy options with your doctor.,
Try taking hydralazine.,
Try taking sodium nitroprusside.,
Consider taking labetalol.,
Avoid taking diuretics.,
Take magnesium sulfate to treat seizures.,
Monitor your blood pressure.,
Talk to your doctor about how to lower your blood pressure if need be.,
Treat any underlying diseases.,
Keep track of how the kidney is functioning.,
Go to all of your doctor appointments.,
Take low doses of aspirin if you become pregnant in the future.,
Discuss changing your medications if need be.,
Be aware of the risk factors that are involved in this condition.,
Consider the causes of preeclampsia.,
Look for postpartum preeclampsia symptoms.,
Know how this condition is diagnosed.
After seeking medical care, your doctor will determine the best therapy, which will depend on the severity of your symptoms, medical condition and your test results.
Your condition may require hospitalization in case of chronic symptoms or serious signs, such as severe edema or blurred vision.;
, Hydralazine is a vasodilator that is widely used in treating postpartum preeclampsia for lowering the blood pressure quickly, in 10 to 20 minutes. It works by causing peripheral vasodilatation in the arteries, leading to arterial relaxation and lowering blood pressure,
Hydralazine can be given intravenously or by intramuscular route with a dose of 5 mg to be given every fifteen minutes, until a total maximum dose of 20 mg is reached.
The patient is supposed to have lower blood pressure readings after administration, but if not; doctors usually switch to another antihypertensive agent.
Hydralazine may have some side effects such as a sudden drop in blood pressure, rapid heart rate (tachycardia), or headaches.
, Nicardipine is a calcium channel blocker that has a vasodilator effect on the peripheral blood vessels rather than the cardiac muscles. It acts by interfering with the calcium movement at the vascular membranes, resulting in decreased vasoconstriction and therefore reduced blood pressure,
Nicardipine is given in the hospital through an intravenous route with a dose of 5 mg an hour as an initial dose, to be reduced by half til a 15% reduction in blood pressure readings is achieved.
The patient may develop headaches after its usage. For mild cases; Nicardipine tablets can be administrated by the doctor as Pelcard SR to avoid a continuous raise in the blood pressure and the development of other complications.
, Sodium Nitroprusside is a vasodilator that is used in severe cases, as it has a very rapid action (within one minute). It uses peripheral vasodilatation to lower the blood pressure.
This drug is given intravenously with a dose of 0.2 microgram / kg to be increased up to 10 microgram / kg to obtain the desired decrease in blood pressure.
However; this drug has some side effects such as rebound hypertension, headache and cyanide toxicity.
, Labetalol is a non-selective B receptor blocker and selective alpha one blocker, these two actions give it a powerful antihypertensive effect by acting on the alpha one receptors and a type of Beta receptors located at the smooth walls of the systemic vascular system, aiming to reduce the peripheral resistance and so lowering the blood pressure.
Labetalol can be given as an intravenous infusion in hospitalized cases to give a rapid action in about five minutes, with an initial dose of 20 mg. Labetalol tablets are also available for mild preeclampsia cases, and are to be taken under doctor’s prescriptions only.
Overdoses should be avoided to prevent sudden hypotension. Doctors should pay increased attention to women with cardiac failure or asthma while taking this drug.
, Diuretics shouldn’t be used due to the risk of additional hyperuricemia (Increased serum uric acid) or hypokalemia (further decrease in potassium levels), and to prevent an additional decrease in the blood circulation, as a result of renal dysfunction that fails to reabsorb nutrition as potassium, or to eliminate uric acid.
, Magnesium Sulfate is the main therapy line used to treat seizures that arise from postpartum preeclampsia. It is thought to act directly on the brain causing cerebral vasodilatation and increasing the blood perfusion to the brain, thus decreasing the vasospasm from preeclampsia,
It is mainly given through intravenous injection with a dose of four to six gm over twenty minutes as an initial dose, then to be given as an IV infusion with an adjusted dose of 2 gm per hour.
Magnesium sulfate was found to be more powerful in controlling seizures than other drugs as phenytoin or diazepam., Blood pressure should be monitored all the way through the pregnancy months and after delivery, especially if the patient complains of hypertension before getting pregnant or if it developed while having her baby.
Any signs of unusual blood pressure readings should be carefully observed and watched by the doctor and controlled with safe drugs that can be administrated during pregnancy.
Methyldopa is an example of a safe drug to be given to pregnant women without any harm to their babies. However; some doctors reported the development of depression in women using Methyldopa. It’s available as Aldomet tablets to be taken up to three times daily or as doctor’s orders.
, Note that the aim while treating emergency cases of postpartum preeclampsia is to lower the blood pressure readings to be less than 160 / 110 mmHg.
In emergency cases hospitals may receive some cases with hypertension readings of 200 mmHg or more for the systolic readings, which highly indicates cerebral hemorrhage and damage. Lowering the readings to 160 mmHg or less is critical to prevent further cerebral damage.
This can be done using Sodium Nitroprusside, Nifedipine, Hydralazine or Labetalol through the intravenous route, then careful monitoring and observation of the patient’s state is required to gradually decrease her blood pressure til it is within the range of 130-140 / 100-95 mmHg.
, Extra care should be taken if the mother has any other chronic underlying diseases, such as diabetes mellitus, cardiac disorders, renal diseases, obesity, smoking, hypertension or a previous preeclampsia condition.
All of this information can be found in the mother’s medical profile and from a good follow up with her. A close follow up should be made after her delivery.
Any signs of edema, or excessive high blood pressure readings should be noted and treated immediately, other complication signs such as seizures or blurred vision must be treated at once.
, Serum creatinine and uric acid levels, plus protein concentrations in urine provide a good indication of the kidneys state and actual function, so they should be observed closely.
When the medical team find no worries in her test readings, and if her blood pressure readings are stable while on antihypertensive drugs, she can return home with strong recommendations on adhering to her drugs.
The woman will also need to practice constant observation of her blood pressure readings. She can easily keep a record of her readings with her, so she can ask her doctor about unusual signs that might develop.
, After returning home, the patient should attend all of her doctor’s appointments for continuous medical counseling and treatment.
Medical care is continued until the sixth week after birth to ensure that all normal values of blood pressure, kidney and liver functions have returned. Her doctor has to make sure that she is taking all of her medications as instructed and monitor her blood pressure.
The doctor should also physically examine her for any signs of swollen legs or face, headache or any other symptoms.
, In case of any future pregnancies, a woman with a history of preeclampsia or postpartum preeclampsia should be advised to take low doses of aspirin (75 mg) on a daily bases before sleeping.
Reports showed that aspirin helped in reducing the chances of preeclampsia in some cases, when the aspirin was given from 16 weeks of gestation til giving birth.
Moreover; it was found that hypocalcaemia (low calcium concentrations) can contribute to the occurrence of postpartum preeclampsia in many cases by increasing the elevation of blood pressure.
Therefore the woman should take daily calcium supplements or increase her dietary calcium intake to equal a dose of 500 mg calcium daily.
, Woman on any hypertension drugs should be switched to Methyldopa on becoming pregnant. She should then be observed and her blood pressure readings monitored to ensure that they stay within the normal range.
, There are some risk factors that can contribute to the development of preeclampsia after birth, these factors include:
Obesity or excess weight. Many reports showed that the more obese the pregnant woman was, the higher the risk of developing postpartum preeclampsia.
Hypertension (increased blood pressure) or the presence of proteins in urine is another contributing factor.
Cesarean section. If the woman gave birth via c-section during a previous pregnancy, there is a higher risk of her developing postpartum preeclampsia.
Certain chronic diseases can also increase the risk of postpartum preeclampsia, such as renal diseases or diabetes mellitus., The defined cause of preeclampsia is not well known. It could be due to placental abnormalities at the placental arteries, as these abnormalities can minimize the blood perfusion through the placenta, leading to the release of some chemicals that cause vasoconstriction and inflammation.
This leads to systemic damage and endothelial dysfunction, causing further vasoconstriction, capillary leakage, and low platelet counts.
All these changes can cause excessive elevation of blood pressure, escaping of fluids outside the cells due to endothelial cell dysfunction, and other postpartum preeclampsia signs that will be discussed below.
, Symptoms of postpartum preeclampsia happen after the child’s birth, from about 48 hours to six weeks after delivery. Some doctors refer to the latter as “late postpartum preeclampsia”.
Postpartum preeclampsia shows no signs during pregnancy, and the pregnant woman can actually have normal blood pressure while being pregnant. Symptoms include:
Very high blood pressure that can reach up to 180 mmHg for systolic readings, and 110 mmHg for diastole blood pressure. This can lead to other serious problems, such as edema, renal disorders, or cardiovascular issues.
Edema (swelling) in the lower extremities such as the legs, feet, hands or even the face or around the eyes.
The above changes directly affect many vital organs as the kidneys, kidneys are so sensitive and are affected by any change in the blood volume reaching them, and in this case; a decrease in the blood circulation causes a decrease in the normal blood supply to kidneys, this leads to a drop in renal normal functions.
Excessive gain weight or obesity as a result of the gathered fluids and water accumulated under the skin layers.
Other signs related to the central nervous system include severe headache, blurred vision, cerebral edema or seizures.
In severe conditions; pulmonary edema may develop as a result of continuous escaping and gathering of excessive fluids outside the cells due to the endothelial dysfunction, causing a dangerous problem at the affected woman lungs., Diagnosis mainly depends on the symptoms that a recently pregnant woman is experiencing after her birth. If she felt any of the previous symptoms; like excessive swollen legs, feet or face, very strong unusual headache with severe pain, blurred vision, chest or upper stomach pain, she should see her doctor immediately.
Tests that the doctor will perform are blood tests, blood pressure readings, and urine tests. Another less frequent test that is performed in case of chronic untreated cases of postpartum preeclampsia is an Electroencephalogram “EEG” to detect electrical activity of the brain.
A Magnetic Resonance Imaging “MRI” test can also be performed to detect seizures in the patient, and to check on other internal organs.