[IL-CNM] postpartum hypertension

Darryn Dunbar runningstork at yahoo.com
Sun Feb 11 15:42:52 CST 2007


Interesting case, Angel.
   
  I would suggest they attempt to quantify any proteinuria with a 24 hour urine collection.  It does seem more like a zebra than a horse.  
   
  Let us know what happens!
   
  Best regards,
Darryn

angel atkins <angelz777 at msn.com> wrote:
          Hello everyone!
   
  I have a patient who has recently puzzled me and thought I might ask a few more experienced midwives what they think was the cause.
   
  Here is some back ground info:
  My patient, we'll call Kay, is a 24 y.o. G1, P1 who delivered a 8 lb. 4 oz. baby boy at 38 5/7 weeks gestation after an arduous back labor, persistent OP position which finally rotated after 2 days, an epidural, a whiff of pitocin, and prayer. She wouldn't dilate past 4-5cm until that baby finally rotated, and then she only pushed 20 minutes!!  Kay had an uncomplicated pregnancy with the exception of increase LE edema at 38 1/2 weeks with BP's 130's/80's, trace proteinuria, and normal labs. Her pressures during labor were 120-140s/70-80s and temp. 99.1-101.5 (she received PCN G). Immediately post delivery she had a small post partum hemorrhage (EBL-600 cc), which was controlled with str. cath, fundal massage and IV pitocin. During her two day PP stay B/Ps remained 120-130/70-80, she was afebrile and Discharge hgb was 9.8.
   
  Here is where the story becomes puzzling:
  At 5 days Postpartum, kay calls and states her feet are very swollen and she is feeling very shaky and "not right". I send her to the hospital for evaluation (I am fearful of HELLP). In the ER, her B/P is 194/124!  The physicians are now managing Kay's care. Fortunately, her labs are all normal (no HELLP!!!) But after two days in the hospital and two antihypertensives and a diuretic, her B/P's are still 170/115.  I am told, still normal labs & no proteinuria (though I don't think they thought to order a 24 hour urine; I think they are just doing a dipstick!)  
   
  So finally, my question is: Is this likely a delayed onset of pre-eclampsia?  gestational HTN (PIH)?  Her non-pregnant B/P's have always been 110s/60s and she is now 8 days post partum!!
   
  Any thoughts on this patient would be greatly appreciated!
   
  Thanks, Angel Atkins, CNM 
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Darryn W. Dunbar, APN/CNM, MS
  Certified Nurse-Midwife
  "Big Runner D"
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