- Management of women with postpartum pre-eclampsia
Management of women with postpartum pre-eclampsia
HEALTH OF WOMAN. 2019.9(145): 8–13; doi 10.15574/HW.2019.145.8
Kharkiv medical Academy of postgraduate education
Pre-eclampsia found only in humans during the second half of pregnancy or the postpartum period, is known to be featured by the development of arterial hypertension and multiple organ failure syndrome. Almost a third of eclampsia is known to occur in the postpartum period. The pre-eclamptic patients require thorough monitoring of blood pressure and administration of antihypertensive drugs in the puerperium.
The pathogenesis and tactics of the developed de novo postpartum pre-eclampsia have not been sufficiently studied. The greatest risk of stroke after delivery remains for 10 days. In the case of postpartum pre-eclampsia, it is very important to start using antihypertensives in a timely manner. First-line drugs should be used not later than 30-60 minutes from the time of severe pre-eclampsia diagnosing to prevent intracranial hemorrhage. Labetalol or hydralazine should be used in order to reduce blood pressure. Sublingual administration of nifedipine may also be considered as first-line therapy. The use of magnesium sulfate is necessary for the prevention of seizures in patients with severe preeclampsia. In the case of eclampsia, a solution of magnesium sulfate is administered intravenously at a loading dose of 4-5 g for 15-20 minutes and then continued infusion at a dose of 1 g per hour throughout the day. Uterine curettage is also a possible measure of reducing blood pressure in women with pre-eclampsia.
Uterine curettage reduced blood pressure in pre-eclamptic patients, but without adequate reporting of harms of perforation and infection dissemination, so it cannot currently be recommended. However, curettage should be done during a caesarean section of women with preeclampsia.
The own case of a systemic inflammatory response syndrome that occurred in a postpartum woman with mild pre-eclampsia is given. Postpartum endomyometritis, which was caused by group B streptococcus, should have played a triggering role in the progression of preeclampsia. The problem of polychemical resistance has led to the inability of traditional antimicrobial agents to prevent the dissemination of infection after curettage. The systemic inflammatory response syndrome has contributed to the increased severity of preeclampsia and the development of multiple organ failure.
Key words: preeclampsia, postpartum period, antihypertensive drugs.
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