header  
Web-Based Curriculum & Reference  
Editors
Kurt J. Pfeifer, MD, FACP
Steven L. Cohn, MD, FACP
 
Medical College of Wisconsin
State University of New York - Downstate
 
line decor
  Pregnancy
Michael P. Carson, MD & David A. Halle, MD
 
line decor
 
     

    RISK MANAGEMENT

    Postoperative Hypertension
       

    Internists may be called to treat hypertension in women who underwent Caesarean deliveries for severe preeclampsia (see criteria on right).
     
    TREATMENT
    • Labetalol
      • Compatible with breastfeeding
      • Use for SBP>170, DBP>100 not related to pain
      • PO dose: 200 mg BID-TID (max 2400 mg/day)
      • IV bolus dose: 20 mg & double to up to 80 mg if inadequate response (10-20 min between doses)
      • Continuous IV dose: start at 1 mg/kg/hr
    • Methyldopa
      • Literature suggests exposed children do NOT have developmental effects.
      • PO dose: 250 mg BID-TID (max 3000 mg/day - increase dose every 2 days as needed).
    • Other options
      • Beta-blockers acceptable - metoprolol preferred over atenolol.
      • Nifedipine acceptable & used for preterm uterine contractions.

     
    back
    PREECLAMPSIA
    Diagnostic Crieria
    • New SBP>140 or DBP>90
    • Proteinuria >300 mg/24 hrs or more than trace protein on urine dip analysis
    Other Findings
    • Headache
    • Visual changes
    • Right upper quadrant abdominal pain
    • Facial and hand edema

    In urgent settings, do not delay care for hypertension. Treat the mother and use medications and/or treatments with which you are familiar.

    		 
      Contact Us   About Us