Hypertension in the Postpartum Woman: Clinical Update for the Hypertension Specialist

Abstract

Hypertension can persist from pregnancy or present de novo in the postpartum period and continue to pose a risk to maternal well‐being. These risks are magnified as many patients present after hospital discharge and go unrecognized because of decreased medical surveillance after delivery. Guidelines for the management of postpartum hypertension are lacking, often resulting in imprecise diagnoses and incorrect treatment strategies. As hypertension specialists are called upon to provide advice to obstetricians regarding the management of hypertension in the postpartum period, it becomes important for the hypertension specialist to develop expertise in the evaluation and treatment of hypertensive women during the postpartum period. The purpose of this clinical review article is to provide an approach to the management of postpartum hypertension.

Atypical Presentation of Posterior Reversible Encephalopathy Syndrome in a Patient Diagnosed with Postpartum Gestational Hypertension

“…Buna ek olarak birçok kadına doğum ya da sezaryen uygulanırken rejyonal anestezi sırasında ve doğum sonrası dönemde büyük miktarlarda intravenöz sıvılar verilir. Bazı kadınlarda özel-likle suboptimal böbrek fonksiyonu ile ilişkili olarak, büyük hacimde intravenöz sıvıların intravasküler aralığa akut ya da gecikmiş mobilizasyonu hipertansiyona neden olan hacim yüklenmesine yol açabilir (6). Ağrı tedavisinde ibuprofen ve indometasin gibi non-steroid anti inflamatuar ilaçların, uterus atonisi tedavisinde ergot alkaloidlerin (ergometrin veya metilergonovin) kullanımı hipertansiyona neden olabilir.…”

Hipertensión/preeclampsia postparto, Recomendaciones de manejo según escenarios clínicos, seguridad en la lactancia materna, una revisión de la literatura

“…Estos inhiben la conversión de angiotensina I a angiotensina II, reduce la resistencia vascular periférica y aumenta el flujo renal, sin alterar la tasa de filtración glomerular, muy utilizado para la hipertensión en diabetes pre-gestacional o en miocardiopatías, puede producir una hipotensión profunda deterioro de la función renal, tos seca persistente, angioedema, erupción cutánea, pancreatitis, síntomas del tracto respiratorio superior, efectos gastrointestinales, alteración de las pruebas de la función hepática, ictericia colestática, palpitaciones, arritmias, angina, efectos dermatológicos incluyendo el síndrome de StevensJohnson, necrosis epidérmica tóxica, dermatitis exfoliaría dermatitis y pénfigo (19,27). El enalapril es útil en pacientes donde está contraindicado otros antihipertensivos por ejemplo en pacientes con falla cardiaca, asma, donde los betabloqueadores están contraindicados, en este caso de segunda línea está el nifedipino y si fuese necesario otro antihipertensivo para el control de la presión, el enalapril sería el indicado (19,28).…”

Favorable course of peripartum cardiomyopathy (RCD code: VII-III-5C)

“…As a rule, β 1 -selective antagonists are preferred over β 2 as the latter may show antitokolytic action. Diuretics are the basis for symptomatic treatment [12]. Aldosterone antagonists, both spironolactone and eplerenon, should be avoided during pregnancy because of the unknown interactions with hormonal pathways.…”