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Review Articles

Immediate postpartum management of patients with severe hypertensive disorders of pregnancy: pathophysiology guiding practice

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Pages 2009-2019 | Received 08 Apr 2020, Accepted 27 May 2020, Published online: 10 Jun 2020

References

  • Deruelle P, Coudoux E, Ego A, et al. Risk factors for post-partum complications occurring after preeclampsia and HELLP syndrome. A study in 453 consecutive pregnancies. Eur J Obstet Gynecol Reprod Biol. 2006;125(1):59–65.
  • Creanga AA, Berg CJ, Ko JY, et al. Maternal mortality and morbidity in the United States: where are we now? J Womens Health (Larchmt)). 2014;23(1):3–9.
  • ACOG practice bulletin No. 202: gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133(1):e1–e25. DOI:https://doi.org/10.1097/AOG.0000000000003018
  • Menzies J, Magee LA, Li J, et al. Instituting surveillance guidelines and adverse outcomes in preeclampsia. Obstet Gynecol. 2007;110(1):121–127.
  • Martin JN. Jr. Severe systolic hypertension and the search for safer motherhood. Semin Perinatol. 2016;40(2):119–123.
  • Main EK, Goffman D, Scavone BM, Council on Patient Safety in Women's Health Care, et al. National partnership for maternal safety: consensus bundle on obstetric hemorrhage. Obstet Gynecol. 2015;126(1):155–162.
  • Goel A, Maski MR, Bajracharya S, et al. Epidemiology and mechanisms of de novo and persistent hypertension in the postpartum period. Circulation. 2015;132(18):1726–1733.
  • Tomimatsu T, Mimura K, Endo M, et al. Pathophysiology of preeclampsia: an angiogenic imbalance and long-lasting systemic vascular dysfunction. Hypertens Res. 2017;40(4):305–310.
  • Podymow T, August P. Postpartum course of gestational hypertension and preeclampsia. Hypertens Pregnancy. 2010;29(3):294–300.
  • Walters BN, Walters T. Hypertension in the puerperium. Lancet. 1987;2(8554):330.
  • Atterbury JL, Groome LJ, Hoff C. Blood pressure changes in normotensive women readmitted in the postpartum period with severe preeclampsia/eclampsia. J Matern Fetal Med. 1996;5(4):201–205.
  • Buchbinder A, Sibai BM, Caritis S, et al. Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia. Am J Obstet Gynecol. 2002;186(1):66–71.
  • Martin JN, Jr., Thigpen BD, Moore RC, et al. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105(2):246–254.
  • James AH, Bushnell CD, Jamison MG, et al. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol. 2005;106(3):509–516.
  • Zambrano MD, Miller EC. Maternal stroke: an update. Curr Atheroscler Rep. 2019;21(9):33.
  • Morris R, Sunesara I, Rush L, et al. Maternal hemodynamics by thoracic impedance cardiography for normal pregnancy and the postpartum period. Obstet Gynecol. 2014;123(2):318–324.
  • Parrish MR, Laye MR, Wood T, et al. Impedance cardiography facilitates differentiation of severe and superimposed preeclampsia from other hypertensive disorders. Hypertens Preg. 2012;31(3):327–340.
  • Gyselaers W, Tomsin K, Staelens A, et al. Maternal venous hemodynamics in gestational hypertension and preeclampsia. BMC Preg Childbirth. 2014;14(1):212.
  • Khan SG, Melikian N, Mushemi-Blake S, et al. Physiological reduction in left ventricular contractile function in healthy postpartum women: potential overlap with peripartum cardiomyopathy. PLOS One. 2016;11(2):e0147074.
  • Lavie A, Ram M, Lev S, et al. Maternal cardiovascular hemodynamics in normotensive versus preeclamptic pregnancies: a prospective longitudinal study using a noninvasive cardiac system (NICaS). BMC Pregnancy Childbirth. 2018;18(1):229.
  • Levine LD, Lewey J, Koelper N, et al. Persistent cardiac dysfunction on echocardiography in African American women with severe preeclampsia. Pregnancy Hypertens. 2019;17:127–132.
  • Timokhina E, Kuzmina T, Strizhakov A, et al. Maternal cardiac function after normal delivery, preeclampsia, and eclampsia: a prospective study. J Pregnancy. 2019;2019:9795765.
  • Johnson AC, Cipolla MJ. The cerebral circulation during pregnancy: adapting to preserve normalcy. Physiology (Bethesda). 2015;30(2):139–147.
  • Cipolla MJ, Kraig RP. Seizures in women with preeclampsia: mechanisms and management. Fetal Matern Med Rev. 2011;22(2):91–108.
  • Cipolla MJ, Sweet JG, Chan SL. Cerebral vascular adaptation to pregnancy and its role in the neurological complications of eclampsia. J Appl Physiol. 2011;110(2):329–339.
  • Janzarik WG, Jacob J, Katagis E, et al. Preeclampsia postpartum: Impairment of cerebral autoregulation and reversible cerebral hyperperfusion. Pregnancy Hypertens. 2019;17:121–126.
  • van Veen TR, Panerai RB, Haeri S, et al. Cerebral autoregulation in different hypertensive disorders of pregnancy. Am J Obstet Gynecol. 2015;212(4):513 e1–7.
  • Logue OC, George EM, Bidwell GL. 3rd. Preeclampsia and the brain: neural control of cardiovascular changes during pregnancy and neurological outcomes of preeclampsia. Clin Sci. 2016;130(16):1417–1434.
  • Bergman L, Torres-Vergara P, Penny J, et al. Investigating Maternal Brain Alterations in Preeclampsia: the Need for a Multidisciplinary Effort. Curr Hypertens Rep. 2019;21(9):72.
  • Schreurs MP, Hubel CA, Bernstein IM, et al. Increased oxidized low-density lipoprotein causes blood-brain barrier disruption in early-onset preeclampsia through LOX-1. FASEB J. 2013;27(3):1254–1263.
  • Wallace K, Tremble SM, Owens MY, et al. Plasma from patients with HELLP syndrome increases blood-brain barrier permeability. Reprod Sci. 2015;22(3):278–284.
  • Amburgey OA, Chapman AC, May V, et al. Plasma from preeclamptic women increases blood-brain barrier permeability: role of vascular endothelial growth factor signaling. Hypertension. 2010;56(5):1003–1008.
  • Wallace K, Bean C, Bowles T, et al. Hypertension, anxiety, and blood-brain barrier permeability are increased in postpartum severe preeclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome rats. Hypertension. 2018;72(4):946–954.
  • Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494–500.
  • Irani RA, Xia Y. Renin angiotensin signaling in normal pregnancy and preeclampsia. Semin Nephrol. 2011;31(1):47–58.
  • Assali NS, Westersten A. Regional flow-pressure relationship in response to angiotensin in the intact dog and sheep. Circ Res. 1961;9:189–193.
  • Lindheimer MD, Roberts JM, Cunningham FG, et al. Chesley’s hypertensive disorders in pregnancy. 3rd ed. Amsterdam; Boston: Academic Press/Elsevier; 2009. p. 422.
  • Langer B, Grima M, Coquard C, et al. Plasma active renin, angiotensin I, and angiotensin II during pregnancy and in preeclampsia. Obstet Gynecol. 1998;91(2):196–202.
  • Gonik B, Cotton D, Spillman T, et al. Peripartum colloid osmotic pressure changes: effects of controlled fluid management. Am J Obstet Gynecol. 1985;151(6):812–815.
  • Zinaman M, Rubin J, Lindheimer MD. Serial plasma oncotic pressure levels and echoencephalography during and after delivery in severe pre-eclampsia. Lancet. 1985;1(8440):1245–1247.
  • Bandi VD, Munnur U, Matthay MA. Acute lung injury and acute respiratory distress syndrome in pregnancy. Crit Care Clin. 2004;20(4):577–607.
  • Gerbasi FR, Bottoms S, Farag A, et al. Changes in hemostasis activity during delivery and the immediate postpartum period. Am J Obstet Gynecol. 1990;162(5):1158–1163.
  • Egan K, Kevane B, Ni AF. Elevated venous thromboembolism risk in preeclampsia: molecular mechanisms and clinical impact. Biochem Soc Trans. 2015;43(4):696–701.
  • Tepper NK, Boulet SL, Whiteman MK, et al. Postpartum venous thromboembolism: incidence and risk factors. Obstet Gynecol. 2014;123(5):987–996.
  • ACOG committee opinion No. 767. Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Obstet Gynecol. 2019;133(2):e174–e80. DOI:https://doi.org/10.1097/AOG.0000000000003075
  • Redman CW. Hypertension in pregnancy: the NICE guidelines. Heart. 2011;97(23):1967–1969.
  • Nissaisorakarn P, Sharif S, Jim B. Hypertension in pregnancy: defining blood pressure goals and the value of biomarkers for preeclampsia. Curr Cardiol Rep. 2016;18(12):131.
  • Bernstein PS, Martin JN, Jr., Barton JR, et al. National partnership for maternal safety: consensus bundle on severe hypertension during pregnancy and the postpartum period. Obstet Gynecol. 2017;130(2):347–357.
  • Magee LA, Abalos E, von Dadelszen P, CHIPS Study Group, et al. How to manage hypertension in pregnancy effectively. Br J Clin Pharmacol. 2011;72(3):394–401.
  • Knight MS, Brocklehurst P, Neilson J, et al. Saving lives, improving mothers’ care- lessons learned to inform future maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2009–2012. Oxford: National Perinatal Epidemiology Unit, University of Oxford.; 2014.
  • Judy AE, McCain CL, Lawton ES, et al. Systolic hypertension, preeclampsia-related mortality, and stroke in California. Obstet Gynecol. 2019;133(6):1151–1159.
  • Dennis AT. Transthoracic echocardiography in women with preeclampsia. Curr Opin Anaesthesiol. 2015;28(3):254–260.
  • Gainder S, Thakur M, Saha SC, et al. To study the changes in fetal hemodynamics with intravenous labetalol or nifedipine in acute severe hypertension. Pregnancy Hypertens. 2019;15:12–15.
  • Magee L, Sadeghi S. Prevention and treatment of postpartum hypertension. Cochrane Database Syst Rev. 2005;(1):CD004351.
  • Ainuddin J, Javed F, Kazi S. Oral labetalol versus oral nifedipine for the management of postpartum hypertension a randomized control trial. Pak J Med Sci. 2019;35(5):1428–1433.
  • Flack JM, Sica DA, Bakris G, et al. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010;56(5):780–800.
  • Firoz T, Magee LA, MacDonell K, Community Level Interventions for Pre-eclampsia (CLIP) Working Group, et al. Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review. BJOG. 2014;121(10):1210–1218; discussion 20.
  • Nezu M, Miura Y, Noshiro T, et al. Primary aldosteronism as a cause of severe postpartum hypertension in two women. Am J Obstet Gynecol. 2000;182(3):745–746.
  • Altman D, Carroli G, Duley L, Magpie Trial Collaboration Group, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002;359(9321):1877–1890.
  • Johnson AC, Tremble SM, Chan SL, et al. Magnesium sulfate treatment reverses seizure susceptibility and decreases neuroinflammation in a rat model of severe preeclampsia. PLOS One. 2014;9(11):e113670.
  • Fontenot MT, Lewis DF, Frederick JB, et al. A prospective randomized trial of magnesium sulfate in severe preeclampsia: use of diuresis as a clinical parameter to determine the duration of postpartum therapy. Am J Obstet Gynecol. 2005;192(6):1788–1793.
  • Isler CM, Barrilleaux PS, Rinehart BK, et al. Postpartum seizure prophylaxis: using maternal clinical parameters to guide therapy. Obstet Gynecol. 2003;101(1):66–69.
  • Druzin ML, Shields LE, Peterson, NL, et al. Preeclampsia toolkit: improving health care response to preeclampsia (California Maternal Quality Care Collaborative Toolkit to Transform Maternity Care) developed under contract #11-10006 with the California Department of Public Health; Maternal, Child and Adolescent Health Division; Published by the California Maternal Quality Care Collaborative. November 2013.
  • Tomsin K, Mesens T, Molenberghs G, et al. Impedance cardiography in uncomplicated pregnancy and pre-eclampsia: a reliability study. J Obstet Gynaecol. 2012;32(7):630–634.
  • Jia RZ, Qian YJ, Zhang X, et al. Contribution of dysfunction of maternal hemodynamics to renal impairment in preeclampsia. Gynecol Obstet Invest. 2013;76(2):95–99.
  • Lees C, Ferrazzi E. Relevance of haemodynamics in treating pre-eclampsia. Curr Hypertens Rep. 2017;19(9):76.
  • Millman AL, Payne B, Qu Z, Joanne Douglas M, PIERS (Pre-eclampsia Integrated Estimate of RiSk) Study Group, et al. Oxygen saturation as a predictor of adverse maternal outcomes in women with preeclampsia. J Obstet Gynaecol Can. 2011;33(7):705–714.
  • Yen TW, Payne B, Qu Z, Hutcheon JA, PIERS (Pre-eclampsia Integrated Estimate of RiSk) Study Group, et al. Using clinical symptoms to predict adverse maternal and perinatal outcomes in women with preeclampsia: data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study. J Obstet Gynaecol Can. 2011;33(8):803–809.
  • Ascarelli MH, Johnson V, McCreary H, et al. Jr. Postpartum preeclampsia management with furosemide: a randomized clinical trial. Obstet Gynecol. 2005;105(1):29–33.
  • Perdigao JL, Lewey J, Hirshberg A, et al. Furosemide for acclerated recovery of blood pressure postpartum: a randomized placebo controlled trial (FoR BP). American Journal of Obstetrics and Gynecology2020. 2020;222(1):S759–S760.
  • Veena P, Perivela L, Raghavan SS. Furosemide in postpartum management of severe preeclampsia: a randomized controlled trial. Hypertens Pregnancy. 2017;36(1):84–89.
  • Cursino T, Katz L, Coutinho I, et al. Diuretics vs. placebo for postpartum blood pressure control in preeclampsia (DIUPRE): a randomized clinical trial. Reprod Health. 2015;12:66.
  • Keiseb J, Moodley J, Connolly CA. Comparison of the efficacy of continuous furosemide and low-dose dopamine infusion in preeclampsia/eclampsia-related oliguria in the immediate postpartum period. Hypertens Pregnancy. 2002;21(3):225–234.
  • Carr DB, Gavrila D, Brateng D, Easterling TR. Maternal hemodynamic changes associated with furosemide treatment. Hypertens Pregnancy. 2007;26(2):173–178.
  • Mao M, Chen C. Corticosteroid therapy for management of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome: a meta-analysis. Med Sci Monit. 2015;21:3777–3783.
  • Yang L, Ren C, Mao M, et al. Prognostic factors of the efficacy of high-dose corticosteroid therapy in hemolysis, elevated liver enzymes, and low platelet count syndrome during pregnancy: a meta-analysis. Medicine (Baltimore)). 2016;95(13):e3203.
  • Darby M, Martin JN, Jr., Mitchell SQ, et al. Using case reports to determine when liver bleeding occurs during disease progression in HELLP syndrome. Int J Gynaecol Obstet. 2013;123(1):7–9.
  • Martin JN. Jr. Milestones in the quest for best management of patients with HELLP syndrome (microangiopathic hemolytic anemia, hepatic dysfunction, thrombocytopenia). Int J Gynaecol Obstet. 2013;121(3):202–207.
  • Martin JN, Jr., Brewer JM, Wallace K, et al. Hellp syndrome and composite major maternal morbidity: importance of Mississippi classification system. J Matern Fetal Neonatal Med. 2013;26(12):1201–1206.
  • Martin JN, Jr., Owens MY, Keiser SD, et al. Standardized Mississippi protocol treatment of 190 patients with HELLP syndrome: slowing disease progression and preventing new major maternal morbidity. Hypertens Pregnancy. 2012;31(1):79–90.
  • Martin JN, Jr., Perry KG, Jr., Blake PG, et al. Better maternal outcomes are achieved with dexamethasone therapy for postpartum HELLP (hemolysis, elevated liver enzymes, and thrombocytopenia) syndrome. Am J Obstet Gynecol. 1997;177(5):1011–1017.
  • Martin JN, Jr., Rose CH, Briery CM. Understanding and managing HELLP syndrome: the integral role of aggressive glucocorticoids for mother and child. Am J Obstet Gynecol. 2006;195(4):914–934.
  • Martin JN. The 2015 compendium for HELLP syndrome: from bench to bedside. New York: Nova Biomedical; 2015. p. viii, 319.
  • Takahashi A, Kita N, Tanaka Y, et al. Effects of high-dose dexamethasone in postpartum women with class 1 haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. J Obstet Gynaecol. 2019;39(3):335–339.
  • Wallace K, Martin JN, Jr., Tam Tam K, et al. Seeking the mechanism(s) of action for corticosteroids in HELLP syndrome: SMASH study. Am J Obstet Gynecol. 2013;208(5):380 e1–8.
  • Keiser SD, Owens MY, Parrish MR, et al. HELLP syndrome with and without eclampsia. Amer J Perinatol. 2011;28(03):187–194.
  • Tam Tam KB, Keiser SD, Sims S, et al. Jr. Antepartum eclampsia <34 weeks case series: advisable to postpone delivery to administer corticosteroids for fetal pulmonary benefit?. J Perinatol. 2011;31(3):161–165.
  • Brewer J, Owens MY, Wallace K, et al. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol. 2013;208(6):468 e1–6.
  • Cornette J, Herzog E, Buijs EA, et al. Microcirculation in women with severe pre-eclampsia and HELLP syndrome: a case-control study. BJOG: Int J Obstet Gy. 2014;121(3):363–370.
  • DʼAlton ME, Friedman AM, Smiley RM, et al. National partnership for maternal safety: consensus bundle on venous thromboembolism. Obstet Gynecol. 2016;128(4):688–698.
  • Brancazio LR. Maternal mortality in the United States: predictability and the impact of protocols on fatal postcesarean pulmonary embolism and hypertension-related intracranial hemorrhage. Am J Obstet Gynecol. 2014;211(6):713.
  • Friedman AM, Ananth CV. Obstetrical venous thromboembolism: epidemiology and strategies for prophylaxis. Semin Perinatol. 2016;40(2):81–86.
  • Overcash RT, Somers AT, LaCoursiere DY. Enoxaparin dosing after cesarean delivery in morbidly obese women. Obstet Gynecol. 2015;125(6):1371–1376.
  • Friedman AM, D'Alton ME. Venous thromboembolism bundle: risk assessment and prophylaxis for obstetric patients. Semin Perinatol. 2016;40(2):87–92.
  • Sebaaly J, Covert K. Enoxaparin dosing at extremes of weight: literature review and dosing recommendations. Ann Pharmacother. 2018;52(9):898–909.
  • Anastasio HB, Campbell LE, Buermeyer A, et al. Nonsteroidal antiinflammatory drug administration and postpartum blood pressure in women with hypertensive disorders of pregnancy. Obstet Gynecol. 2018;132(6):1471–1476.
  • Blue NR, Murray-Krezan C, Drake-Lavelle S, et al. Effect of ibuprofen vs acetaminophen on postpartum hypertension in preeclampsia with severe features: a double-masked, randomized controlled trial. Am J Obstet Gynecol. 2018;218(6):616 e1–e8.
  • Triebwasser JE, Hesson A, Langen ES. A randomized-controlled trial to assess the effect of ibuprofen on postpartum blood pressure in women with hypertensive disorders of pregnancy. Pregnancy Hypertens. 2019;18:117–121.

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