Blood pressures pospartum-what to report

imenid37 · Dec 9, 2008

Generally report 140/90 or above. A significant (I think 20-30% of women) do seize after delivery, esp. in the first 48 hours. Be especially vigilant if there are headaches, visual problems, or epigastric pain as well. I have seen over the years, several discharged patients go home and seize. I have also had a couple of patients seize in the hospital after delivery. Here is a good article for you from E-medicine.

http://www.emedicine.com/MED/topic633.htm

Elvish, BSN, DNP, RN, NP · Dec 9, 2008

Wow, imenid, those are high numbers. We don't see nearly that # of women who seize....are you talking about all women or preeclamptic women? I work in a high risk hospital & we don't see nearly that number.

We have postpartum parameters for which to call about a BP. Our parameters are 160/100...now, I will call for a BP lower than that if mom is having sx like those mentioned above. I have had moms go into preeclampsia after delivery, but it is (thankfully) rare where I am.

imenid37 · Dec 10, 2008

It is abt. 25% of pre-eclamptics who seize after do so delivery according to the literature, not of all women. (sorry to give that impression). A lot of doctors will blow off some elevated BP's after delivery, only to have the pt. go home and seize. I have seen this happen several times. It does happen. A pt. who has had high BP's needs to know this when she is dc'd, so she can have herself checked and not attribute that HA or lousy feeling to being a very overtired mom. So many times, they just are told, the baby is out and your BP will be fine now. As you say, sometimes the numbers to report will be higher IF you have orders. If you do not, I'd be reporting the 140/90 range. If you have orders, then it is usually on the provider's radar there is a problem and perhaps the pt. is or was on meds, etc. and will be cheked in the office after discharge. I have made the follow up phone calls after dc and had moms say I have an awful headache, spots before my eyes, etc., but my doctor told me don't worry about the BP now that the baby is here. Low and behold, they will call office, have elevated BP, and need meds. The truth is they need to f/u w/ the dr. and have the BP checked, not wait until the 5-6 week check up. There is a hospital about 20 miles from mine and in the past several years, I know that we have received 4-5 moms who delivered at their facilty, went home seized, and were brought to our ED.

Elvish, BSN, DNP, RN, NP · Dec 10, 2008

Ok, that makes more sense now. Thanks for the clarification. And, I agree w/ you that preeclamptic moms need to know to continue to watch for sx even if baby is out.

CoffeeRTC, BSN, RN · Dec 13, 2008

Ok, that makes more sense now. Thanks for the clarification. And, I agree w/ you that preeclamptic moms need to know to continue to watch for sx even if baby is out.

Yes, this is very true. With baby #1 and 2 I had preeclampsia. #1 was more severe. After delivery, I was questioning why my BP issues were not followed up on. Took a day or two for them to order meds for my BPs well into 150/100s! Oddly with baby #3, I don't remember bp issues. With my #4 I had minor issues but was given Valium postpartum for BP issues and I kept a close eye after D/c. We will see what #5 holds.

I do thing that postpartum teaching should include monitoring and notifying MD, etc with any s/s. If I wasn't a nurse..I wouldn't have know...

PEDSOBRN · Jan 4, 2009

So you would report any BP's over 140/90? Most people where I work report 160/100. If I get one high reading (say after pt comes out to postpartum) I usually wait an hour and recheck it. You?

cnm in progress · Jan 6, 2009

So you would report any BP's over 140/90? Most people where I work report 160/100. If I get one high reading (say after pt comes out to postpartum) I usually wait an hour and recheck it. You?

Unless you have a protocol that says you have to report all BPs > 140/90, I'd say it's patient-specific. If you have someone who is a known hypertensive, then you have more leeway. Also, someone with BPs 150/95 who has already been ruled out for pre-eclampsia and isn't displaying any new symptoms, I'd sit on them too unless their pressures climbed further. If I had a patient who was completely normotensive who now has pressures of 140/90, I'd recheck a few and then call the provider. I think it's hard to have "set in stone" parameters. You need to assess the whole picture.