late-onset postpartum PIH??/Mag. question too

Specialties Ob/Gyn

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TOnight we got a pt who delivered around the end of September. Normal pregnancy, no concerns during or immediately after. But then today she came in w/ high bp and headache and got admitted, put on mag sulfate drip, the whole nine yards (hourly vs, reflexes etc) 24h urine, bloodwork etc.

Doesn't that seem a bit late for PIH? I thought it was within a couple days of birth, maxx. I am thinking we are overtreating her, and separating from her baby unecessarily. I gave her..can't remember what it was...began with an N and was PO, and pressures came from 170's/low 100s to 130s/80s.

Why couldn't she just be treated orally and maybe even as an outpt? Isn't it late for the whole mag sulfate procedure?

Also, debate on the floor tonight about Mag sulfate---I was taught and tested on the fact that mag does NOT reduce your blood pressure, but it DOES raise your seizure threshold. That's why labetolol, and the other med mentioned above are given. Another nurse (been there way longer than I) said that mag does bring your pressure down (relaxes smooth muscle) and combining it w/ that N drug could cause a pt to crash quick into a low bp. Anyone want to weigh in on this one?

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Specializes in Emergency.

N drug? Norvasc?

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N drug? Norvasc?

no...something like nepedamine? nip- nep- or nif-. I was so busy, I can't remember the name!

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Amlodipine?

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Nifedipine! I remembered!

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Specializes in Med-Surg, OB/GYN, L/D, NBN.
Nifedipine! I remembered!

Otherwise known as Procardia... LOL Docs at our L/D use it a lot. Its also a tocolytic and can be used for mild onset PTL (guess that is how it works with the blood pressure too...relaxes the blood vessels etc.)

As for the PIH, I have never seen anyone come in past a week for that related to pregnancy.... Maybe she was just stressing over the baby! :uhoh21: Babies are a big thing, especially for an 18 yr old. I know I just about obsessed over mine and I was 21.

However, to think about it, you are technically in your "postpartum" period for 6 weeks, right? (You know... no sex, no douche, no tampons for at least 6 weeks or until dr oks blah, blah, blah...:nono: ) So maybe it is possible.

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I wonder what I will find when I get in there today. How her bloodwork comes out etc. She had a headache (3/10) but her affect was kind of flatter than expected and they did refer to SW for depression. I don't know..I just think it might be overkill. Plus Mag just makes a person feel so crappy, its too bad to do it.

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Specializes in Almost everywhere.

It is my understanding that patients can continue to have blood pressure issues such as this up to 12 weeks post partum. Anything after that needs to be investigated further. Also my understanding that magnesium sulfate is a mild vasodilator. But that is about all I know.

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Specializes in OB, lactation.

The preeclampsia foundation website says "Preeclampsia can appear at any time during the pregnancy, delivery and up to six weeks post-partum,..."

http://www.preeclampsia.org/FAQ.asp#nine

We use nifedipine/Procardia a lot also.

I was also wondering, was her affect flat before or during the mag? That can be a side effect of the mag... or sleepless nights with a new baby. I'd probably want more to go on than just that but I guess a referral for better screening isn't going to hurt. Edinburgh Postnatal Depression Scale can be used for screening:

http://www.aafp.org/afp/20051215/2491_f1.gif

I hope she's better &/or it can be arranged for her to not be separated from her baby, let us know the scoop :)

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I was on Nifedipine for PTL. It's also widely used to bring preterm contractions under control if Brethine cannot be used in any given case (in mine, my heart rate was over 100 when I was pregnant, for some unknown reason).

The worse and most scary case of PIH-related problems I saw occured in a woman who seized about 7 days AFTER delivery and having been on mag before, during and after delivery, for about 4 days.

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thank you to everyone!

I have been looking for the edinburgh scale for another project I am trying to get going at work so appreciate the link.

Today I d/c'd her mag @ 24h.

Good to hear that mags been used longer than 24 h but thats awful about the pt that seized anyway. I guess once its out of your system you are at risk again.

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Specializes in ER, NICU, NSY and some other stuff.

I also have seen a couple of moms more than a week pp who returned with dx of PIH. It seemed like they were the sickest ones I had seen. Probably reason being they weren't being monitored like one would be antepartum, (ie: frequent doctor visits). In fact both siezed and one ended up ventilated in the ICU.

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