Preeclampsia during postpartum period

a case report

Authors

DOI:

https://doi.org/10.11606/issn.2176-7262.v53i1p43-48

Keywords:

Preeclampsia, Postpartum Period, Pregnancy

Abstract

Preeclampsia, a frequent complication of pregnancy, is a leading cause of maternal and perinatal morbidity and mortality. A major advance in the classification of preeclampsia was its subdivision into early- (<34 weeks of gestation) and late-onset variants. Although they present a higher prevalence in the gestational period, the appearance of these intercurrences in the postpartum and puerperal period should not be neglected given their clinical importance. It is described a case of late preeclampsia: a 37-year-old patient, at the postpartum period, who went to emergency service after being dyspneic, torporous, peripheral cyanosis, and with pulmonary edema. The diagnosis was made not only based on the medical signs and patient-reported symptoms, but also after laboratory findings such as 24h proteinuria and blood pressure measure. Other diagnoses, as HELLP Syndrome, were excluded after normal laboratory results. Her clinical condition was made stable after being medicated with sodium nitroprusside and using a continuous positive airway pressure (CPAP) for cyanosis correction. After the preeclampsia diagnosis, at another medical center, it was added to the prescription magnesium sulfate as an eclâmpsia prophylaxis. After the seventh day of admission, without other complications, the patient was discharged from the hospital.

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References

1. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;21;376(9741):631-44. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60279-6/fulltext

2. Brasil. Ministério da Saúde Gestação de alto risco: manual técnico. 5. ed. Brasília (DF), 2012. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/gestacao_alto_risco.htm

3. Rodrigues ARM. Gravidez de alto risco: análise dos determinantes de saúde. SANARE. 2017;16(1):23-8. Disponível em: https://sanare.emnuvens.com.br/sanare/article/viewFile/1135/620

4. Souza JP, Gülmezoglu AM, Vogel J. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381:1747–55. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23683641

5. American College of Obstetricians and Gynecologists, and the Task Force on Hypertension in Pregnancy. Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122-31. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24150027.

6. Krettli WSC, Catae MA, Rocha PM, Coelho RA, Madeira RA, Leao TM, et al. Late eclampsia. RevMed Minas Gerais. 2011;21(2 Supl 4):S1-S113. Disponível em: http://www.scielo.br/pdf/rsbmt/v36n4/16734.pdf

7. Hitti J, Sienas L, Walker S, Benedetti TJ, Easterling T. Contribution of hypertension to severe ma-ternal morbidity. Am. J. Obstet. Gynecol. 2018;219(4):405.e1-405.e7. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/30012335

8. Hirshfeld-Cytron J, Lam C, Karumanchi SA, Lindheimer M. Late postpartum eclampsia: examples and review. Obstet Gynecol Surv. 2006;61(7):471-80. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/16787550

9. Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol. 2009;200(5):481.e1-7. Disponível em: https://www.ajog.org/article/S0002-9378(08)00866-1/abstract

10. Kahhale S, Francisco R, Zugaib M. Pré-eclampsia. revistadc [Internet]. 15jun.2018 [citado 3jan.2019];97(2):226-34. Available from: http://www.revistas.usp.br/revistadc/article/view/143203

11. Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J ObstetGynecolReprodBiol. 2013;170(01):1–7. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23746796

12. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982;142:159-67. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/7055180

13. Ruano R, Alves EA, Zugaib M. Sulfato de magnésio (MgSO4) no tratamento e prevenção da e-clâmpsia: qual esquema adotar? Rev. Assoc. Med. Bras. 2004;50(3):241-2. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302004000300018&lng=en&nrm=iso

14. Yung HW, Atkinson D, Smith T, Olovsson M. Differential activation of placental unfolded protein response pathways implies heterogeneity in causation of early- and lateonset pre-eclampsia. J. Pathol. 2014;262-276. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24931423

15. Grill S, Rusterholz C, Zanetti-Dällenbach R. Potential markers of preeclampsia–a re-view.ReprodBiolEndocrinol2009;7:70. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19602262

16. Alensise H, Vasapollo B, Gagliardi G, Novelli GP. Early and late preeclampsia: two different mater-nal hemodynamic states in the latent phase of the disease. Hypertension 2008;52:873-880. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/18824660

17. Ogge G, Chaiworapongsa T, Romero R, Hussein Y, Kusanovic JP, Yeo L et al. Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia. J PerinatMed 2011;39:641-52. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/21848483

18. Mori T, Watanabe K, Iwasaki A, Kimura C, Wakatsuki A. Vascular reactivity and carotid artery inti-ma media thickness (IMT) in women with early and late-onset preeclampsia and chronic hyperten-sion. PregnancyHypertens. 2015;5:147. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4713258/

19. Utsch PR, Freitas LR, Caetano O. Pré-Eclâmpsia puerperal: um relato de caso. Revista de Saúde 2017;8(1):137-138. Disponível em: http://editora.universidadedevassouras.edu.br/index.php/RS/article/view/975

Published

2020-04-27

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Section

Relato de Caso

How to Cite

1.
Brito Neto RM de, Ramos AP, Zamais LN, Carvalho TA de, Souza MCA de, Côrtes Júnior JC de S. Preeclampsia during postpartum period: a case report. Medicina (Ribeirão Preto) [Internet]. 2020 Apr. 27 [cited 2024 May 17];53(1):43-8. Available from: https://www.periodicos.usp.br/rmrp/article/view/155458