Diferencia entre revisiones de «Postpartum emergencies»

Sin resumen de edición
(Expanded with concise EM-focused content: hemorrhage 4Ts, endometritis, postpartum preeclampsia, cardiomyopathy, VTE, psychosis)
 
(No se muestran 8 ediciones intermedias de 2 usuarios)
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#[[Post-Partum Hemorrhage]]
==Background==
#[[Uterine Rupture]]
*Postpartum period is defined as up to 6 weeks after delivery (some complications up to 12 weeks)
#[[Endometritis (Postpartum)]]
*Postpartum patients may present to the ED rather than to OB for emergent complications
#[[Amniotic Fluid Embolus]]
*Key EM concern: '''postpartum hemorrhage''' is the most common cause of maternal death worldwide
#[[Preeclampsia, Eclampsia, and HELLP]]
#[[Peripartum Cardiomyopathy]]


[[Category:OB/GYN]]
==Emergencies==
{{Postpartum emergencies DDX}}
 
===[[Postpartum hemorrhage]]===
*Defined as >500 mL blood loss (vaginal delivery) or >1000 mL (cesarean)
*Most common cause: '''uterine atony''' (70-80%) — risk factors include prolonged labor, overdistension, chorioamnionitis
*Other causes (4 T's): Tone (atony), Trauma (lacerations, uterine rupture), Tissue (retained products), Thrombin (coagulopathy)
*Management: uterine massage, uterotonics ([[oxytocin]], [[methylergonovine]], [[misoprostol]], [[carboprost]]), transfusion, OB consultation, may need surgical intervention
 
===[[Postpartum endometritis]]===
*Polymicrobial uterine infection, typically 2-10 days after delivery
*Higher risk after cesarean section
*Fever, uterine tenderness, purulent lochia
*Treatment: IV broad-spectrum antibiotics (clindamycin + gentamicin is classic regimen)
 
===[[Postpartum preeclampsia]] / Eclampsia===
*Can occur up to 6 weeks postpartum, even without antepartum diagnosis
*Headache, visual changes, RUQ pain, hypertension, proteinuria
*Treat with IV [[magnesium sulfate]] for seizure prophylaxis/treatment and antihypertensives
 
===Peripartum Cardiomyopathy===
*Heart failure occurring in last month of pregnancy to 5 months postpartum
*Presents with dyspnea, edema, orthopnea
*Echocardiography for diagnosis; manage as heart failure
 
===[[DVT]] / [[Pulmonary Embolism]]===
*Postpartum period is highest risk for VTE
*Low threshold for workup — D-dimer less useful in postpartum period
*CTA for suspected PE; compression US for DVT
 
===Postpartum Depression / Psychosis===
*Depression: common (10-15%), screen with Edinburgh Postnatal Depression Scale
*Psychosis: rare but dangerous — onset typically 2-4 weeks postpartum; hallucinations, delusions, risk of harm to self/infant → psychiatric emergency, admit
 
===Other===
*Mastitis / breast abscess
*Wound infection / dehiscence (cesarean)
*Ovarian vein thrombophlebitis (septic pelvic thrombophlebitis)
*Urinary retention
 
==Disposition==
*Low threshold for OB consultation
*Admit: hemorrhage, endometritis, preeclampsia/eclampsia, cardiomyopathy, PE, psychosis
*Discharge: mild mastitis, minor wound issues — with close OB follow-up and return precautions
 
==See Also==
*[[Emergent delivery]]
*[[Postpartum hemorrhage]]
*[[Preeclampsia]]
*[[Vaginal bleeding]]
 
==References==
<references/>
 
[[Category:OBGYN]]

Revisión actual - 00:35 21 mar 2026

Background

  • Postpartum period is defined as up to 6 weeks after delivery (some complications up to 12 weeks)
  • Postpartum patients may present to the ED rather than to OB for emergent complications
  • Key EM concern: postpartum hemorrhage is the most common cause of maternal death worldwide

Emergencies

3rd Trimester/Postpartum Emergencies

Postpartum hemorrhage

  • Defined as >500 mL blood loss (vaginal delivery) or >1000 mL (cesarean)
  • Most common cause: uterine atony (70-80%) — risk factors include prolonged labor, overdistension, chorioamnionitis
  • Other causes (4 T's): Tone (atony), Trauma (lacerations, uterine rupture), Tissue (retained products), Thrombin (coagulopathy)
  • Management: uterine massage, uterotonics (oxytocin, methylergonovine, misoprostol, carboprost), transfusion, OB consultation, may need surgical intervention

Postpartum endometritis

  • Polymicrobial uterine infection, typically 2-10 days after delivery
  • Higher risk after cesarean section
  • Fever, uterine tenderness, purulent lochia
  • Treatment: IV broad-spectrum antibiotics (clindamycin + gentamicin is classic regimen)

Postpartum preeclampsia / Eclampsia

  • Can occur up to 6 weeks postpartum, even without antepartum diagnosis
  • Headache, visual changes, RUQ pain, hypertension, proteinuria
  • Treat with IV magnesium sulfate for seizure prophylaxis/treatment and antihypertensives

Peripartum Cardiomyopathy

  • Heart failure occurring in last month of pregnancy to 5 months postpartum
  • Presents with dyspnea, edema, orthopnea
  • Echocardiography for diagnosis; manage as heart failure

DVT / Pulmonary Embolism

  • Postpartum period is highest risk for VTE
  • Low threshold for workup — D-dimer less useful in postpartum period
  • CTA for suspected PE; compression US for DVT

Postpartum Depression / Psychosis

  • Depression: common (10-15%), screen with Edinburgh Postnatal Depression Scale
  • Psychosis: rare but dangerous — onset typically 2-4 weeks postpartum; hallucinations, delusions, risk of harm to self/infant → psychiatric emergency, admit

Other

  • Mastitis / breast abscess
  • Wound infection / dehiscence (cesarean)
  • Ovarian vein thrombophlebitis (septic pelvic thrombophlebitis)
  • Urinary retention

Disposition

  • Low threshold for OB consultation
  • Admit: hemorrhage, endometritis, preeclampsia/eclampsia, cardiomyopathy, PE, psychosis
  • Discharge: mild mastitis, minor wound issues — with close OB follow-up and return precautions

See Also

References

Obtenido de «https://www.wikem.org/w/index.php?title=Postpartum_emergencies&oldid=387618»