Postpartum subarachnoid hemorrhage – questions on gestational hypertension diagnosis and treatment threshold: A case report
Hypertensive disorders of pregnancy (HDP) are a leading cause of morbidity and mortality for pregnant patients, but how aggressively to address non-severe hypertension in pregnancy remains controversial. The American College of Obstetrics and Gynecology (ACOG) currently recommends a blood pressure t...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Case Reports in Women's Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214911223000930 |
| _version_ | 1797399073381154816 |
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| author | Elana A. King-Nakaoka Heather M. Beasley Stephen R. Kessinger David C. Pfeiffer |
| author_facet | Elana A. King-Nakaoka Heather M. Beasley Stephen R. Kessinger David C. Pfeiffer |
| author_sort | Elana A. King-Nakaoka |
| collection | DOAJ |
| description | Hypertensive disorders of pregnancy (HDP) are a leading cause of morbidity and mortality for pregnant patients, but how aggressively to address non-severe hypertension in pregnancy remains controversial. The American College of Obstetrics and Gynecology (ACOG) currently recommends a blood pressure treatment threshold of 140/90 mmHg during pregnancy. However, 2017 American College of Cardiology/American Heart Association (ACC-AHA) guidelines define stage 1 hypertension by blood pressures of >130/80 mmHg within the general population. There is now an understudied population of pregnant patients considered to have stage 1 hypertension by ACC-AHA guidelines but who do not meet the treatment threshold by ACOG's standards. This article presents a patient who met ACC-AHA-defined stage 1 hypertension throughout her pregnancy and went on to develop severe hypertension and a postpartum subarachnoid hemorrhage (SAH) secondary to venous hemorrhage. She presented to the emergency department 17 days postpartum complaining of an extreme headache and with a blood pressure of 230/125 mmHg. Magnetic resonance imaging showed SAH in the parietal region adjacent to the superior sagittal sinus. Magnesium and labetalol were administered followed by a clevidipine drip. The patient was continued on antihypertensives and made a full recovery. This article's objective is to draw attention to the urgent need for increased clarity of practice guidelines, consensus between societies, and further study of peripartum health outcomes for pregnant patients defined as having stage 1 hypertension by 2017 ACC-AHA criteria. |
| first_indexed | 2024-03-09T01:34:12Z |
| format | Article |
| id | doaj.art-5a8285f720fa4f039d8cfb45f6911ed2 |
| institution | Directory Open Access Journal |
| issn | 2214-9112 |
| language | English |
| last_indexed | 2024-03-09T01:34:12Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Case Reports in Women's Health |
| spelling | doaj.art-5a8285f720fa4f039d8cfb45f6911ed22023-12-09T06:06:27ZengElsevierCase Reports in Women's Health2214-91122023-12-0140e00569Postpartum subarachnoid hemorrhage – questions on gestational hypertension diagnosis and treatment threshold: A case reportElana A. King-Nakaoka0Heather M. Beasley1Stephen R. Kessinger2David C. Pfeiffer3WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844-4061, USAWWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844-4061, USASt. Joseph Regional Medical Center, 415 6th Street, Lewiston, ID 83501, USAWWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844-4061, USA; Corresponding author at: WWAMI Medical Education Program, University of Idaho, 875 Perimeter Drive, Moscow, Idaho 83844-4061, USA.Hypertensive disorders of pregnancy (HDP) are a leading cause of morbidity and mortality for pregnant patients, but how aggressively to address non-severe hypertension in pregnancy remains controversial. The American College of Obstetrics and Gynecology (ACOG) currently recommends a blood pressure treatment threshold of 140/90 mmHg during pregnancy. However, 2017 American College of Cardiology/American Heart Association (ACC-AHA) guidelines define stage 1 hypertension by blood pressures of >130/80 mmHg within the general population. There is now an understudied population of pregnant patients considered to have stage 1 hypertension by ACC-AHA guidelines but who do not meet the treatment threshold by ACOG's standards. This article presents a patient who met ACC-AHA-defined stage 1 hypertension throughout her pregnancy and went on to develop severe hypertension and a postpartum subarachnoid hemorrhage (SAH) secondary to venous hemorrhage. She presented to the emergency department 17 days postpartum complaining of an extreme headache and with a blood pressure of 230/125 mmHg. Magnetic resonance imaging showed SAH in the parietal region adjacent to the superior sagittal sinus. Magnesium and labetalol were administered followed by a clevidipine drip. The patient was continued on antihypertensives and made a full recovery. This article's objective is to draw attention to the urgent need for increased clarity of practice guidelines, consensus between societies, and further study of peripartum health outcomes for pregnant patients defined as having stage 1 hypertension by 2017 ACC-AHA criteria.http://www.sciencedirect.com/science/article/pii/S2214911223000930Postpartum subarachnoid hemorrhageGestational hypertensionHypertensive disorders of pregnancy |
| spellingShingle | Elana A. King-Nakaoka Heather M. Beasley Stephen R. Kessinger David C. Pfeiffer Postpartum subarachnoid hemorrhage – questions on gestational hypertension diagnosis and treatment threshold: A case report Case Reports in Women's Health Postpartum subarachnoid hemorrhage Gestational hypertension Hypertensive disorders of pregnancy |
| title | Postpartum subarachnoid hemorrhage – questions on gestational hypertension diagnosis and treatment threshold: A case report |
| title_full | Postpartum subarachnoid hemorrhage – questions on gestational hypertension diagnosis and treatment threshold: A case report |
| title_fullStr | Postpartum subarachnoid hemorrhage – questions on gestational hypertension diagnosis and treatment threshold: A case report |
| title_full_unstemmed | Postpartum subarachnoid hemorrhage – questions on gestational hypertension diagnosis and treatment threshold: A case report |
| title_short | Postpartum subarachnoid hemorrhage – questions on gestational hypertension diagnosis and treatment threshold: A case report |
| title_sort | postpartum subarachnoid hemorrhage questions on gestational hypertension diagnosis and treatment threshold a case report |
| topic | Postpartum subarachnoid hemorrhage Gestational hypertension Hypertensive disorders of pregnancy |
| url | http://www.sciencedirect.com/science/article/pii/S2214911223000930 |
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