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• W4384564786 abstract "Magnesium sulfate reduces the risk of eclamptic seizures antepartum, intrapartum, and in the immediate postpartum period, however there are no studies evaluating the benefits and risks of magnesium sulfate in women with late postpartum severe hypertension only. Juxtaposed on this clinical uncertainty is the increased incidence of severe hypertension due to a rise in pregnancies complicated by advanced maternal age, obesity, chronic hypertension, diabetes, and recent protocols for intensive monitoring of blood pressure in the postpartum period. These factors have resulted in a significant increase in postpartum presentations for evaluation and management of severe hypertension, in some cases resulting in postpartum readmissions for administration of anti-hypertensive therapy and magnesium sulfate, without clear data demonstrating clinical benefit. Postpartum readmissions can have several negative consequences, including interfering with early bonding with a newborn, breastfeeding, and also utilization of scarce healthcare resources. Additionally, magnesium sulfate is associated with risks of serious cardiorespiratory depression as well as bothersome side effects, and can delay the determination of the optimal anti-hypertensive regimen, typically the most pressing clinical need during postpartum presentations of late-onset severe hypertension. Eclampsia greater than 48 hours after delivery is rare (constitutes 16% of all cases of eclampsia), and is most commonly preceded by headaches or other cerebral symptoms. In this commentary, we propose an approach to evaluating and managing patients with late-onset postpartum severe hypertension aimed at identifying those women at highest risk of end-organ injury. We recommend the short- and long-term focus for all patients with severe hypertension to be optimal management of blood pressures, with a goal of close outpatient monitoring when logistically feasible and clinically appropriate. We suggest reserving magnesium sulfate therapy for the subset of patients with neurologic symptoms, who may be at highest risk of an eclamptic seizure." @default.
• W4384564786 created "2023-07-18" @default.
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• W4384564786 date "2023-07-01" @default.
• W4384564786 modified "2023-09-25" @default.
• W4384564786 title "Is magnesium sulfate therapy warranted in all cases of late postpartum severe hypertension? A suggested approach to a clinical conundrum" @default.
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• W4384564786 doi "https://doi.org/10.1016/j.ajog.2023.07.021" @default.
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