Although severe postpartum hypertension usually follows labor and delivery complicated by hypertension, 8 percent of women develop de novo hypertension postpartum (Goel, 2015). In either case, if diiculty arises in controlling severe hypertension or if intravenous hydralazine or labetalol are being used repeatedly, then oral regimens can be given. Examples include labetalol or another 3-blocker, or nifedipine or another calcium-channel blocker (Sharma, 2017). Women so treated are less likely to require readmission (Hirshberg, 2016). Persistent or refractory hypertension is likely aggravated by mobilization of pathological interstitial fluid and redistribution into the intravenous compartment, underlying chronic hypertension, or usually both (Sibai, 2012; Tan, 2002). Chronic, but not sporadic, administration of some nonsteroidal antiinflammatory drugs, namely ibuprofen, may aggravate postpartum hypertension in those with preeclampsia (Vigil-De Gracia, 2017; Viteri, 2017). In women with chronic hypertension and let-ventricular hypertrophy, severe postpartum hypertension can cause pulmonary edema from cardiac failure (Cunningham, 1986,2012; Sibai, 1987a).
Because persistence of severe hypertension corresponds to the onset and length of diuresis and extracellular fluid mobilization, it seems logical that furosemide-augmented diuresis might serve to hasten blood pressure control. One randomized trial included 264 postpartum preeclamptic women who, ater onset of spontaneous diuresis, were assigned to 20-mg oral furosemide given daily or to no therapy (Ascarelli, 2005). Women with mild disease had similar blood pressure control regardless of whether they received treatment or placebo. However, ater 2 days, women with severe preeclampsia who were treated, compared with those receiving placebo, had a lower mean systolic blood pressure-142 versus 153 mm Hg. They also less frequently required supplemental antihypertensive therapy during the remainder of hospitalization-14 versus 26 percent, respectively. In a recent randomized study, Veena and colleagues (2017) treated severe postpartum eclampsia with nifedipine plus furosemide or nifedipine alone. They reported that this prophylactic therapy signiicantly lowered the need for an additional antihypertensive-26 versus 8 percent, respectively.
We use a simple method to estimate excessive extracellular! interstitial luid. he posparum weight is compared with the most recentprenatal weight, either from the last clinic visit or on admission for delivery. Typically, soon ater delivery, maternal weight should be reduced by at least 10 to 15 pounds depending on newborn and placental weight, amnionic luid volume, and blood loss. Because of various interventions, especially intravenous crystalloid inusions given with labor epidural analgesia or during operative vaginal or cesarean delivery, women with severe preeclampsia oten have an immediate postpartum weight in excess of their st prenatal weight. If this weight increase is associated with severe persistent postpartum hypertension, then diuresis with intravenous urosemide is usually helpul in controlling blood pressure.