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Unexpected post-partum hypertension
UNEXPECTED HARRY (From
POST-PARTUM M.D.,
MEYER,
HYPERTENSION
AND SAMUEL B. NADLER, PH.D., NEW ORLEANS, LA.
the Obstetrioal and Medical Medicine, Tulane
Cli?zics, lJ&uersity
l’owro I@mnary, and School of Me&&w)
M.D.,
the Department
F
of
OR the purposes of this paper, “unexpected post-partum hypertension ’ ’ is defined as an elevation of the blood pressure above physiologic limits as found by us at the routine six weeks’ post-partum examination. Elevations above 140 systolic and 90 diastolic are considered abnormal. To eliminate all ‘ ‘toxemias of pregnancy” and cardiovascular renal disease, it is also required that the prenatal and immediate post-partum pressure be normal. Elsewhere, one of us (H. M.)l has reported 23 cases of post-partum hypertension. Since that time, we have observed 28 additional eases which have confirmed our original observations and brought to light some new and interesting data. Our routine has been simple : Cases.of post-partum hypertension were carefully studied in the obstetric clinic and then referred to various departments of the outpatient clinic for special study. In most instances medical examination was followed by ophthalmoscopic examination, x-ray, electrocardiogram, blood, urine, and kidney function studies. The salient features of this condition may be noted upon reference to the tables of data. In Table I it may be noted that most of the patients are multiparas. They were Sor the most part observed during pregnancy long enough to obtain adequate control data on the blood pressure. The post-partum hypertension usually lasts six to seventeen weeks. The attainment of the maximum pressure may not occur until the sixteenth post-partum week, though usually the maximum is seen about the sixth post-partum week (Table I). TABLE I. Age II. Gravida Cases
III. IV.
Enrolled Number of prenatal visits Cases
I
18-202 i
ii
cases 111 v vi .‘.
20-3015 cases vii
viii
Maximum post-partum Weeks post partum Cases
x
xi
30-4011
cases
xiii
48231312211 First
Trimester
Second
5 3-5 4
blood
Trimester 19
Third
5-10
21 19 15
2
1 1
pressure
231
4
10
18 40
rise
6 7 8 8 10 20 3 31 4
Trimester over
6
V. Number of pregnancies with post-partum Unknown duration of post-part)um rise Known duration of post-partum hypertension Six to seventeen weeks post partum Seventeen to twenty-two weeks post partum Forty-six weeks post partum Forty-nine weeks post partum VI.
ix
11
1
16
1
232
AMERICAK
JOTTRiXAT,
OF
OBSTETRICS
A03
GYSECOLOGP
In view of the fact that we have been able t,o find post-partum hypertension only in the negress, we calculated the average pressure for narma1 white and colored patients during the prenatal and post-partum periods. One hundred case records of white and colored patients were studied in compiling the data, recorded in Table II. The average prenatal pressure was also obtained for the patients in this series who showed the unexpected post-partum rise. Two facts are apparent. First, while prenatal pressures of normal white and colared patients are about, the same, the normal colored patients tend to show a higher post-partum rise. Second, normal colored patient,s show a somewhat lower prenatal pressure than do t.hose exhibiting the unexpcctetl post-partum rise (Table IT).
_____---1. Normal patients a. Colored (a) Prenatal 1. Systolic
109.48
c
7.39
3. Diastolic
09.0
2
5.1
Post partum 1. Systolic
114.15
i
8.1
0. Diastolic
73.9
t-
7.3
+
ti.0
t-
4.2
2. Diastolic (11)
Post partum 1. Systolic 2. Diastolic
I). White (a) Prenatal 1. Systolic
(b)
Il.
Patients (a)
with post-partum Prenatal 1. Systolic 2. Diastolic
hypertension 1162 7x3s
Tables III to X represent data from selected cases of post-partum hypertension designed to illustrate the salient features of this syndrome. Table III shows that the maximum pressure may occur as early as six weeks post partum, and Table IV reveals that the maximum rise may not occur until much later. This post-partum rise does return to normal and has been observed to remain there as indicated in Table V. While the duration of this hypertension is usually about ten weeks, it may last twenty-five weeks or more (Table VI). The case reported in Table VII supplies a number of interesting observations. The patient’s pressure during pregnancy and labor was somewhat lower than it was a year previously. At no time during or after pregnancy was she aware of any illness despite the fact that she exhibited a marked unexpected post-partum rise lasting at least forty-two weeks. Observed in
MEYER
AND
NADLER:
UNEXPECTED
POST-PARTUM
TABLE 152-491, aged 20, Blood pressure Blood
pressure
primipara, during during
trimester,
labor
Immediately post partum Six weeks post partum Twelve weeks post partum Thirteen weeks post partum Fifty-one weeks Blood picture, chemistry, urinalysis, date. and Dhvsical examination
114-383, aged 29, (1937) Blood pressure
gravida during
v,
trimester,
19
pregnancy
Blood pressure during labor Blood pressure 6 weeks post partum Blood pressure 10 weeks post partum Blood pressure 11 weeks post partum Blood pressure 12 weeks post partum Blood pressure 13 weeks post partum Blood pressure 14 weeks post partum Blood 15 weeks post partum pressure Blood pressure 16 weeks post parturn Blood pressure 18 weeks post partum Blood pressure 20 weeks post partum Blood 79 weeks post partum pressure Physical examination and laboratory tive.
14942, aged 38, gravida Blood pressure during
8 prenatal visits 112-120 70-86 130-136 70-80 135/85 160/120 150/105 130/85 US/88 eyegrounds, chest all negative.
IV
first
TABLE ii, second pregnancy
233
III
second pregnancy
TABLE
HYPERTENSION
test
prenatal
visits
108-124 70-80 132/84 146/94 154/100 170/110 160/110 118/96 130/95 130/88 115/80 130/85 130/85 122/80 entirely nega-
V trimester,
13
Blood pressure six weeks post partum Seven weeks post partum Thirteen weeks post partum Fourteen weeks post partum One hundred twenty-four weeks post partum One hundred thirty-four weeks post partum One hundred thirty-six weeks post partum Wassermann, Fishberg, urinalysis, and physical tion negative.
prenatal visits go-114 60-72 __ .~ 192/110 190/110 152/110 122/80 116/80 138/80 130/80 examina-
the postpartum period, a diagnosis of arteriosclerosis of the retinal vessels and hypertensive vascular disease was made. Table VIII illustrates that postpartum hypertension can and does recur with succeeding pregnaneiee and that a repetition of the syndromes may be less severe than the preceding one. This speaks for a functional disorder rather than an organic disease. A5 a matter of fact, the postpartum rise may be entirely absent in subsequent pregnancies as shown in Table IX. In Table X it can be seen that the unexpected rise occurs in 3 suoeessive pregnancies after a normal postpartum blood pressure in the first pregnancy.
234
AMERICAS
JOURiYht,
OF
OBSTETRICS
TABLE 13574,
aged 32, gravida Blood pressure during
rZND
GP?XCOIAOGY
VI
x, second pregnancy
trimester,
Blood pressure six weeks post partum Blood pressure seven weeks post par-turn Twenty-four weeks post partum Twenty-five weeks post partum Forty-six weeks post partum Seventv-five weeks post partum Four
months prior to pregnamy the 142/96. laboratory and physical examinations TABLE
blood
5 prenatal visits 115-148 70-84 170/105 I Go/ion x54/94 160/100 120/90 120/90 pressure
was
negative.
VII -
X7377, aged 32, gravida viii, second Blood pressure during pregnancy Blood
pressure
during
trimester,
labor
1’) prenatal visits 120-134 68-84 108-118 68-88 148/110 ?00/130 220/120 160,WO 180/115 164/94 156/100
Blood pressure six weeks post partum Nine weeks post partum Twenty weeks post partmu Twenty-eight weeks post partum Thirty-six weeks post partum Thirty-eight weeks post partum Forty-two weeks post partum One year before the onset of pregnancy the blood pressure was 140-154/80-88. Blood picture, urinalysis, Wassermann, chest plate, an11 basal metabolism negative. Eye grounds, marked arteriosclerosis. Medical diagnosis : hypertensive vascular disease.
TABLE 110-492, aged 28, (1934) Good pressure
VIII
gravida
v,
first
during
pregnancy
trimester,
12
prenatal
visits
100-122 60-78 Blood pressure six weeks post partum 768/120 Blood pressure eight weeks post partum 126;SS Twelve weeks post partum 120/90 Sixteen weeks post partum 124/92 11936.37), aged 31, gravida vi, first trimeste !r, 12 prenatal visit,s Blood pressure during pregnancy 100-118 60-80 Blood pressure during labor 130/96 Blood pressure six weeks post partum 146/100 Seven weeks post partum 140/105 Thirteen weeks post partum 138/90 Twenty-six weeks post partum 136;/94 Thirtv-seven weeks nest oartum 136/96 Laboratory and physical examination negative.
Certain facts not recorded in the tables are worthy of comment. Upon survey of the literature, it was found that “unexpected post-partum hypertension” has been recorded on only two occasions.1g 2 Stout found
MEYER
AND
NADLER:
UNEXPECTED
POST-PARTUM
TABLE
HYPERTENSION
%85
IX
90419
The blood pressure during three pregnancies from 1928 to 1933 never exceeded 128/80, an average of 100 to 116. 1935, aged 27, gravida iv, second trimester, 14 prenatal visits 112-136 Blood pressure during pregnancy 70-84 Blood pressure six weeks post partum 180/110 Blood pressure ten weeks post partum 172/114 Blood pressure fourteen weeks post partum 192/112 180/120 Blood pressure eighteen weeks post par-turn 1937, aged 29, gravida v, second trimester, 14 prenatal visits Blood pressure during pregnancy 110-132 70-86 Blood pressure six weeks post partum 120/78 Blood pressure ten weeks post partum 120/86 Blood pressure one year post partum 126/88 TABLE 136-490, aged 28, (1934-35) Blood pressure Blood
(1936)
pressure
-gravida
i,
third
during
pregnancy
during
labor
X trimester,
Blood pressure six weeks post partum Aged 29, gravida ii, second trimester, Blood pressure during pregnancy Blood
pressure
during
labor
5 prenatal
visits
122-140 70-80 124-138 80-94 120/72 15 prenatal visits 108-130 60-84 122-128 70-84 148/98 144/96 150/80
Blood pressure six weeks post partum Blood pressure seven weeks post partum Blood pressure eleven weeks post partum Laboratory and physical examination negative. (1937-38) Aged 31, gravida iii, first trimester, 22 prenatal visits Blood pressure during pregnancy 112-134 58-78 Blood pressure during ‘Labor 110-122 78-84 Immediately post par-turn 126/80 Six weeks post partum 160/105 Ten weeks post partum’ 130/95 Laboratory and physical examinations negative. (1938-39) Aged 32 gravida iv, second trimester, 16 prenatal visits Blood pressure during pregnancy 112-140 60-80 Blood pressure during labor 130-144 84-100 Immediately post partum 126/80 Six weeks post partum 140/100 Laboratory and physical examinations negative.
that it occurs in white as well as colored patients; we have found it only in colored patients. When these patients were observed in the medical clinic, a diagnosis of hypertensive vascular disease seemed warranted in all instances, although only two patients in the entire series showed any vascular damage and that was limited to the eye grounds, The seeming self-limitation
236
AMERICAX
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
In no other case was a diagnosis sugof the syndrome was significant. post-partum hypergested. The possibility of confusing “unexpected tension” and hypertensive vascular disease (essential hypertension) is a real one and the guarded prognosis of the latter given t,o the post-partum patient is entirely unwarranted. We have as yet failed to observe congestive heart .failure in any case of post-partum hypertension. The possible relationship of this syndrome to the curious post-partum congestive heart failure reported3-5 is at present quite obscure. SVMMARY
1. “Unexpected post-partum hypertension,” coined term, is an idiopathic syndrome, relatively unstudied, and found by us only in t.he colored race. 2. The findings in 51 cases are summarized in this report. 3. Most of the patients are multiparas. 4. Practically all of the patients were observed during the prenatal period for an adequate time period to allow for evaluation of the postpartum blood pressure. 5. The duration of the post-part,mn rise is about six to seventeen weeks. It is self-limited. 6. The ma.ximum pressure while usually observed six weeks’ post part’um may be as late as 16 weeks post partum. 7. The average normal colored patient shows a slightly higher postpartum pressure than does the average normal white patient. The average normal colored patient shows a lower prenat.al pressure than domesthe colored patient who develops “ unexpected post-partum hypertension. ’ ’ 8. The syndrome map or map not be present at subsequent pregnancies and if so, may be more or less severe than the previous occurrence. 9. No relationship of t,his syndrome to post-partum heart failure (idiopathic) has been apparent. 10. No etiologic factor is evident; there is some suggestion that it is purely functional. REFERENCES
(1) Meyer, Haery: AM. J. OBST. & GYr;EC. 35: 150, 1938. (2) Stout, M. L.: Ibid. 27: 730, 1934. (3) Musser, J. H., Sodeman, W. 4., and T’urnm, R. H.: Ann. Int. Med. 12: 6, 1938. (4) Hull, G., und Hafkesbrhg, E.: New Orleans M. & S. J. 89: 550, 1937. (5) Gothy, B. A., McMilZm, T. M., am3 Bitlet, S.: Am. J. M. SC. 194: 185, 1937.
POST-PARTUM M.D.,
MEYER,
HYPERTENSION
AND SAMUEL B. NADLER, PH.D., NEW ORLEANS, LA.
the Obstetrioal and Medical Medicine, Tulane
Cli?zics, lJ&uersity
l’owro I@mnary, and School of Me&&w)
M.D.,
the Department
F
of
OR the purposes of this paper, “unexpected post-partum hypertension ’ ’ is defined as an elevation of the blood pressure above physiologic limits as found by us at the routine six weeks’ post-partum examination. Elevations above 140 systolic and 90 diastolic are considered abnormal. To eliminate all ‘ ‘toxemias of pregnancy” and cardiovascular renal disease, it is also required that the prenatal and immediate post-partum pressure be normal. Elsewhere, one of us (H. M.)l has reported 23 cases of post-partum hypertension. Since that time, we have observed 28 additional eases which have confirmed our original observations and brought to light some new and interesting data. Our routine has been simple : Cases.of post-partum hypertension were carefully studied in the obstetric clinic and then referred to various departments of the outpatient clinic for special study. In most instances medical examination was followed by ophthalmoscopic examination, x-ray, electrocardiogram, blood, urine, and kidney function studies. The salient features of this condition may be noted upon reference to the tables of data. In Table I it may be noted that most of the patients are multiparas. They were Sor the most part observed during pregnancy long enough to obtain adequate control data on the blood pressure. The post-partum hypertension usually lasts six to seventeen weeks. The attainment of the maximum pressure may not occur until the sixteenth post-partum week, though usually the maximum is seen about the sixth post-partum week (Table I). TABLE I. Age II. Gravida Cases
III. IV.
Enrolled Number of prenatal visits Cases
I
18-202 i
ii
cases 111 v vi .‘.
20-3015 cases vii
viii
Maximum post-partum Weeks post partum Cases
x
xi
30-4011
cases
xiii
48231312211 First
Trimester
Second
5 3-5 4
blood
Trimester 19
Third
5-10
21 19 15
2
1 1
pressure
231
4
10
18 40
rise
6 7 8 8 10 20 3 31 4
Trimester over
6
V. Number of pregnancies with post-partum Unknown duration of post-part)um rise Known duration of post-partum hypertension Six to seventeen weeks post partum Seventeen to twenty-two weeks post partum Forty-six weeks post partum Forty-nine weeks post partum VI.
ix
11
1
16
1
232
AMERICAK
JOTTRiXAT,
OF
OBSTETRICS
A03
GYSECOLOGP
In view of the fact that we have been able t,o find post-partum hypertension only in the negress, we calculated the average pressure for narma1 white and colored patients during the prenatal and post-partum periods. One hundred case records of white and colored patients were studied in compiling the data, recorded in Table II. The average prenatal pressure was also obtained for the patients in this series who showed the unexpected post-partum rise. Two facts are apparent. First, while prenatal pressures of normal white and colared patients are about, the same, the normal colored patients tend to show a higher post-partum rise. Second, normal colored patient,s show a somewhat lower prenatal pressure than do t.hose exhibiting the unexpcctetl post-partum rise (Table IT).
_____---1. Normal patients a. Colored (a) Prenatal 1. Systolic
109.48
c
7.39
3. Diastolic
09.0
2
5.1
Post partum 1. Systolic
114.15
i
8.1
0. Diastolic
73.9
t-
7.3
+
ti.0
t-
4.2
2. Diastolic (11)
Post partum 1. Systolic 2. Diastolic
I). White (a) Prenatal 1. Systolic
(b)
Il.
Patients (a)
with post-partum Prenatal 1. Systolic 2. Diastolic
hypertension 1162 7x3s
Tables III to X represent data from selected cases of post-partum hypertension designed to illustrate the salient features of this syndrome. Table III shows that the maximum pressure may occur as early as six weeks post partum, and Table IV reveals that the maximum rise may not occur until much later. This post-partum rise does return to normal and has been observed to remain there as indicated in Table V. While the duration of this hypertension is usually about ten weeks, it may last twenty-five weeks or more (Table VI). The case reported in Table VII supplies a number of interesting observations. The patient’s pressure during pregnancy and labor was somewhat lower than it was a year previously. At no time during or after pregnancy was she aware of any illness despite the fact that she exhibited a marked unexpected post-partum rise lasting at least forty-two weeks. Observed in
MEYER
AND
NADLER:
UNEXPECTED
POST-PARTUM
TABLE 152-491, aged 20, Blood pressure Blood
pressure
primipara, during during
trimester,
labor
Immediately post partum Six weeks post partum Twelve weeks post partum Thirteen weeks post partum Fifty-one weeks Blood picture, chemistry, urinalysis, date. and Dhvsical examination
114-383, aged 29, (1937) Blood pressure
gravida during
v,
trimester,
19
pregnancy
Blood pressure during labor Blood pressure 6 weeks post partum Blood pressure 10 weeks post partum Blood pressure 11 weeks post partum Blood pressure 12 weeks post partum Blood pressure 13 weeks post partum Blood pressure 14 weeks post partum Blood 15 weeks post partum pressure Blood pressure 16 weeks post parturn Blood pressure 18 weeks post partum Blood pressure 20 weeks post partum Blood 79 weeks post partum pressure Physical examination and laboratory tive.
14942, aged 38, gravida Blood pressure during
8 prenatal visits 112-120 70-86 130-136 70-80 135/85 160/120 150/105 130/85 US/88 eyegrounds, chest all negative.
IV
first
TABLE ii, second pregnancy
233
III
second pregnancy
TABLE
HYPERTENSION
test
prenatal
visits
108-124 70-80 132/84 146/94 154/100 170/110 160/110 118/96 130/95 130/88 115/80 130/85 130/85 122/80 entirely nega-
V trimester,
13
Blood pressure six weeks post partum Seven weeks post partum Thirteen weeks post partum Fourteen weeks post partum One hundred twenty-four weeks post partum One hundred thirty-four weeks post partum One hundred thirty-six weeks post partum Wassermann, Fishberg, urinalysis, and physical tion negative.
prenatal visits go-114 60-72 __ .~ 192/110 190/110 152/110 122/80 116/80 138/80 130/80 examina-
the postpartum period, a diagnosis of arteriosclerosis of the retinal vessels and hypertensive vascular disease was made. Table VIII illustrates that postpartum hypertension can and does recur with succeeding pregnaneiee and that a repetition of the syndromes may be less severe than the preceding one. This speaks for a functional disorder rather than an organic disease. A5 a matter of fact, the postpartum rise may be entirely absent in subsequent pregnancies as shown in Table IX. In Table X it can be seen that the unexpected rise occurs in 3 suoeessive pregnancies after a normal postpartum blood pressure in the first pregnancy.
234
AMERICAS
JOURiYht,
OF
OBSTETRICS
TABLE 13574,
aged 32, gravida Blood pressure during
rZND
GP?XCOIAOGY
VI
x, second pregnancy
trimester,
Blood pressure six weeks post partum Blood pressure seven weeks post par-turn Twenty-four weeks post partum Twenty-five weeks post partum Forty-six weeks post partum Seventv-five weeks post partum Four
months prior to pregnamy the 142/96. laboratory and physical examinations TABLE
blood
5 prenatal visits 115-148 70-84 170/105 I Go/ion x54/94 160/100 120/90 120/90 pressure
was
negative.
VII -
X7377, aged 32, gravida viii, second Blood pressure during pregnancy Blood
pressure
during
trimester,
labor
1’) prenatal visits 120-134 68-84 108-118 68-88 148/110 ?00/130 220/120 160,WO 180/115 164/94 156/100
Blood pressure six weeks post partum Nine weeks post partum Twenty weeks post partmu Twenty-eight weeks post partum Thirty-six weeks post partum Thirty-eight weeks post partum Forty-two weeks post partum One year before the onset of pregnancy the blood pressure was 140-154/80-88. Blood picture, urinalysis, Wassermann, chest plate, an11 basal metabolism negative. Eye grounds, marked arteriosclerosis. Medical diagnosis : hypertensive vascular disease.
TABLE 110-492, aged 28, (1934) Good pressure
VIII
gravida
v,
first
during
pregnancy
trimester,
12
prenatal
visits
100-122 60-78 Blood pressure six weeks post partum 768/120 Blood pressure eight weeks post partum 126;SS Twelve weeks post partum 120/90 Sixteen weeks post partum 124/92 11936.37), aged 31, gravida vi, first trimeste !r, 12 prenatal visit,s Blood pressure during pregnancy 100-118 60-80 Blood pressure during labor 130/96 Blood pressure six weeks post partum 146/100 Seven weeks post partum 140/105 Thirteen weeks post partum 138/90 Twenty-six weeks post partum 136;/94 Thirtv-seven weeks nest oartum 136/96 Laboratory and physical examination negative.
Certain facts not recorded in the tables are worthy of comment. Upon survey of the literature, it was found that “unexpected post-partum hypertension” has been recorded on only two occasions.1g 2 Stout found
MEYER
AND
NADLER:
UNEXPECTED
POST-PARTUM
TABLE
HYPERTENSION
%85
IX
90419
The blood pressure during three pregnancies from 1928 to 1933 never exceeded 128/80, an average of 100 to 116. 1935, aged 27, gravida iv, second trimester, 14 prenatal visits 112-136 Blood pressure during pregnancy 70-84 Blood pressure six weeks post partum 180/110 Blood pressure ten weeks post partum 172/114 Blood pressure fourteen weeks post partum 192/112 180/120 Blood pressure eighteen weeks post par-turn 1937, aged 29, gravida v, second trimester, 14 prenatal visits Blood pressure during pregnancy 110-132 70-86 Blood pressure six weeks post partum 120/78 Blood pressure ten weeks post partum 120/86 Blood pressure one year post partum 126/88 TABLE 136-490, aged 28, (1934-35) Blood pressure Blood
(1936)
pressure
-gravida
i,
third
during
pregnancy
during
labor
X trimester,
Blood pressure six weeks post partum Aged 29, gravida ii, second trimester, Blood pressure during pregnancy Blood
pressure
during
labor
5 prenatal
visits
122-140 70-80 124-138 80-94 120/72 15 prenatal visits 108-130 60-84 122-128 70-84 148/98 144/96 150/80
Blood pressure six weeks post partum Blood pressure seven weeks post partum Blood pressure eleven weeks post partum Laboratory and physical examination negative. (1937-38) Aged 31, gravida iii, first trimester, 22 prenatal visits Blood pressure during pregnancy 112-134 58-78 Blood pressure during ‘Labor 110-122 78-84 Immediately post par-turn 126/80 Six weeks post partum 160/105 Ten weeks post partum’ 130/95 Laboratory and physical examinations negative. (1938-39) Aged 32 gravida iv, second trimester, 16 prenatal visits Blood pressure during pregnancy 112-140 60-80 Blood pressure during labor 130-144 84-100 Immediately post partum 126/80 Six weeks post partum 140/100 Laboratory and physical examinations negative.
that it occurs in white as well as colored patients; we have found it only in colored patients. When these patients were observed in the medical clinic, a diagnosis of hypertensive vascular disease seemed warranted in all instances, although only two patients in the entire series showed any vascular damage and that was limited to the eye grounds, The seeming self-limitation
236
AMERICAX
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
In no other case was a diagnosis sugof the syndrome was significant. post-partum hypergested. The possibility of confusing “unexpected tension” and hypertensive vascular disease (essential hypertension) is a real one and the guarded prognosis of the latter given t,o the post-partum patient is entirely unwarranted. We have as yet failed to observe congestive heart .failure in any case of post-partum hypertension. The possible relationship of this syndrome to the curious post-partum congestive heart failure reported3-5 is at present quite obscure. SVMMARY
1. “Unexpected post-partum hypertension,” coined term, is an idiopathic syndrome, relatively unstudied, and found by us only in t.he colored race. 2. The findings in 51 cases are summarized in this report. 3. Most of the patients are multiparas. 4. Practically all of the patients were observed during the prenatal period for an adequate time period to allow for evaluation of the postpartum blood pressure. 5. The duration of the post-part,mn rise is about six to seventeen weeks. It is self-limited. 6. The ma.ximum pressure while usually observed six weeks’ post part’um may be as late as 16 weeks post partum. 7. The average normal colored patient shows a slightly higher postpartum pressure than does the average normal white patient. The average normal colored patient shows a lower prenat.al pressure than domesthe colored patient who develops “ unexpected post-partum hypertension. ’ ’ 8. The syndrome map or map not be present at subsequent pregnancies and if so, may be more or less severe than the previous occurrence. 9. No relationship of t,his syndrome to post-partum heart failure (idiopathic) has been apparent. 10. No etiologic factor is evident; there is some suggestion that it is purely functional. REFERENCES
(1) Meyer, Haery: AM. J. OBST. & GYr;EC. 35: 150, 1938. (2) Stout, M. L.: Ibid. 27: 730, 1934. (3) Musser, J. H., Sodeman, W. 4., and T’urnm, R. H.: Ann. Int. Med. 12: 6, 1938. (4) Hull, G., und Hafkesbrhg, E.: New Orleans M. & S. J. 89: 550, 1937. (5) Gothy, B. A., McMilZm, T. M., am3 Bitlet, S.: Am. J. M. SC. 194: 185, 1937.