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DRG Category: 765
Mean LOS: 5.2 days
Description SURGICAL: Cesarean Section with CC or Major CC
DRG Category: 775
Mean LOS: 2.3 days
Description MEDICAL: Vaginal Delivery without Complicating Diagnoses
Preeclampsia is a pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation that affects approximately 7% of all pregnant women. It is characterized by hypertension (blood pressure [BP] > 140/90) and proteinuria (300 mg in 24 hours or 1+ dipstick) after 20 weeks' gestation. Although it is often present, edema is no longer included as a diagnostic criterion for preeclampsia because it is an expected occurrence in pregnancy and has not been shown to be discriminatory.
If untreated (or sometimes even with aggressive treatment), the symptoms get progressively worse. Symptoms relate to decreased perfusion to the major organs: kidneys (proteinuria, oliguria), liver (epigastric pain, elevated enzymes), brain (headache, blurred vision, hyperreflexia, clonus, seizures) and the placenta (fetal distress, intrauterine growth restriction). Two different complications of preeclampsia are (1) eclampsia (seizure occurs) and (2) HELLP syndrome (hemolysis, elevated liver enzyme levels, low platelet count). Eclampsia and HELLP may or may not occur together. Another complication can be disseminated intravascular coagulation, which is often fatal. Not only is preeclampsia life threatening for the mother, but it can also cause intrauterine growth retardation, decreased fetal movement, chronic hypoxia, or even death in the fetus caused by decreased placental perfusion. If seizures occur, the patient has a risk for placental abruption, neurological deficits, aspiration pneumonia, pulmonary edema, cardiopulmonary arrest, acute renal failure, and death. Fetal bradycardia is typical during the seizure, usually with slow recovery to the baseline heart rate upon the seizure ending.
In addition to preeclampsia, there are four other categories of hypertension disorders in pregnancy: (1) gestational hypertension—BP of 140/90 after 20 weeks' gestation in a normotensive woman, no proteinuria, and postpartum return to normal BP; (2) preeclampsia—which includes eclampsia or the development of seizures along with preeclampsia and HELLP syndrome; (3) superimposed preeclampsia on chronic hypertension—new onset of proteinuria in a hypertensive woman; and (4) chronic hypertension—BP greater than 140/90 before pregnancy occurred or hypertension diagnosed before the 20th week that persists past the 12th week postpartum. Patients with proteinuria without hypertension initially have a higher incidence of progressing to preeclampsia than women with gestational hypertension.