Diagnosis: postpartum hypertension
Treatment: inpatient stay

The insurer denied the inpatient stay. The health plan's determination is upheld.

In this case, the patient is a female who was postpartum day 5 status post SVD (spontaneous vaginal delivery) with pregnancy complicated by gestational hypertension with reported severe range blood pressures at home at 170/100. She had a headache with 3/10 pain. She had used the blood pressure (BP) cuff for the first time that evening and the BP was high. She had prior severe range blood pressures in the office. The patient was admitted with severe range blood pressures meeting criteria for preeclampsia with severe features on the fifth day postpartum.

In this case, the patient presented with headache and postpartum severe range blood pressures supporting postpartum preeclampsia in need of magnesium sulfate. She was given magnesium sulfate and IV (4) hydralazine for control of blood pressure. Fetal status was not considered as she was day 5 postpartum. There was no acute range blood pressure ongoing. The patient was noted to have mild range blood pressures without any hypertensive emergency. There was no low platelet count. The liver enzymes were normal. There was no right upper quadrant (RUQ) or epigastric pain. There was no doubling of serum Cr (creatinine). There was no evidence of hemolysis. There was no evidence of end organ damage in this case. There was no evidence of cerebral infarction or intracerebral hemorrhage. There was no evidence of vision loss or unstable angina. The patient had no history or symptoms suggesting myocardial infarction, pulmonary edema, aortic dissection, seizures, or acute renal failure. The patient was noted to have normal renal function as measured by her creatinine and had a normal physical exam with normal neurologic exam. There is no evidence of intracranial abnormality or indication for imaging. In this case, a lower level of care would have been appropriate.