Lasix for the Prevention of De Novo Postpartum Hypertension
Lasix for the Prevention of De Novo Postpartum Hypertension
Primary objective: To evaluate whether oral furosemide can help prevent de novo postpartum
 hypertension (new-onset high blood pressure after delivery) by reducing blood pressure after
 delivery in high-risk women.

 Secondary objectives: To evaluate whether oral furosemide administered to high-risk women
 after delivery can reduce the frequency of postpartum hypertensive episodes, the need for
 antihypertensive therapy, the risk of postpartum preeclampsia, and the incidence of severe
 maternal morbidity.
Hypertensive disorders of pregnancy are one of the leading causes of maternal morbidity and
 mortality worldwide. The majority of clinical research has focused on pregnancy-related
 hypertension that develops in the antenatal period, while studies of the incidence, risk
 factors, and prevention of postpartum hypertension are limited. In particular, there is a
 paucity of data about the clinical entity known as de novo postpartum hypertension, in which
 women who are normotensive throughout pregnancy and delivery subsequently go on to develop
 high blood pressure in the immediate to late postpartum period. Of those with postpartum
 preeclampsia, 33-69% were normotensive antepartum.

 Early identification and treatment of antepartum preeclampsia has been shown to decrease some
 severe maternal outcomes. Conversely, women with de novo postpartum hypertensive disorders
 remain among the highest risk for severe maternal morbidity due to decreased surveillance and
 lack of data regarding preventive therapies and interventions. Evidence from multiple
 randomized controlled trials have demonstrated a benefit in the use of oral loop-diuretics in
 decreasing postpartum systolic blood pressure, promoting faster normalization of blood
 pressure, and decreasing the need for antihypertensive therapy in women with an antenatal
 diagnosis of preeclampsia. Biological plausibility suggests that loop-diuretic therapy may
 similarly mitigate the normal physiologic mechanism that has been implicated in the
 pathogenesis of hypertensive complications after delivery in women at risk for de novo
 postpartum hypertension.

 This study is a double-blind randomized placebo-controlled trial of 82 high-risk women to
 assess whether treatment with oral Lasix (furosemide) after delivery reduces blood pressure
 at the time of discharge. Women at high risk for de novo postpartum hypertension will be
 randomized to a five-day course of either 20 mg oral Lasix (furosemide) or placebo once daily
 initiated after delivery. Women will be monitored through their routine 2-week and 6-week
 postpartum visits, during which times hypertensive complications and adverse effects of
 therapy will be assessed.
Inclusion Criteria:

 -  Postpartum women

 -  No antenatal diagnosis of hypertensive disorder of pregnancy at the time of admission
 for delivery, defined as existing chronic hypertension diagnosis or documented blood
 pressure of ≥140 systolic OR ≥90 diastolic on at least 2 occasions at least 4 hours
 apart prior to delivery admission who do not go on to get magnesium for seizure
 prophylaxis by the time of delivery

 -  At least 18 years of age

 -  English or Spanish speakers

 -  One or more high risk factors for development of de novo postpartum hypertension

 Exclusion Criteria:

 -  Non-English or Spanish speakers

 -  Women with a contraindication to diuretic therapy

 -  Women who have used diuretics in the two weeks prior to delivery