Pregnancy complication

[Shajal]

One patient delivered a baby 3 days back by C/S. Now complaining occasional mild SOB, palpitation, body-ache and leg edema. All vitals are normal. Lungs are clear. ECG normal. Chest X'ray showed very mild plural effusion at rt lung. D-dimer was positive at 4th pod. ECHO showed mild to moderate MR & TR with good EF. However baby is fine and taking breast milk. Pt is getting LMWH, beta blocker, syldenafil and diuretics. My question is what to do next? Is there any possibility to appear any medical emergency? Thanks.  

[Shajal]

Thanks doctor. I will share again the update of the patient.

[Elaine Brown, MD]

Hi!
If your patient was my own, I would advise you that I have seen several cases  similar to this one in which the patient was simply fluid overloaded due to IV fluids during labor and delivery.  Other possibilities include pulmonary embolus (d dimer is normally elevated in pregnancy and therefore can be difficult to interpret) Spiral Chest CT would be the next step if pulmonary symptoms worsen or persist. (I don't know if LMWH is therapeutic or prophyllactic) Post partum cardiomyopathy--the patient has a good EF, so this is probably not the case unless the ECHO deteriorates
Post Partum Pre-eclampsia/HELLP syndrome though you mention that vitals are normal, so again unlikely unless blood pressure increases or Platelets drop or Liver Enzymes are abnormal.Infection is another possibility and I would watch for any evidence of fever or elevated WBC.
Hope this is helpful!
Dr B