From the Guidelines
Postpartum eclampsia can occur up to 6 weeks after delivery, with the risk window extending throughout the entire postpartum period. While most cases of eclampsia happen during pregnancy or within the first 48-72 hours postpartum, the risk persists due to the time it takes for physiological changes of pregnancy to normalize after delivery, and inflammatory processes triggered during pregnancy may persist into the postpartum period 1. During this time, women should be monitored for warning signs such as severe headaches, visual disturbances, upper abdominal pain, and significant swelling, particularly if they had hypertensive disorders during pregnancy.
Key Considerations
- The risk of morbidity and mortality directly due to hypertension is highest during the first 1 to 6 days postpartum, making BP monitoring and treatment crucial during this period 1.
- BP that is transiently elevated related to HDP should fully resolve by postpartum week 12, and persistently elevated BP after this period should prompt an evaluation of chronic hypertension and workup for potential secondary causes as clinically indicated 1.
- Individuals who are diagnosed with an HDP have an increased risk of chronic hypertension in the first year after delivery and throughout their lifespan and should have their BP monitored and assessed at least annually 1. If symptoms develop, immediate medical attention is necessary as treatment typically involves magnesium sulfate for seizure prevention, antihypertensive medications to control blood pressure, and close monitoring in a hospital setting.
From the Research
Postpartum Eclampsia Window
The postpartum eclampsia window is a critical period after delivery during which women are at risk of developing eclampsia. According to the studies, this window can last up to 4 weeks after delivery 2 or 6 weeks after delivery 3.
Key Findings
- The diagnosis of postpartum preeclampsia should be considered in women with new-onset hypertension 48 hours to 6 weeks after delivery 3.
- Postpartum preeclampsia/eclampsia is the presence of hypertension and proteinuria, with or without seizures, occurring up to 4 weeks after delivery 2.
- Most women with delayed-onset postpartum preeclampsia present within the first 7 to 10 days after delivery 3.
Duration of Postpartum Magnesium Sulfate
The duration of postpartum magnesium sulfate for seizure prophylaxis in women with preeclampsia is typically 24 hours 4. However, some studies suggest that a shorter course of postpartum magnesium sulfate may be effective in preventing eclampsia 5.
Symptoms and Presentation
Common prodromal symptoms and signs in the postpartum presentation of preeclampsia/eclampsia include headache, visual changes, hypertension, edema, proteinuria, elevated uric acid, and elevated liver function tests 2. Women can present with these symptoms up to 4 weeks after delivery 2 or 6 weeks after delivery 3.
Management and Treatment
The cornerstones of treatment for postpartum preeclampsia include the use of antihypertensive agents, magnesium, and diuresis 3. Intravenous magnesium sulfate is the gold standard for the management of preeclampsia, but it has a short action time that does not provide stable maintenance of blood pressure 6. Other treatment options, such as intravenous labetalol and oral nifedipine, may also be effective in reducing blood pressure in women with preeclampsia 6.