What are the diagnostics for postpartum preeclampsia?

From the Guidelines

Postpartum preeclampsia is diagnosed through a combination of blood pressure measurements, laboratory tests, and symptom evaluation, with a focus on monitoring blood pressure at least 4 to 6 hourly during the day for at least 3 days postpartum, as recommended by the ISSHP classification, diagnosis, and management recommendations for international practice 1.

Diagnostic Criteria

The diagnosis of postpartum preeclampsia requires a systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg on two occasions at least 4 hours apart, occurring within 6 weeks after delivery, along with proteinuria (≥300 mg in 24-hour urine collection or protein/creatinine ratio ≥0.3) or evidence of end-organ damage.

Laboratory Tests and Symptom Evaluation

Laboratory tests include:

• Complete blood count
• Comprehensive metabolic panel (liver function tests, creatinine)
• Uric acid levels
• Urinalysis for protein Additional tests may include:
• 24-hour urine collection for protein quantification
• Assessment for hemolysis with peripheral smear, LDH, and haptoglobin levels Clinicians should monitor for symptoms such as:
• Severe headache
• Visual disturbances
• Right upper quadrant pain
• Shortness of breath
• Excessive edema

Management and Monitoring

According to the ISSHP guidelines, women with preeclampsia should be considered at high risk for preeclamptic complications for at least 3 days and should have their BP and clinical condition monitored at least every 4 hours while awake 1.

Risk Factors

Women with risk factors such as preeclampsia during pregnancy, obesity, advanced maternal age, and multiple gestation should be monitored more closely during the postpartum period. Early diagnosis is crucial as postpartum preeclampsia can lead to serious complications including eclampsia, HELLP syndrome, stroke, and pulmonary edema.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Diagnostics of Postpartum Preeclampsia

The diagnostics of postpartum preeclampsia involve several key considerations, including:

• New-onset hypertension 48 hours to 6 weeks after delivery 2
• Presence of severe features, such as severely elevated blood pressure, even in women with no history of hypertension 2
• Exclusion of other etiologies to facilitate recognition and timely management 2
• Use of ambulatory and home blood pressure monitoring to detect masked hypertension 3

Diagnostic Criteria

The diagnostic criteria for postpartum preeclampsia include:

• New-onset hypertension, defined as a systolic blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg or higher 2
• Presence of any severe features, such as:
  • Severely elevated blood pressure (systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher) 2
  • Neurologic symptoms, such as headache 2
  • Other symptoms, such as visual disturbances or abdominal pain 2

Diagnostic Tools

Several diagnostic tools can be used to aid in the diagnosis of postpartum preeclampsia, including:

• Ambulatory blood pressure monitoring (ABPM) 3
• Home blood pressure monitoring (HBPM) 3
• Point-of-care tests, such as glycosylated fibronectin testing 4
• Laboratory tests, such as complete blood count and liver function tests 5

Risk Factors

Several risk factors are associated with an increased risk of postpartum preeclampsia, including:

• Older maternal age 2
• Black race 2
• Maternal obesity 2
• Cesarean delivery 2
• History of preeclampsia in a previous pregnancy 6