Differential Diagnosis for Postpartum Hypertension

When considering the diagnosis of postpartum hypertension, it's crucial to differentiate it from regular physiological changes that occur postpartum. The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis

  • Postpartum preeclampsia: This condition is characterized by the onset of hypertension and often proteinuria after 20 weeks of gestation, persisting or developing after delivery. It is a leading cause of maternal and fetal morbidity and mortality worldwide. The justification for this being the single most likely diagnosis is its direct association with pregnancy and the postpartum period, where the physiological changes of pregnancy can lead to the development of hypertension.

• Other Likely Diagnoses

  • Chronic hypertension: This condition can be pre-existing or may have been undiagnosed during pregnancy. The stress of pregnancy and the postpartum period can exacerbate chronic hypertension, making it a likely consideration in the differential diagnosis.
  • Gestational hypertension: Although this condition typically resolves after delivery, in some cases, it can persist into the postpartum period, making it another likely diagnosis to consider.
  • Postpartum renal disease: Conditions such as postpartum acute kidney injury or other renal diseases can lead to hypertension due to fluid retention and electrolyte imbalances.

• Do Not Miss Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic or sustained hypertension. Although rare, missing this diagnosis could be catastrophic due to the potential for severe, uncontrolled hypertension.
  • Postpartum thyroid storm: Thyrotoxicosis can cause hypertension among other symptoms, and in the postpartum period, it could be related to postpartum thyroiditis. Missing this diagnosis could lead to severe complications.
  • Eclampsia: Although less common than preeclampsia, eclampsia (seizures in a woman with preeclampsia) is a life-threatening condition that must not be missed.

• Rare Diagnoses

  • Liddle syndrome: A rare genetic disorder leading to excessive sodium absorption and hypertension. It's unlikely but could be considered in cases where other causes are ruled out and there's a family history of similar conditions.
  • Hyperaldosteronism: A condition where the adrenal glands produce too much aldosterone, leading to hypertension. It's rare but could be a consideration in the differential diagnosis of postpartum hypertension, especially if other causes are excluded.