How soon after discharge from Labor and Delivery (L&D) should a female with gestational hypertension follow up with her Obstetrician (OB)?

Follow-up Timing for Women with Gestational Hypertension After Labor and Delivery Discharge

Women with gestational hypertension should be reviewed within 1 week after discharge from the hospital if still requiring antihypertensive medications, and all women with gestational hypertension should have a follow-up visit within 7-10 days postpartum regardless of medication status. 1, 2

Immediate Postpartum Monitoring

• Blood pressure should be monitored at least 4-6 hourly during the day for at least 3 days postpartum, as preeclampsia may develop de novo intra- or early postpartum 1
• Women with gestational hypertension should not be discharged early (before 24 hours) to ensure adequate monitoring of vital signs 1
• All women should stay in the healthcare facility for at least 24 hours after delivery or until vital signs are normal 1

Discharge Planning and Follow-up Schedule

For Women on Antihypertensive Medications:

• Women still requiring antihypertensive medications at discharge should be reviewed within 1 week 1
• Antihypertensive medications should be continued after delivery and tapered slowly only after days 3-6 postpartum unless BP becomes low (<110/70 mm Hg) 1

For All Women with Gestational Hypertension:

• Initial follow-up should occur within 7-10 days postpartum 2
• Additional check-ups should be scheduled at 7-14 days and at 6 weeks postpartum 1
• All women should be reviewed at 3 months postpartum by which time BP, urinalysis, and all laboratory tests should have normalized 1

Risk Stratification for Follow-up

• Women with more severe disease features require closer monitoring 2
• Factors associated with higher risk and need for closer follow-up include:
  • Preeclampsia (versus gestational hypertension alone) 2
  • Severe hypertension during hospitalization 2
  • Magnesium sulfate use during hospitalization 2
  • Cesarean delivery 2

Monitoring Parameters at Follow-up Visits

• Blood pressure measurement 1
• Urinalysis to check for persistent proteinuria 1
• Laboratory tests if abnormal before delivery (hemoglobin, platelets, creatinine, liver transaminases) 1
• Assessment for depression, anxiety, or posttraumatic stress disorder symptoms 1

Important Considerations

• Persistent abnormalities at 3 months require further investigation, including work-up for secondary causes of persistent severe hypertension or underlying renal disease 1
• Women should be educated about the danger signs of preeclampsia after birth, including headaches, visual disturbances, nausea, vomiting, epigastric pain, and convulsions 1
• Special attention should be paid to ensure follow-up in populations at higher risk for poor outcomes, as studies show non-Hispanic Black women have lower rates of postpartum follow-up despite higher rates of maternal morbidity and mortality 2

Long-term Follow-up

• All women with gestational hypertension require lifelong follow-up because of their increased cardiovascular risk 1
• Regular follow-up with a general practitioner to monitor BP and periodic measurement of fasting lipids and blood sugar is recommended 1
• Women should be advised that they have approximately a 4% risk for developing preeclampsia and a 25% risk for gestational hypertension in a future pregnancy 1

Following this follow-up schedule is crucial for preventing complications, as hypertensive disorders can worsen or initially present after delivery and account for up to 44% of pregnancy-related deaths in the first six days postpartum 3.