What are the stages of hypertension and eclampsia in a postpartum (post-partum) mother?

From the Guidelines

Hypertension in a postpartum mother can progress through several stages, including gestational hypertension, preeclampsia, severe preeclampsia, and ultimately eclampsia, with management prioritizing blood pressure control and prevention of seizures, particularly in the first 48 hours after delivery 1. The stages of hypertension in a postpartum mother are:

• Gestational hypertension: blood pressure ≥140/90 mmHg after 20 weeks in previously normotensive women
• Preeclampsia: hypertension plus proteinuria or end-organ dysfunction
• Severe preeclampsia: blood pressure ≥160/110 mmHg with severe features like thrombocytopenia, liver dysfunction, or pulmonary edema
• Eclampsia: preeclampsia with seizures Management of postpartum hypertension includes:
• Antihypertensive medications like labetalol and nifedipine to maintain blood pressure below 160/110 mmHg 1
• Magnesium sulfate as the first-line treatment for severe preeclampsia or eclampsia to prevent seizures 1
• Blood pressure monitoring should continue postpartum as hypertension may worsen in the first 48 hours after delivery 1
• All women with hypertension in pregnancy should have their BP and urine checked at 6 weeks postpartum and persistent hypertension confirmed by 24-h ambulatory monitoring 1 It is crucial to prioritize early recognition and prompt treatment of hypertension in postpartum mothers to prevent serious maternal and fetal complications, including stroke, placental abruption, and fetal growth restriction 1.

From the Research

Stages of Hypertension in Postpartum Mothers

• Hypertensive disorders of pregnancy, including chronic and gestational hypertension, preeclampsia, and eclampsia, can worsen or initially present after delivery 2
• The stages of hypertension in postpartum mothers are not explicitly defined, but the management of hypertensive disorders of pregnancy is crucial to prevent maternal morbidity and mortality 2, 3
• Blood pressure monitoring is essential in the postpartum period, and antihypertensive therapy should be initiated or titrated at a blood pressure threshold of 140/90 mm Hg or greater for patients with chronic hypertension 2

Stages of Eclampsia in Postpartum Mothers

• Eclampsia is a severe complication of preeclampsia, characterized by seizures in pregnant or postpartum women 2, 4
• The stages of eclampsia are not explicitly defined, but the management of eclampsia involves immediate stabilization and inpatient treatment with magnesium sulfate for seizure prophylaxis and antenatal corticosteroids (if preterm) 2
• The use of antihypertensive drugs, such as labetalol and nifedipine, is crucial in the management of severe hypertension in pregnancy, including eclampsia 3, 5, 4

Management of Hypertension and Eclampsia in Postpartum Mothers

• The management of hypertensive disorders of pregnancy, including eclampsia, involves a multidisciplinary approach, including blood pressure monitoring, laboratory testing, and antenatal testing for fetal well-being 2, 6
• Antihypertensive therapy should be initiated expeditiously for acute-onset severe hypertension to prevent hemorrhagic stroke 2, 3
• The choice of antihypertensive medication depends on the severity of hypertension and the presence of other complications, such as preeclampsia or eclampsia 5, 4