Differential Diagnosis for Postpartum Pre-eclampsia

Single Most Likely Diagnosis

• Postpartum Pre-eclampsia: This condition is characterized by the onset of hypertension and often proteinuria after delivery, typically within 48 hours but can occur up to 4-6 weeks postpartum. It is a direct continuation or recurrence of pre-eclampsia that was present during pregnancy.

Other Likely Diagnoses

• Chronic Hypertension: Pre-existing hypertension that may have been exacerbated by pregnancy, leading to elevated blood pressure readings postpartum.
• Postpartum Thyroiditis: An inflammatory condition of the thyroid gland that can occur after childbirth, leading to transient hyperthyroidism followed by hypothyroidism, which may present with hypertension among other symptoms.
• Postpartum Anxiety or Stress: Significant anxiety or stress postpartum can lead to elevated blood pressure readings, though this would not typically be associated with proteinuria.

Do Not Miss Diagnoses

• Pulmonary Embolism: A potentially life-threatening condition where a blood clot lodges in the lungs. While not directly related to hypertension, it's a critical diagnosis to consider in the postpartum period due to increased risk of thromboembolic events.
• Postpartum Hemorrhage (PPH) with Hypertension: Though PPH itself is characterized by excessive bleeding, the associated stress and potential for fluid resuscitation could complicate the clinical picture with hypertension.
• Pharmacologically Induced Hypertension: Certain medications (e.g., non-steroidal anti-inflammatory drugs, certain antidepressants) can cause or exacerbate hypertension.

Rare Diagnoses

• Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic or sustained hypertension due to excessive catecholamine production.
• Primary Aldosteronism (Conn's Syndrome): A rare condition characterized by excessive production of aldosterone, leading to hypertension and hypokalemia.
• Cushing's Syndrome: A rare endocrine disorder caused by excess cortisol levels, which can lead to hypertension among other symptoms.

Each of these diagnoses has a distinct set of clinical features and diagnostic criteria. A thorough medical history, physical examination, and appropriate laboratory tests are essential for making an accurate diagnosis.