From the Guidelines
At this 6-week postpartum visit, blood pressure monitoring and screening for postpartum depression should be performed due to the patient's history of preeclampsia with severe features and her comments about fatigue and sleep difficulties. While her current blood pressure of 130/80 mm Hg is not in the hypertensive range, women with preeclampsia remain at risk for postpartum hypertension for up to 12 weeks after delivery, as noted in the 2018 study on hypertensive disorders of pregnancy 1. The patient should have her blood pressure checked regularly during this period to ensure it remains controlled, as recommended by the International Society for the Study of Hypertension in Pregnancy (ISSHP) classification, diagnosis, and management recommendations for international practice 1.
Additionally, screening for postpartum depression would be appropriate given her comments about fatigue and sleep difficulties, which could be early signs of postpartum depression rather than just normal adjustment to caring for a newborn. A standardized screening tool such as the Edinburgh Postnatal Depression Scale should be administered, as it has been shown to be a reliable and effective tool for screening postpartum depression, with a sensitivity of 94% and a specificity of 98% when using a cutoff score of 80 or higher 1.
Other routine components of this visit should include:
- Assessment of breastfeeding status
- Contraception (which appears appropriate with her progestin-only pill while breastfeeding)
- Physical recovery from childbirth
- Patient education regarding warning signs of postpartum complications and the importance of follow-up care, as emphasized in the 2018 study on hypertensive disorders of pregnancy 1.
It is also important to note that family planning counseling should be provided, as recommended by the ISSHP, to educate the patient on postpartum contraception and family planning, including limiting or spacing of the next pregnancy 1.
From the Research
Postpartum Checkup Recommendations
The patient, a 26-year-old woman, is attending a 6-week postpartum checkup after an induction of labor and vaginal delivery at 38 weeks gestation for preeclampsia with severe features. Given her current situation, the following should be considered:
- Screening for postpartum depression and anxiety using a validated instrument such as the Edinburgh Postnatal Depression Scale (EPDS) 2, 3, 4, 5.
- The EPDS has been shown to be a useful tool in identifying postpartum depression and anxiety, with a recommended cut-off score of 11/12 for postnatal depression and 8/9 for postnatal anxiety 4.
- The patient's symptoms of fatigue and sleep disturbance should be evaluated in the context of postpartum depression and anxiety, as these are common symptoms of these conditions 3, 6.
- The patient's use of a progestin-only pill for contraception should be considered in the context of postpartum depression and anxiety, as hormonal changes can affect mood and emotional well-being.
Key Considerations
- The EPDS is a widely used and validated instrument for screening postpartum depression and anxiety 2, 3, 4, 5.
- Postpartum depression and anxiety are common complications of pregnancy and the postpartum period, affecting up to 17.4% of women 5.
- Early identification and treatment of postpartum depression and anxiety are crucial for improving maternal and infant health outcomes 5.
- The patient's history of preeclampsia with severe features and her current symptoms of fatigue and sleep disturbance should be taken into account when evaluating her risk for postpartum depression and anxiety 6.