From the Guidelines
The best next step in management for this 29-year-old woman at her 3-week postpartum visit is to perform a comprehensive postpartum evaluation, including screening for postpartum depression, assessing breastfeeding status, and providing contraceptive counseling. Her physical examination is unremarkable, and her light vaginal bleeding (lochia) is normal at this stage. The patient's fatigue is likely related to normal sleep disruption from infant care rather than a medical concern. Given her history of gestational hypertension, her current normal blood pressure (122/74 mmHg) is reassuring but should be monitored, as suggested by the 2020 European Heart Journal study 1. The patient should be counseled about the importance of adequate rest, proper nutrition, and hydration to support breastfeeding. She should also be advised about postpartum warning signs that would require immediate medical attention, such as heavy bleeding, fever, severe headache, or worsening pelvic pain, as recommended in the 2024 Lancet Global Health study 1. A discussion about birth spacing and contraceptive options compatible with breastfeeding is appropriate at this visit, as fertility may return even while exclusively breastfeeding. Additionally, scheduling follow-up for any ongoing concerns and routine preventive care would complete her postpartum management. It is also essential to consider the patient's long-term cardiovascular risk, as women with a history of gestational hypertension are at increased risk of developing hypertension, stroke, and cardiovascular disease in later life, as highlighted in the 2020 European Heart Journal study 1. Therefore, cardiovascular risk assessment and lifestyle modifications should be recommended to avoid complications in subsequent pregnancies and to reduce maternal cardiovascular risk in the future. The most recent and highest quality study, published in 2024 in The Lancet Global Health 1, provides guidance on the comprehensive postpartum evaluation and emphasizes the importance of screening for postpartum depression, assessing breastfeeding status, and providing contraceptive counseling.
From the Research
Patient Assessment
The patient is a 29-year-old woman, gravida 1 para 1, who had a spontaneous vaginal delivery of a 4.2-kg male infant three weeks ago. She was treated for asymptomatic bacteriuria in the first trimester and had an otherwise uncomplicated pregnancy, except for gestational hypertension.
Current Condition
The patient's current blood pressure is 122/74 mm Hg, and she is breastfeeding exclusively. She reports fatigue due to frequent sleep interruption but otherwise feels well. Her physical examination is unremarkable.
Management Considerations
- The patient's gestational hypertension was managed during pregnancy, and her current blood pressure is within a normal range.
- According to the study 2, gestational hypertension usually resolves within 6 weeks postpartum.
- The studies 3, 4, 5, and 6 discuss the importance of managing hypertensive disorders of pregnancy to reduce maternal and fetal morbidity and mortality.
- However, the patient's current blood pressure does not indicate a need for immediate antihypertensive treatment.
- The patient should be monitored for any signs of postpartum complications, such as hypertension or preeclampsia, as discussed in the studies 3, 4, and 5.
Next Steps
- The best next step in management would be to continue monitoring the patient's blood pressure and overall health during the postpartum period.
- The patient should be educated on the signs and symptoms of postpartum complications, such as hypertension or preeclampsia, and instructed to seek medical attention if she experiences any concerning symptoms, as recommended in the study 6.
- A follow-up appointment should be scheduled to assess the patient's blood pressure and overall health, as discussed in the study 2.