From the Guidelines
Postpartum preeclampsia is diagnosed when a woman who has recently given birth (typically within 6 weeks postpartum) develops hypertension and either proteinuria or end-organ dysfunction, with diagnostic criteria including new-onset hypertension (blood pressure ≥140/90 mmHg on two occasions at least 4 hours apart) after delivery, plus either proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3 or dipstick reading ≥2+) or evidence of end-organ damage, as recommended by the most recent guidelines 1. The specific diagnostic criteria for postpartum preeclampsia include:
- New-onset hypertension (blood pressure ≥140/90 mmHg on two occasions at least 4 hours apart) after delivery
- Proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3 or dipstick reading ≥2+)
- Evidence of end-organ damage, such as:
- Thrombocytopenia (platelet count <100,000/μL)
- Renal insufficiency (serum creatinine >1.1 mg/dL)
- Liver involvement (elevated transaminases to twice normal concentration)
- Pulmonary edema
- Cerebral/visual symptoms Women presenting with severe features such as blood pressure ≥160/110 mmHg, thrombocytopenia, impaired liver function, severe persistent right upper quadrant pain, renal insufficiency, pulmonary edema, or new-onset headache or visual disturbances require immediate evaluation and treatment, as stated in the guidelines 1. Management typically includes antihypertensive therapy (such as labetalol, nifedipine, or hydralazine) to maintain blood pressure below 160/110 mmHg, and magnesium sulfate for seizure prophylaxis in severe cases, as recommended by the guidelines 1. It is essential to note that postpartum preeclampsia can develop without preceding antepartum hypertensive disorders, making vigilance important even in women without previous pregnancy complications, as highlighted in the guidelines 1.
From the Research
Diagnostic Criteria for Postpartum Preeclampsia
The diagnostic criteria for postpartum preeclampsia include:
- New-onset hypertension 48 hours to 6 weeks after delivery 2
- Presence of any severe features, including severely elevated blood pressure in women with no history of hypertension 2
- Systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg on two occasions at least 4 hours apart 3
- Proteinuria ≥ 300 mg/day in a woman with a gestational age of > 20 weeks with previously normal blood pressures 3
Severe Features of Postpartum Preeclampsia
Severe features of postpartum preeclampsia include:
- Severely elevated blood pressure (SBP ≥ 160 mm Hg and/or DBP ≥ 110 mmHg) 4
- Thrombocytopenia < 100,000/μL 4
- Liver transaminases above twice the normal values 4
- HELLP syndrome 4
- Renal failure 4
- Persistent epigastric or right upper quadrant pain 4
- Visual or neurologic symptoms 4
- Acute pulmonary edema 4
Presentation of Postpartum Preeclampsia
Postpartum preeclampsia often presents to the emergency department without a history of preeclampsia during pregnancy 5
- Common prodromal symptoms and signs in the postpartum presentation include:
- Women with postpartum preeclampsia may present with neurologic symptoms, typically headache, within the first 7 to 10 days after delivery 2