When to Discontinue Labetalol After Eclampsia
Labetalol should be tapered slowly starting only after days 3 to 6 postpartum, unless blood pressure drops below 110/70 mmHg or the patient becomes symptomatic earlier. 1
Immediate Postpartum Period (Days 0-3)
- Continue antihypertensive therapy without tapering during the first 3 days postpartum, as blood pressure commonly worsens between days 3 to 6 after delivery in women with eclampsia and preeclampsia 1
- Monitor blood pressure at least every 4 to 6 hours during the day for at least 3 days postpartum 1
- Maintain blood pressure control below 140/90 mmHg throughout this critical period 1
When to Begin Tapering (Days 3-6 Onward)
- Start tapering labetalol slowly only after day 3 postpartum if blood pressure remains stable and controlled 1
- Do not begin tapering before day 3, even if blood pressure appears well-controlled, as this is when hypertension typically peaks postpartum 1
Criteria for Earlier Discontinuation
Stop or reduce labetalol immediately if:
- Blood pressure drops below 110/70 mmHg 1
- The patient develops symptomatic hypotension (dizziness, lightheadedness, weakness) 1
Monitoring During Tapering
- Continue monitoring blood pressure closely during dose reduction 1
- Most women can be discharged by day 5 postpartum, especially when able to monitor blood pressure at home 1
- If still requiring antihypertensives at discharge, review the patient within 1 week 1
Long-Term Follow-Up
- All women should have blood pressure and urine checked at 6 weeks postpartum 1
- By 3 months postpartum, blood pressure and all laboratory tests should have normalized 1
- Persistent hypertension or proteinuria at 6 weeks postpartum requires referral to a specialist 1
Critical Pitfalls to Avoid
- Never discontinue labetalol abruptly, as this can cause rebound hypertension 2
- Do not taper before day 3 postpartum, even if blood pressure appears controlled, as eclampsia can occur postpartum and hypertension typically worsens during days 3-6 1
- Avoid NSAIDs for pain relief in these patients, as they can worsen hypertension and interfere with blood pressure control 1