From the Guidelines
Postpartum hypertension is the development of high blood pressure after delivering a baby, and it is crucial to manage it properly to prevent complications. This condition typically occurs within the first six weeks after childbirth, though it most commonly develops within the first week postpartum. Women who had hypertensive disorders during pregnancy (such as preeclampsia or gestational hypertension) are at higher risk, but postpartum hypertension can also develop in women who maintained normal blood pressure throughout pregnancy 1.
Key Points to Consider
- All women with hypertension in pregnancy should have their BP and urine checked at 6 weeks postpartum and persistent hypertension confirmed by 24-h ambulatory monitoring 1.
- Antihypertensive medication should be selected with respect to breastfeeding, and many guidelines still consider methyldopa the drug of choice for management of postpartum hypertension, however, it should be used with caution in women at risk of developing depression 1.
- Women with persisting hypertension or proteinuria 6 weeks after delivery should be referred to a specialist 1.
Treatment and Management
Treatment depends on severity but often includes antihypertensive medications, and blood pressure monitoring is essential, with a goal of keeping readings below 150/100 mmHg. Women experiencing severe headaches, visual changes, chest pain, or shortness of breath should seek immediate medical attention as these may indicate postpartum preeclampsia, a serious condition requiring urgent treatment.
Causes and Risk Factors
Postpartum hypertension occurs due to the body's adjustment to significant fluid shifts and hormonal changes following delivery, as well as the stress of childbirth and potential medication effects. Women under the age of 40 with persisting hypertension should be assessed for a secondary cause of hypertension 1.
From the Research
Definition of Postpartum Hypertension
- Postpartum hypertension is defined as systolic blood pressure 140 mm Hg or greater and/or diastolic blood pressure 90 mm Hg or greater on 2 or more occasions at least 4 hours apart 2.
- Severe hypertension is defined as systolic blood pressure 160 mm Hg or greater and/or diastolic blood pressure 110 mm Hg or greater on 2 or more occasions repeated at a short interval (minutes) 2.
Diagnosis and Management
- The diagnosis of postpartum preeclampsia should be considered in women with new-onset hypertension 48 hours to 6 weeks after delivery 3.
- New-onset postpartum preeclampsia is an understudied disease entity with few evidence-based guidelines to guide diagnosis and management 3.
- The cornerstones of treatment include the use of antihypertensive agents, magnesium, and diuresis 3.
- Labetalol, hydralazine, and nifedipine are all effective for acute management, although nifedipine may work the fastest 2.
Risk Factors
- Older maternal age, black race, maternal obesity, and cesarean delivery are all associated with a higher risk of postpartum preeclampsia 3.
- The presence of proteinuria is an independent risk factor for needing postpartum antihypertensive medications 4.
- Patients with proteinuria and those with severe disease may warrant closer surveillance in the post-partum period than those without proteinuria 4.
Treatment and Readmission
- Any nifedipine prescription was found to significantly decrease the risk of readmission for hypertensive complications 5.
- Labetalol monotherapy was associated with increased risk of readmission for hypertensive complications 5.
- The risk of postpartum readmission for hypertensive complication was reduced by 65% when patients were discharged on nifedipine monotherapy and 56% with combined nifedipine and labetalol treatment when compared with no treatment 5.