What is the term for the development of hypertension after delivery, also known as pre-eclampsia (Preeclampsia)?

From the Guidelines

Postpartum hypertension, not pre-eclampsia, is the correct term for the development of high blood pressure after delivering a baby. While preeclampsia typically occurs during pregnancy (before delivery), when high blood pressure develops for the first time after childbirth, it is specifically called postpartum hypertension or postpartum preeclampsia 1. This condition usually develops within 48 hours after delivery but can occur up to 6 weeks postpartum.

Key Points to Consider

• Treatment typically includes antihypertensive medications, with the goal of keeping blood pressure below 150/100 mmHg 1.
• Women with a history of preeclampsia during pregnancy, obesity, or first-time mothers are at higher risk and should monitor their blood pressure closely after delivery 1.
• Postpartum hypertension requires prompt medical attention as it can lead to serious complications including stroke, seizures, or organ damage.
• The condition develops when blood vessels that formed during pregnancy don't properly revert to their pre-pregnancy state, causing increased blood pressure.

Management and Monitoring

• Monitor BP at least 4 to 6 hourly during the day for at least 3 days postpartum 1.
• Antihypertensives should be restarted after delivery and tapered slowly only after days 3 to 6 postpartum unless BP becomes low (<110/70 mm Hg) or the woman becomes symptomatic in the meantime 1.
• Most women can be discharged by day 5 postpartum, especially when they are able to monitor their BP at home 1.

From the FDA Drug Label

Magnesium is said to have a depressant effect on the central nervous system (CNS), but it does not adversely affect the woman, fetus or neonate when used as directed in eclampsia or pre-eclampsia.

The development of high blood pressure after delivering a baby is not called pre-eclampsia. Pre-eclampsia is a condition that occurs during pregnancy, characterized by high blood pressure and often accompanied by significant amounts of protein in the urine.

• Postpartum preeclampsia or postpartum hypertension are terms that may be used to describe the development of high blood pressure after delivering a baby. The FDA drug label does not provide a specific term for the development of high blood pressure after delivering a baby, but it does mention the use of magnesium sulfate in eclampsia or pre-eclampsia 2.

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 3.
• 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) 3, 4.

Postpartum Preeclampsia

• Postpartum preeclampsia is a condition where high blood pressure develops after delivery, typically within 48 hours to 6 weeks postpartum 5.
• The diagnosis of postpartum preeclampsia should be considered in women with new-onset hypertension and severe features, such as severely elevated blood pressure, after exclusion of other etiologies 5.
• Postpartum preeclampsia may be associated with a higher risk of maternal morbidity than preeclampsia with antepartum onset 5.

Management of Postpartum Hypertension

• The management of postpartum hypertension includes the use of antihypertensive agents, such as labetalol, hydralazine, and nifedipine, to rapidly reduce blood pressure 3, 4, 6.
• For persistent postpartum hypertension, a long-acting antihypertensive agent should be started, such as labetalol or nifedipine 3.
• The cornerstones of treatment for postpartum preeclampsia include the use of antihypertensive agents, magnesium, and diuresis 5.

Risk Factors and Prevention

• Older maternal age, black race, maternal obesity, and cesarean delivery are associated with a higher risk of postpartum preeclampsia 5.
• Providers must be aware of the risks associated with postpartum hypertension and educate women about the symptoms of postpartum preeclampsia 3.
• Future research should focus on the pathophysiology and specific risk factors of postpartum preeclampsia to improve patient care and counseling 5.