Average Onset of Postpartum Preeclampsia
Most women with delayed-onset postpartum preeclampsia present within the first 7–10 days after delivery, with the majority (82–93%) developing symptoms within the first 48 hours postpartum. 1, 2, 3, 4
Timing of Onset
Early Postpartum Period (First 48 Hours)
- Approximately 82% of postpartum eclampsia cases occur within the first 24 hours after delivery 3
- The greatest risk period for postpartum preeclampsia is the first 3 days after delivery, requiring intensive blood pressure monitoring every 4–6 hours while awake 1
- Serious morbidity associated with preeclampsia can occur from 20 weeks' gestation through the entire postpartum period 5
Delayed-Onset Postpartum Preeclampsia (After 48 Hours)
- The median postpartum day of presentation for delayed-onset postpartum preeclampsia is day 7 (interquartile range 5.0–9.0 days) 4
- Most delayed-onset cases present within 7–10 days postpartum 1, 2
- Cases have been documented as late as the sixth week postpartum (day 60), though this is uncommon 3
- By definition, delayed-onset postpartum preeclampsia is diagnosed between 48 hours and 6 weeks after delivery 2, 4
Clinical Presentation Patterns
Symptom-Driven Presentation
- 93.4% of women with delayed-onset postpartum preeclampsia present due to symptoms rather than routine screening 4
- Neurological symptoms dominate the presentation, with persistent headache being the most common complaint 1
- Additional warning signs include severe abdominal pain, shortness of breath, visual changes, or markedly elevated blood pressure (≥160/110 mmHg) 1
Eclampsia-Specific Timing
- Approximately 50% of all eclampsia cases occur in the postpartum period, with the majority presenting within the first 48 hours after delivery 1
- Eclampsia is most common at term (≥37 weeks' gestation) 5, 6
- 16% of women with postpartum preeclampsia develop eclamptic seizures, which can occur for the first time after delivery even without antepartum disease 1
Risk Stratification by Timing
High-Risk Window (Days 0–3)
- Blood pressure should be measured at least every 4–6 hours while awake for a minimum of 3 days postpartum 1
- Antihypertensive medications should be continued and only tapered slowly after days 3–6, unless blood pressure falls below target 1
- Laboratory surveillance (hemoglobin, platelets, creatinine, liver transaminases) should be repeated the day after delivery and every second day until stable if any were abnormal 1
Extended Surveillance Window (Days 4–42)
- Most women can be discharged by day 5 postpartum if blood pressure is controlled and home monitoring is available 1
- All women should be reviewed at 3 months postpartum to confirm normalization of blood pressure, urinalysis, and laboratory parameters 1
- Women with persisting hypertension or proteinuria at 3 months warrant referral for further investigation 1
Common Pitfalls to Avoid
- Do not assume safety after the first 48 hours: while most cases occur early, delayed presentations up to 6 weeks postpartum are well-documented 2, 3, 4
- Do not rely solely on scheduled visits: 93% of delayed-onset cases present symptomatically between routine appointments 4
- Do not neglect patient education: women must be instructed about warning symptoms (severe headache, visual changes, epigastric pain) and how to contact healthcare professionals at any time during the first 4 weeks postpartum 1
- Do not abruptly discontinue antihypertensive therapy: taper gradually after the critical 3–6 day postpartum period 1