Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy

High blood pressure in the postpartum period is most commonly seen in women with antenatal hypertensive disorders, but it can develop de novo in the postpartum time frame. Whether postpartum preeclampsia or eclampsia represents a separate entity from preeclampsia or eclampsia with antepartum onset is unclear. Although definitions vary, the diagnosis of postpartum preeclampsia should be considered in women with new-onset hypertension 48 hours to 6 weeks after delivery. New-onset postpartum preeclampsia is an understudied disease entity with few evidence-based guidelines to guide diagnosis and management. We propose that new-onset hypertension with the presence of any severe features (including severely elevated blood pressure in women with no history of hypertension) be referred to as postpartum preeclampsia after exclusion of other etiologies to facilitate recognition and timely management. Older maternal age, black race, maternal obesity, and cesarean delivery are all associated with a higher risk of postpartum preeclampsia. Most women with delayed-onset postpartum preeclampsia present within the first 7 to 10 days after delivery, most frequently with neurologic symptoms, typically headache. The cornerstones of treatment include the use of antihypertensive agents, magnesium, and diuresis. Postpartum preeclampsia may be associated with a higher risk of maternal morbidity than preeclampsia with antepartum onset, yet it remains an understudied disease process. Future research should focus on the pathophysiology and specific risk factors. A better understanding is imperative for patient care and counseling and anticipatory guidance before hospital discharge and is important for the reduction of maternal morbidity and mortality in the postpartum period.

Automated summary

High blood pressure in the postpartum period can occur in women with antenatal hypertensive disorders or develop de novo. The distinction between postpartum preeclampsia or eclampsia and those with antepartum onset is unclear. The diagnosis of postpartum preeclampsia should be considered in women with new-onset hypertension 48 hours to 6 weeks after delivery. There are limited evidence-based guidelines for the diagnosis and management of this condition. Risk factors for postpartum preeclampsia include older maternal age, black race, maternal obesity, and cesarean delivery. Prompt recognition and treatment are important, as delayed-onset postpartum preeclampsia can lead to maternal morbidity. Further research is needed to better understand the pathophysiology and specific risk factors. Improved understanding of postpartum preeclampsia is crucial for patient care, counseling, and reducing maternal morbidity and mortality in the postpartum period.