Postpartum preeclampsia can happen to any woman up to six weeks after childbirth. Call your provider right away or head to the ER if you have postpartum preeclampsia symptoms, including high blood pressure along with severe headache, abdominal pain, vision changes, shortness of breath, or swelling in the face and extremities. Your provider will run blood tests and a urinalysis to check for protein, and determine the best treatment plan for you.
IN THIS ARTICLE
- What is preeclampsia?
- Why does postpartum preeclampsia occur?
- Who’s most at risk for postpartum preeclampsia?
- Postpartum preeclampsia symptoms
- Complications of postpartum preeclampsia
- What to do about postpartum preeclampsia
- What are the treatment options for postpartum preeclampsia?
What is preeclampsia?
Preeclampsia is a dangerous blood pressure disorder (or hypertensive disorder) that can happen in the last 20 weeks of pregnancy, during labor, or postpartum.
Because it can progress quickly and cause serious complications and even death, it’s important that women recognize the symptoms of preeclampsia and get help as soon as possible.
Postpartum preeclampsia means that you develop hypertension and protein in your urine (and sometimes other laboratory abnormalities) after childbirth. It usually happens within the first 48 hours after childbirth, but it can happen up to six weeks after delivery.
Why does postpartum preeclampsia occur?
There’s no clear cause of postpartum preeclampsia.
If you had preeclampsia during pregnancy, though, your blood pressure can fluctuate in the days after delivery, improving initially and then worsening again. It’s also possible that you had preeclampsia during pregnancy but weren’t diagnosed until after you delivered your baby.
But postpartum preeclampsia can happen to any woman after delivery, whether or not she had preeclampsia during pregnancy and whether or not she has any risk factors (see below).
Who’s most at risk for postpartum preeclampsia?
About 60 percent of patients with new postpartum preeclampsia have no previous hypertensive disorder of pregnancy.
A higher risk of postpartum preeclampsia is associated with:
- Older maternal age. Women 35 years or older have a doubled risk of postpartum preeclampsia.
- Black race. Black women have a 2- to 4-fold increased risk of postpartum preeclampsia compared with women of other races.
- History of a hypertensive disorder in a previous pregnancy
- Chronic high blood pressure (before pregnancy)
- Cesarean delivery. C-section increases the risk of postpartum preeclampsia by 2- to 7-fold compared with vaginal delivery.
- Maternal obesity (BMI or 30 or higher)
- Higher rates of IV fluid infusion during labor and delivery
- Diabetes. This includes gestational diabetes or type 1 or type 2 diabetes.
Postpartum preeclampsia symptoms
Most women with preeclampsia have no symptoms. But in addition to high blood pressure (at or above 140/90 – some women at high risk monitor their blood pressure at home), you may have:
- Severe headache. This is the most common symptom.
- Pain high in abdomen, usually under the ribs on the right side
- Vision changes, such as blurred vision, light sensitivity, seeing spots
- Shortness of breath
- Stomach pain, nausea, vomiting
- Swelling in hands, feet, and/or face
- Decreased urination
- Proteinuria (protein in the urine)
If you notice any symptoms of postpartum preeclampsia, call your provider right away. If you can’t reach your provider, go to the emergency room.
Call 911 or have someone take you to the ER if your blood pressure reaches 160/110 or above or you:
- Have shortness of breath or trouble breathing
- Experience seizures
Complications of postpartum preeclampsia
The majority of women with postpartum preeclampsia have good outcomes. But postpartum preeclampsia can cause severe complications, some of which are life threatening. And some researchers think that the risk of severe complications is higher among women who have postpartum preeclampsia than those who have preeclampsia during pregnancy.
Possible complications include:
- Eclampsia, which is seizures in a woman with preeclampsia. These seizures can cause permanent damage to the brain, eyes, liver, and kidneys.
- Stroke, caused by blood clots (thromboembolism) that interrupt blood flow to the brain
- Pulmonary edema (excess fluid in the lungs, making breathing difficult)
- HELLP syndrome, which stands for hemolysis (the breakdown of red blood cells), elevated liver enzymes, and low platelet count
- Death
Women who have had preeclampsia have an increased risk of cardiovascular disease later in life. And your risk of the hypertension of preeclampsia continuing into chronic hypertension is increased if it occurs postpartum.
What to do about postpartum preeclampsia
If you develop signs of postpartum preeclampsia (see above), tell your provider or – for the more serious signs – call 907 right away.
You may need to be readmitted to the hospital. To find out if you have postpartum preeclampsia, your provider will:
- Monitor your blood pressure
- Order blood tests to see how your liver and kidneys are functioning and to look at the number of platelets you have in your blood (Platelets help your blood clot.)
- Order a urinalysis to see if your urine contains protein. It might be collected over the course of 24 hours for a total protein count. Since you are postpartum and are likely having vaginal bleeding (lochia), your healthcare team may need to place a temporary catheter in your bladder to get a “clean” sample of urine.
What are the treatment options for postpartum preeclampsia?
The treatment options for postpartum preeclampsia include:
Antihypertensive medications. These lower and stabilize your blood pressure. You’ll receive IV medication to stabilize your blood pressure initially (until it’s out of the severe range) and oral medication after that.
Magnesium sulfate to prevent seizures, if necessary. Magnesium sulfate acts as a vasodilator, opening small blood vessels. If you had preeclampsia during pregnancy, your doctor may have already started you on magnesium sulfate before delivery to reduce the chance of maternal seizures (eclampsia). Usually this medication is continued for 24 hours after delivery, but in some instances it’s continued for longer. If you weren’t given magnesium sulfate before, your provider may start you on it now.
Anti-coagulant medication (a blood thinner) to reduce the risk of blood clots
Talk with your provider about medication for high blood pressure if you’re breastfeeding. It’s important that it’s controlled, and they can prescribe medication that’s safe to take while nursing.
You’ll be able to leave the hospital once your blood pressure and other symptoms are under control. Your provider will want you to continue monitoring your blood pressure at home (by yourself or remotely, with a healthcare worker). Many women will need to continue taking oral blood pressure medication for a few weeks, sometimes even longer. Your provider will monitor you closely to adjust your medication appropriately.
To prevent preeclampsia in your next pregnancy, your provider may recommend that you take a daily baby aspirin (81 mg).
Postpartum preeclampsia is one of the serious complications women can experience after childbirth. But there are others. Read our article on the warning signs of postpartum complications so you’ll know what to be on the lookout for and when to call your healthcare provider or head to the ER.
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