For decades, it has been said that “delivery is the cure for preeclampsia.” This assertion comes from the fact that delivery is a necessary intervention. Removing the placenta is the only way to begin reversing the disease process, so when the mother or baby is too unwell to continue the pregnancy, delivery is indicated. The nuance here, though, is the definition of “cure.”
The term “cure” implies that women are no longer at risk of preeclampsia-related complications once they deliver. This could not be farther from the truth. In fact, 97% of maternal deaths related to preeclampsia in the United States (U.S.) happen in the postpartum period. All patients, families and health professionals must be aware that a woman who has delivered is still at risk for preeclampsia and needs to monitor symptoms of preeclampsia and related comorbidities for at least six weeks after delivery.
Most people with preeclampsia will deliver healthy babies and fully recover. However, some will experience complications, several of which may be life-threatening to the mother and/or the baby. A pregnant woman’s condition can progress to severe preeclampsia, eclampsia or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome quickly. Delivery, sometimes after a period of expectant management (“watchful waiting”), is a necessary intervention.
Any woman can develop preeclampsia after her baby is born, whether she experienced high blood pressure during pregnancy or not. Because the majority of deaths due to preeclampsia happen after the baby is born, it is critical that patients are advised after delivery and before they are discharged to continue monitoring their health. Below are some key takeaways related to postpartum preeclampsia.
What is postpartum preeclampsia?
Postpartum preeclampsia is a serious condition related to high blood pressure. It can happen to any woman who just had a baby. It has most of the same features of preeclampsia or other hypertensive disorders of pregnancy, without affecting the baby.
Risks to postpartum person:
- Organ damage
- Stomach pain
- Nausea or vomiting
- Swelling in hands and face
- Severe headache
- Seeing spots (or other vision changes)
- Shortness of breath
- Ask if a one-week follow-up appointment is necessary
- Keep all follow-up appointments
- Watch for warning signs and report any to their healthcare provider
- Monitor their blood pressure
It is also important that hospital staff are aware of postpartum signs and symptoms so postpartum women arriving at the emergency room are triaged properly. Many states have developed quality improvement collaboratives that create toolkits for hospitals including tools that aid in diagnosis, evaluation and treatment of postpartum preeclampsia. The California Maternal Quality Care Collaborative has extensive resources for health care systems looking to improve quality protocols.
The American College of Obstetricians and Gynecologists has recently release new guidelines for optimizing postpartum care, recommending that all postpartum women have contact with their obstetric care providers within the first three weeks after delivery.
This growing concern for postpartum women is a step in the right direction for maternal health outcomes. Unfortunately, we understand that as many as 40% of all postpartum visits in the U.S. are not attended due to a number of barriers. It is imperative that women understand they are still at risk for poor outcomes related to preeclampsia even after delivering—and to know the symptoms and how to respond accordingly.
This information can be delivered to patients easily using postpartum patient education materials offered by the Preeclampsia Foundation.
Learn more about participating in World Preeclampsia Day.
Join the conversation on social media using #WorldPreeclampsiaDay.
Tune in today, 22 May at 9:30 am ET for a live webcast, “Non-Communicable Diseases: Preeclampsia Risk Factors and Long Term Complications.”
Read more about reducing preventable deaths from preeclampsia.
Download and share the Obstetric Emergency Drills Training Kit, a resource for clinicians seeking ways to prepare for obstetric emergencies such as preeclampsia (available in English and Spanish).