Postpartum preeclampsia

Overview

Postpartum preeclampsia is a rare condition that occurs when you have high blood pressure and excess protein in your urine soon after childbirth. Preeclampsia is a similar condition that develops during pregnancy and typically resolves with the birth of the baby.

Most cases of postpartum preeclampsia develop within 48 hours of childbirth. But, postpartum preeclampsia sometimes develops up to six weeks or later after childbirth. This is known as late postpartum preeclampsia.

Postpartum preeclampsia requires prompt treatment. Left untreated, postpartum preeclampsia can cause seizures and other serious complications.

Symptoms

Postpartum preeclampsia can be difficult to detect on your own. Many women who experience postpartum preeclampsia show no signs or symptoms during pregnancy. Also, you might not suspect that anything is wrong when you're focused on recovering after childbirth and caring for a newborn.

Signs and symptoms of postpartum preeclampsia — which are typically the same as symptoms of preeclampsia prior to delivery — might include:

• High blood pressure (hypertension) — 140/90 millimeters of mercury (mm Hg) or greater
• Excess protein in your urine (proteinuria)
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Pain in your upper belly, usually under the ribs on the right side
• Nausea and vomiting
• Shortness of breath
• Decreased urination

When to see a doctor

If you have signs or symptoms of postpartum preeclampsia shortly after childbirth, contact your health care provider right away. Depending on the circumstances, you might need immediate medical care.

Contact your health care provider if you have questions or concerns about your health as you recover from childbirth.

Causes

The causes of postpartum preeclampsia and preeclampsia that occurs during pregnancy aren't well understood.

Risk factors

Limited research suggests that risk factors for postpartum preeclampsia might include:

• High blood pressure during your most recent pregnancy. You're at increased risk of postpartum preeclampsia if you developed high blood pressure after 20 weeks of pregnancy (gestational hypertension).
• Obesity. The risk of postpartum preeclampsia is higher if you're obese.
• Having multiples. Having twins, triplets or more increases your risk of preeclampsia.
• Chronic high blood pressure. Having uncontrolled high blood pressure before pregnancy increases your risk of preeclampsia and postpartum preeclampsia.
• Diabetes. Having type 1 or type 2 diabetes or gestational diabetes increases your risk of preeclampsia and postpartum preeclampsia.

Complications

Complications of postpartum preeclampsia include:

• Postpartum eclampsia. Postpartum eclampsia is essentially postpartum preeclampsia plus seizures. Postpartum eclampsia can permanently damage vital organs, including your brain, eyes, liver and kidneys.
• Pulmonary edema. This life-threatening lung condition occurs when excess fluid develops in the lungs.
• Stroke. A stroke occurs when the blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. A stroke is a medical emergency.
• Thromboembolism. Thromboembolism is the blockage of a blood vessel by a blood clot that travels from another part of the body. This condition is also a medical emergency.
• HELLP syndrome. HELLP syndrome — which stands for hemolysis (destruction of red blood cells), elevated liver enzymes and low platelet count — can rapidly become life-threatening. Symptoms of HELLP syndrome include nausea and vomiting, headache, and upper right abdominal pain. HELLP syndrome is particularly dangerous because it represents damage to several organ systems. On occasion, it may develop suddenly, even before high blood pressure is detected, or it may develop without any symptoms at all.

Prevention

Your doctor may:

• Discuss the signs and symptoms of preeclampsia with you
• Recommend taking baby aspirin (81 milligrams) to prevent preeclampsia during your next pregnancy
• Encourage you to have an active lifestyle and to eat a healthy diet

Diagnosis

If you've already been discharged from the hospital after childbirth and your health care provider suspects that you have postpartum preeclampsia, you might need to be readmitted to the hospital.

Postpartum preeclampsia is usually diagnosed with lab tests:

• Blood tests. These tests can determine how well your liver and kidneys are functioning and whether your blood has a normal number of platelets — the cells that help blood clot.
• Urinalysis. Your health care provider might test a sample of your urine to see if it contains protein, or he or she might have you collect your urine for 24 hours so it can be tested for the total amount of protein.

Treatment

Postpartum preeclampsia may be treated with medication, including:

• Medication to lower high blood pressure. If your blood pressure is dangerously high, your health care provider might prescribe a medication to lower your blood pressure (antihypertensive medication).
• Medication to prevent seizures. Magnesium sulfate can help prevent seizures in women with postpartum preeclampsia who have severe signs and symptoms. Magnesium sulfate is typically taken for 24 hours. After treatment with magnesium sulfate, your health care provider will closely monitor your blood pressure, urination and other symptoms.

If you're breastfeeding, it's generally considered safe to breastfeed while taking these medications. Ask your health care provider if you have any questions or you're not sure.

Preparing for your appointment

If you've recently given birth and you have any signs or symptoms of postpartum preeclampsia, contact your health care provider right away.

Here's some information to help you get ready for your appointment, as well as what to expect from your health care provider.

What you can do

Before your appointment, you might want to:

• Make a list of symptoms you're having. Include detailed descriptions and include any symptoms that may seem unrelated.
• Find a loved one or friend who can join you for your appointment. Fear and anxiety might make it difficult to focus on what your health care provider says. Take someone along who can help you remember all the information.
• Make a list of questions to ask your health care provider. That way, you won't forget anything important that you want to ask, and you can make the most of your time with your health care provider.

Basic questions to ask your health care provider may include:

• How serious is my condition?
• What are the treatment options?
• What kinds of tests do I need?
• Can I continue to breastfeed and care for my newborn?
• How can I best manage other health conditions along with postpartum preeclampsia?
• What signs or symptoms should prompt me to call you or go to the hospital?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, too. For example:

• Have you had any unusual symptoms lately, such as blurred vision or headaches?
• When did you first notice your signs or symptoms?
• Do you usually have high blood pressure?
• Did you experience preeclampsia or postpartum preeclampsia with any previous pregnancies?
• Have you had any other complications during a previous pregnancy?
• Do you have any other health conditions?
• Do you have a history of headache or migraine?