Expectant management of preeclampsia

Postpartum management

Because preeclampsia can worsen, or first appear, in the postpartum period, extra vigilance is important, and pharmacotherapy may be appropriate.

Management of preeclampsia does not end with delivery of the fetus and the placenta. These events do signal the beginning of the curative process, but complications can occur in the postpartum period. Indeed, in some women, the disease process worsens immediately postpartum. Therefore, women with diagnosed preeclampsia or severe gestational hypertension require close monitoring of blood pressure and maternal symptoms and accurate measurement of fluid intake and urine output. Some of these women are at increased risk for pulmonary edema; exacerbation of severe hypertension; eclampsia; and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.

Treating postpartum hypertension

Women who continue to have severe hypertension (systolic pressure at or above 155 mm Hg or diastolic pressure of 105 mm Hg or higher) will benefit from oral nifedipine (10 mg every 6 hours) or long-acting nifedipine (10 to 20 mg twice daily), the drugs of choice because of their favorable effects on renal function.

Women with severe hypertension also may require diuretics for better control of blood pressure, as may women with a history of congestive heart failure or left ventricular dysfunction.

Start women with vascular diabetes mellitus or diabetic nephropathy on ACE inhibitors immediately postpartum.

Patients can be discharged home once blood pressure is stable, provided there are no maternal symptoms of preeclampsia.

Postpartum preeclampsia can develop even in healthy women

Because severe hypertension or preeclampsia may develop for the first time in the postpartum period, it is important to educate all gravidas about the signs and symptoms. All health-care providers should be on the lookout for these symptoms as well.

The author reports no financial relationships relevant to this article.