Follow-up Timing for Women with Gestational Hypertension After Labor and Delivery Discharge

Immediate Postpartum Monitoring

Blood pressure should be monitored at least 4-6 hourly during the day for at least 3 days postpartum, as preeclampsia may develop de novo intra- or early postpartum 1
Women with gestational hypertension should not be discharged early (before 24 hours) to ensure adequate monitoring of vital signs 3, 4
All women should stay in the healthcare facility for at least 24 hours after delivery or until vital signs are normal 3, 4

Women still requiring antihypertensive medications at discharge should be reviewed within 1 week 1, 5
Antihypertensive medications should be continued after delivery and tapered slowly only after days 3-6 postpartum unless BP becomes low (1)
Additional check-ups should be scheduled at 7-14 days and at 6 weeks postpartum 3, 4
All women should be reviewed at 3 months postpartum by which time BP, urinalysis, and all laboratory tests should have normalized 1

Blood pressure measurement should be performed at follow-up visits 1, 6
Urinalysis to check for persistent proteinuria should be performed at follow-up visits 1, 6
Laboratory tests if abnormal before delivery (e.g. hemoglobin, platelets, creatinine, liver transaminases) should be performed at follow-up visits 1
Assessment for depression, anxiety, or posttraumatic stress disorder symptoms should be performed at follow-up visits 1

Persistent abnormalities at 3 months require further investigation, including work-up for secondary causes of persistent severe hypertension or underlying renal disease 1
Women should be educated about the danger signs of preeclampsia after birth, including headaches, visual disturbances, nausea, vomiting, epigastric pain, and convulsions 3, 4

All women with gestational hypertension require lifelong follow-up because of their increased cardiovascular risk 1, 2
Regular follow-up with a general practitioner to monitor BP and periodic measurement of fasting lipids and blood sugar is recommended 2
Women should be advised that they have approximately a 4% risk for developing preeclampsia and a 25% risk for gestational hypertension in a future pregnancy 2