Preeclampsia Resolution and Management

Definition and Diagnosis

Preeclampsia is defined as new-onset hypertension (≥140/90 mmHg) that develops at or after 20 weeks' gestation. 1
Preeclampsia is accompanied by at least one of the following: proteinuria (≥300 mg/24 hours), other maternal organ dysfunction (renal, liver, neurological, or hematological complications). 1
Uteroplacental dysfunction is considered one of the diagnostic criteria for preeclampsia. 2
Preeclampsia typically resolves after delivery, with the condition confirmed as preeclampsia if it resolves postpartum. 1, 3

Blood pressure should be monitored at least every 4-6 hours for at least 3 days postpartum in women with preeclampsia. 4
Antihypertensive medications should be continued after delivery and tapered slowly only after days 3-6 postpartum unless blood pressure becomes low (<110/70 mmHg). 4
Laboratory tests that were abnormal before delivery should be repeated the day after delivery and then every second day until stable. 4
Assessment should include checking for depression, anxiety, or post-traumatic stress disorder symptoms. 4
NSAIDs should be avoided in women with preeclampsia if possible, especially with acute kidney injury, and alternative pain relief should be used as first choice. 4
Antihypertensive medication should be selected with respect to breastfeeding if continued treatment is needed. 5

Women still requiring antihypertensives at discharge should be reviewed within 1 week. 4
All women with preeclampsia should be reviewed at 3 months postpartum. 4
By 3 months, blood pressure, urinalysis, and all laboratory tests should have normalized; persistent abnormalities require further investigation for secondary causes. 4
Eclampsia can still occur postpartum, so continued vigilance is necessary. 4

Women with a history of preeclampsia require lifelong follow-up due to increased risk of cardiovascular disease, stroke, diabetes mellitus, venous thromboembolic disease, and chronic kidney disease. 4
Persistent abnormalities at 3 months require investigation for underlying renal disease or secondary causes of hypertension. 4

Right upper quadrant/epigastric pain and hyperreflexia and clonus are common symptoms of postpartum preeclampsia, according to the European Heart Journal 6
Edema is a physical finding that may be associated with postpartum preeclampsia, as reported in the BMJ 7

The American College of Cardiology recommends monitoring blood pressure at least every 4 hours while awake for at least 3 days postpartum, and treating hypertension with antihypertensive medications, aiming for systolic BP <160 mmHg, as stated in Hypertension 8
Avoiding NSAIDs for postpartum analgesia, especially in women with renal disease, placental abruption, or acute kidney injury, is advised by the American Heart Association, as reported in Hypertension 8

Women with a history of preeclampsia, including postpartum preeclampsia, have increased risks of cardiovascular disease, as reported in Hypertension 8
The American Heart Association recommends annual medical review lifelong, with emphasis on maintaining healthy lifestyle, for women with a history of preeclampsia, including postpartum preeclampsia, as stated in Hypertension 8