Diagnosing Postpartum Preeclampsia

Diagnostic Criteria

Postpartum preeclampsia is diagnosed by new-onset hypertension (≥140/90 mmHg) occurring 48 hours to 6 weeks after delivery, accompanied by either proteinuria (≥0.3g/24h or protein/creatinine ratio ≥30 mg/mmol) or evidence of maternal organ dysfunction 1
Blood pressure measurement should confirm systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg on two separate occasions at least 15 minutes apart 1
Proteinuria assessment can be done through a protein/creatinine ratio ≥30 mg/mmol (0.3 mg/mg) 2, 24-hour urine protein ≥300 mg 1, or dipstick ≥1+ (requires confirmation with quantitative methods) 1

Measure blood pressure at least every 4 hours while awake for at least 3 days postpartum 2, 3
Perform urinalysis for protein assessment if hypertension is detected 1
Screen for symptoms: headache, visual disturbances, epigastric pain, nausea/vomiting 1

All women with postpartum preeclampsia should be reviewed at 3 months to ensure BP, urinalysis, and laboratory abnormalities have normalized 2, 3
Women still requiring antihypertensive medications at discharge should be reviewed within 1 week 3

Previous preeclampsia increases the risk of postpartum preeclampsia (RR 7.19) 1
Presence of antiphospholipid antibodies increases the risk of postpartum preeclampsia (RR 9.72) 1
Pre-existing diabetes increases the risk of postpartum preeclampsia (RR 3.56) 1
Multiple pregnancy increases the risk of postpartum preeclampsia (RR 2.93) 1
Nulliparity increases the risk of postpartum preeclampsia (RR 2.91) 1
Family history of preeclampsia increases the risk of postpartum preeclampsia (RR 2.90) 1
Advanced maternal age ≥40 years increases the risk of postpartum preeclampsia (RR 1.68-1.96) 1
Elevated BMI at booking increases the risk of postpartum preeclampsia (RR 1.55) 1