Understanding Postpartum Preeclampsia

Preeclampsia is less common after childbirth, but it can have serious consequences. Learn the signs of postpartum preeclampsia and how it is treated.

Preeclampsia is a potentially fatal pregnancy-related complication marked by high blood pressure. It usually develops during pregnancy after the 20-week mark but can also occur up to six weeks after your baby's arrival.

Postpartum preeclampsia is a rare but severe condition that can quickly escalate into seizures, stroke, and even death. If you experience any signs of postpartum preeclampsia—severe headaches, vision problems, nausea, vomiting, or swelling in your face or hands—contact your OB/GYN.

"The scary part of postpartum preeclampsia is the delay that can occur between the onset of symptoms and diagnosis, which means a serious illness can become life-threatening," says Ira Bernstein, M.D., professor of obstetrics and gynecology at the University of Vermont College of Medicine.

Fortunately, with prompt treatment, most people with postpartum preeclampsia recover entirely. This article explains the warning signs of postpartum preeclampsia and how it is diagnosed and treated.

Related: What Is Preeclampsia and Can It Be Prevented?

What Is Postpartum Preeclampsia?

Postpartum preeclampsia is a rare but dangerous condition that can develop between 48 hours and six weeks after giving birth. More common in the later half of pregnancy, preeclampsia causes high blood pressure and excess protein in the urine.

Of the estimated 250,000 cases of preeclampsia in the United States each year, roughly 5% occur postpartum.

"It takes time for the uterus to shed its lining after birth, so this process may be behind the delay that's sometimes seen in late-onset preeclampsia after delivery," says James N. Martin, M.D., past president of the American College of Obstetricians and Gynecologists.

It's also possible this condition begins during pregnancy but doesn't show signs or symptoms until after the baby has arrived.

Related: Signs of Preeclampsia Every Pregnant Woman Should Know

Postpartum Preeclampsia Symptoms

Postpartum preeclampsia develops between 48 hours and six weeks after childbirth. High blood pressure is often the first sign: 140/90 mm Hg or higher.

However, it typically doesn't occur until you're home from the hospital—when you no longer have your vitals monitored.

Signs of postpartum preeclampsia to watch out for include:

• A headache that is new, sudden, or severe

• New vision problems, including blurry vision, vision loss, and sensitivity to light
  

• Severe water retention (signs: swollen face, arms, legs, hands, and feet)

• Sudden weight gain (more than 2 pounds a week)

• Abdominal pain, especially near the ribs or under the right rib
  

• Nausea or vomiting

• Decreased urine output

• Shortness of breath

"If you notice any of these signs or symptoms, contact your health care provider right away," says Dr. Martin.

Possible Complications

Preeclampsia can be fatal and lead to serious complications, including:

• Blood clots

• Brain damage

• Coma

• Damage to red blood cells

• Fluid in your lungs

• Kidney or liver failure

• Seizure

• Stroke

About 15 percent of postpartum preeclampsia patients go on to experience seizures (eclampsia) and other serious complications.

What Causes Postpartum Preeclampsia?

Researchers aren't exactly sure what causes preeclampsia after childbirth.

Preeclampsia during pregnancy is believed to be caused by a dysfunctional placenta. The placenta releases chemicals that prompt an inflammatory immune response.

It's unclear how this plays a role in developing postpartum preeclampsia. However, scientists have isolated a handful of placental biomarkers that may help identify high-risk patients.

Risk Factors

Postpartum preeclampsia is more common in those diagnosed with gestational hypertension (high blood pressure) or preeclampsia in a prior pregnancy.

Research also shows Blacks and Latinos have a significantly higher risk of postpartum preeclampsia. A body mass index (BMI) of 30 or higher before conception or during the first trimester also increases the risk.

Other factors that increase the risk of postpartum preeclampsia include:

• Age (younger than 20 and older than 40)

• Birthing multiples (twins, triplets)

• Family history of high blood pressure

• Gestational diabetes
  

• Low socioeconomic status

How Is Postpartum Preeclampsia Diagnosed?

If you develop signs of preeclampsia during the postpartum period, call your OB/GYN. Tests used to diagnose preeclampsia include blood pressure monitoring, bloodwork, and a 24-hour urine collection.

Preeclampsia is diagnosed based on blood pressure readings with a top number (systolic) of 140 mmHg and higher or bottom number (diastolic) of 90 mmHg and above, along with one or more of the following:

• High protein in the urine (0.3 grams or more in a 24-hour urine collection)

• Blood tests show signs of kidney or liver dysfunction

• Fluid in the lungs and difficulty breathing 
  

• Visual impairments

Treating Preeclampsia After Birth

If your healthcare suspects you have postpartum preeclampsia, you will be hospitalized for treatment and monitoring. Preeclampsia can quickly turn into a medical emergency.

Magnesium sulfate is the primary treatment for preeclampsia. It is delivered through an IV for 24 hours. An anticonvulsant, magnesium sulfate, helps to prevent seizures, the main concern with preeclampsia.

Magnesium sulfate can cause uncomfortable side effects, including skin flushing, sweating, low blood pressure, and slow reflexes. You will likely be confined to bed during treatment and have a Foley catheter to collect urine, which will be tested for protein.

Your blood pressure and other vital signs will be monitored throughout treatment. Blood tests will check the following:

• Blood platelets (which help blood clot)

• Liver function

• Kidney function
  

You may also be given antihypertensive medication if your blood pressure is too high and other medications your healthcare team deems necessary.

Preeclampsia increases the risk of venous thromboembolism (VTE), the leading cause of childbirth-related death. VTE occurs when blood clots form in veins and block blood and oxygen flow to the brain or other organs. Those with postpartum preeclampsia and a high risk of VTE may also be treated with heparin, an anticoagulant.

Can Postpartum Preeclampsia Be Prevented?

Postpartum preeclampsia is not entirely preventable, though complications can be avoided with prompt treatment.

Research shows that low-dose aspirin may help prevent preeclampsia in high-risk individuals. If you have one high-risk factor or two moderate-risk factors, your OB may recommend taking low-dose aspirin.

However, aspirin may also increase the risk of postpartum bleeding, so talk to your OB about the pros and cons.

If you are at high risk for postpartum preeclampsia, your healthcare provider may also recommend monitoring your blood pressure at home.

Other than that, your best bet is to be aware of how you're feeling and call your OB if you develop symptoms of preeclampsia. Don't wave away a bad headache, vision problems, or abdominal pain as mere postpartum problems—get it checked out.

Related: Your Preeclampsia Risks, Explained

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