Postpartum management of hypertension in pregnancy
Blood pressure rises progressively over the first five postnatal
days, peaking on days three to six after delivery. Research has
focused on the antenatal complications, for both mother and
baby, and the risks and benefits of administering antihypertensive
therapy prior to delivery. There is very little information on
how best to manage postpartum hypertension, regardless of type
or severity, to optimize maternal safety and minimize hospital
stay. Women with postpartum hypertension may also experience
longer hospital stays and possibly, heightened anxiety about
their recovery. NICE recommendations for postnatal care of
women with hypertension in pregnancy include stopping methyldopa
within two days of birth and asking the woman about
severe headache and epigastric pain every time blood pressure is
measured. In cases of mild or moderate pre-eclampsia platelet
count, transaminases and serum creatinine should be measured
48e72 hours after birth or step-down. These do not need to be
repeated if results are normal. In most cases of gestational hypertension
and pre-eclampsia there is a rapid and complete resolution
within 6 weeks of delivery of the fetus. Patients requiring
antihypertensive agents should be weaned off slowly and medications
should not be stopped suddenly as there may often be a
rebound hypertension.