Postpartum Pre-eclampsia - Causes, Symptoms, and Treatment

Introduction

The postpartum period is the time from childbirth to six weeks after delivery. According to the World Health Organization (WHO), this is the most critical yet neglected period in a woman's life. Studies show that most maternal and newborn death occurs during this period. Postpartum preeclampsia can occur up to six weeks after the birth of the baby. This is a rare condition where blood pressure increases along with high amounts of protein in the urine. It can be life-threatening if not managed appropriately.

What Is Postpartum Pre-eclampsia?

A rare condition where the blood pressure shoots up, and excess protein is eliminated through urine is termed postpartum preeclampsia. Most cases of preeclampsia develop within forty-eight hours after the baby's birth. However, preeclampsia can develop even six weeks after delivery or later in some women. This is called late postpartum preeclampsia. It can cause seizures and other complications if left untreated.

What Are the Causes of Postpartum Preeclampsia?

The exact cause behind the condition is still not clear. However, healthcare professionals point out some risk factors that may lead to the condition. Sharing any past medical history with them helps to detect if there are any chances for postpartum pre-eclampsia.

What Are the Risk Factors of Postpartum Pre-eclampsia?

Certain risk factors can cause postpartum pre-eclampsia. They can include:

• Obesity.

• High blood pressure during pregnancy.

• Family history of preeclampsia or postpartum preeclampsia.

• Pre-eclampsia or postpartum pre-eclampsia in previous delivery.

• Age lesser than twenty or older than forty years.

• Pregnant with more than one baby (twins, triplets, etc).

• Autoimmune conditions (when the body's immune system destroys healthy cells, it is called an autoimmune condition).

• Type 1 or Type 2 Diabetes.

• A cesarean delivery increases the risk of postpartum preeclampsia by two to sevenfold.

What Are the Symptoms of Postpartum Pre-eclampsia?

The symptoms of postpartum pre-eclampsia may not be able to be identified by the patient herself. This can be due to the fatigue associated with childbirth, trying to recover after the tedious process, and adapting to the new role of a mother. The signs and symptoms of postpartum pre-eclampsia can include:

• High blood pressure 140/90 mm of Hg or higher.

• Proteinuria (presence of protein in urine).

• Severe headaches.

• Changes in vision like blurry vision, a temporary loss of vision, or sensitivity to light.

• Pain in the upper abdomen, usually on the right side.

• Nausea.

• Vomiting.

• Shortness of breath.

• Decreased urination.

• Rapid weight gain.

• Swelling of the face, hands, feet, or limbs.

• Peripheral edema (swelling in the lower parts of hands and legs).

How Is Postpartum Preeclampsia Diagnosed?

If the condition is diagnosed while the patient is still in the hospital, healthcare professionals will take care to treat it, and the patient will only be discharged once she gets normal. However, if the condition occurs after the patient is discharged, it should be appropriately diagnosed, and medical care must be given. The following tests will help in diagnosing the disorder:

• Checking for blood pressure.

• Blood test to check for platelet count.

• Liver function tests.

• Kidney function tests like blood urea nitrogen (BUN), serum creatinine, and estimated glomerular filtration rate (eGFR).

• Urinalysis to check for proteinuria.

• If the patient has a seizure, a brain scan will be advised to check for any damage that could have happened.

• Neuroimaging, like magnetic resonance imaging (MRI), should be considered in cases that show persistent headaches or vision changes even after the treatment is given. This is to evaluate any cerebrovascular accident (damage to the brain due to insufficient blood supply).

How Is Postpartum Preeclampsia Treated?

1. The condition is treated depending on the cause. Anti-hypertensives will be given to control high blood pressure.

2. Anti-epileptic drugs like magnesium sulfate will be given to prevent seizures.

3. Anticoagulants (medicines that prevent blood clotting) will be given to prevent the formation of blood clots.

4. Breastfeeding mothers are given medicines that are safe during lactation.

What Are the Complications of Postpartum Preeclampsia?

The complications of postpartum pre-eclampsia can include:

• Postpartum Eclampsia: This is a condition where seizures occur with postpartum pre-eclampsia. Permanent damage to internal organs like the kidneys, liver, and brain can be caused.

• Pulmonary Edema: This is a condition where fluid accumulates in the lungs. The condition is critical and life-threatening.

• Stroke: When the blood supply to the brain is compromised, it leads to a condition called stroke. This is a medical emergency and can lead to brain damage.

• Thromboembolism: When a blood vessel is blocked by a clot that traveled from another part of the body is called a thromboembolism. It is also a medical emergency.

• HELLP Syndrome: HELLP syndrome stands for hemolysis (destruction of the red blood cells), elevated liver enzymes, and low platelet count. Nausea, vomiting, headache, and upper right abdominal pain are the symptoms. It is life-threatening and can cause damage to many internal organs. It can develop suddenly, even without association with elevated blood pressure.

• Death: If the condition is not diagnosed correctly or not managed appropriately, it can result in the death of the patient.

What Are the Differential Diagnosis of Postpartum Preeclampsia?

The differential diagnosis of postpartum pre-eclampsia can include postpartum headaches like

• Post-dural puncture headache (a potential complication of lumbar puncture).

• Subarachnoid hemorrhage (bleeding in the space between the brain and tissue covering the brain).

• Central venous sinus thrombosis (blood clot formed in the brain's venous sinuses).

• Thrombotic thrombocytopenic purpura (a rare, life-threatening blood disorder where clots are formed in small blood vessels in the body).

• Migraine.

• Epilepsy.

• Intracerebral hemorrhage ( a condition where hematoma or collection of blood is formed within the brain tissue).

• Pheochromocytoma (a rare benign tumor that develops in the adrenal gland).

• Metabolic disorders.

Can Postpartum Preeclampsia Be Prevented?

The condition cannot be diagnosed beforehand and, therefore, cannot be prevented. However, if the patient is at an increased risk of developing postpartum pre-eclampsia, they can be monitored by those around for the signs and symptoms. Once appropriately diagnosed, adequate medical care must be given to prevent further complications. It may take several days for the blood pressure to get back to normal. The risk of complications is lesser once the blood pressure levels are normal. This helps in faster recovery.

Conclusion

The recovery after childbirth is hard. Conditions like postpartum preeclampsia make it even harder. However, further complications can be avoided if diagnosed early and managed appropriately. The new mother must be allowed ample rest to recover to normal health. Support from the family and loved ones will do wonders in this.