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Study finds postpartum preeclampsia may occur days or weeks after delivery

Oct. 25, 2011

By Maria Serraino

Preeclampsia – a condition in which high blood pressure arises in pregnancy – can occur even after delivery. In fact, a new study finds that postpartum preeclampsia may be delayed and appear more than two days to six weeks after delivery. 

While preeclampsia occurs primarily during pregnancy (usually after 20 weeks of gestation), postpartum preeclampsia can occur after giving birth.  Because preeclampsia often resolves with delivery, measures to treat the condition tend to be discontinued after 48 hours. However, up to 26 per cent of eclamptic seizures occur beyond 48 hours and as late as six weeks after delivery. Researchers at Wayne State University conducted a study of patients who were discharged and later readmitted with the diagnosis of delayed postpartum preeclampsia. 

According to background information in the study, preeclampsia is responsible for major maternal and perinatal morbidity and mortality. It affects approximately five to nine per cent of pregnancies and if untreated, it can lead to eclampsia. Eclampsia is a condition involving seizures or convulsions in pregnant women. In recent years, there has been a marked reduction in the incidence of eclampsia. However, there has been an increased frequency of postpartum preeclampsia.  The shift could be the result of the persistence and progression of preeclampsia that started during pregnancy, but was unrecognized before discharge.

During the study period of January 2003 to August 2009, 48,498 deliveries were recorded and preeclampsia occurred in 3,072 patients. Within six weeks of their initial discharge, 152 patients were admitted with the diagnosis of postpartum preeclampsia or eclampsia. Of these, 96 patients had no previous diagnosis of hypertensive disease in their current pregnancy, whereas seven had gestational hypertension, 14 had chronic hypertension, 28 had preeclampsia and seven had preeclampsia superimposed on chronic hypertension.

The overall rate of eclampsia for patients readmitted with the diagnosis of postpartum preeclampsia was 14.5 per cent, accounting for 22 patients. Over 90 per cent of these patients presented symptoms within seven days after being discharged from the hospital. Eclampsia was more common in patients with no prior hypertensive disease. 

Headache was found to be the most common symptom in 105 of the patients diagnosed. Other symptoms included shortness of breath, blurry vision, nausea, vomiting, edema, seizure and other neurological symptoms. The study also found that young age was associated with greater odds of developing eclampsia and requiring a second admission to the hospital. 

The study concludes that one week after discharge may be a critical period for the development of postpartum eclampsia. The researchers suggest that patients should be educated about the possibility of delayed postpartum preeclampsia and eclampsia after delivery, whether or not they develop hypertensive disease before being discharged from the hospital.

The study is published in the November 2011 issue of Obstetrics & Gynecology.

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  • A publication of:
  • Women's College Hospital