Treatment postpartum-immediate and long term

Puerperium

Hypertension may worsen transiently postpartum, especially be­tween days 3 and 6 when BP peaks in all women, whether normoten- sive or hypertensive. Women with postpartum hypertension should be evaluated for pre-eclampsia (either arising de novo or worsening from the antenatal period).

Hypertension and pre- eclampsia may even develop for the first time postpartum. Antihypertensive therapy may be continued postpartum, particularly in women with antenatal pre-eclampsia and those who delivered preterm. Severe postpartum hypertension must be treated with antihypertensive therapy, to keep SBP less than 160 mmHg and DBP less than 110 mmHg. Antihypertensive therapy may be used to treat non-severe postpartum hypertension, to keep BP at less than 140/90 mmHg for all but women with pregestational diabetes mellitus among whom the target should be less than 130/80 mmHg (14, 15, 17). Antihypertensive agents acceptable for use in breastfeeding in­clude nifedipine XL, labetalol, methyldopa, and ACE inhibitors.

Non-steroidal anti-inflammatory drugs should not be given post­partum if hypertension is difficult to control, there is evidence of kidney injury (oliguria and/or elevated creatinine (>90 μmol∕L)), or the platelet count is less than 50 ? 10⁹∕L. As stated previously, post­partum thromboprophylaxis should be considered in women with pre-eclampsia who have other risk factors for thromboembolism.

Hypertension, proteinuria, and the biochemical changes of pre­eclampsia begin to resolve by 6 weeks postpartum but may persist for longer, especially when those changes have been extreme. Care in the 6 weeks postpartum includes management of hypertension, ensuring resolution of biochemical changes, and screening for sec­ondary causes of hypertension in women with resistant hyperten­sion, impaired renal function, or abnormal urinalysis.

Long-term treatment

Care providers should be aware of the mental health implica­tions of the HDP, such as anxiety, depression, and post-traumatic stress disorder and refer women for appropriate evaluation and treatment (105).

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