De novo late postpartum preeclampsia: a case report with review of literature

Authors

  • Basanta Manjari Hota Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana, India https://orcid.org/0000-0002-5845-8597
  • N. S. Sai Anusha Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana, India
  • Guguloth Sneha Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana, India
  • Yallamandala Devisri Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20241090

Keywords:

De novo, Late postpartum preeclampsia, Pregnancy, Hypertension

Abstract

De Novo late postpartum preeclampsia is defined by many authors as new onset postpartum hypertension of ≥140/90 mmHg with features of organ system malfunctioning during 48 hours to six weeks of delivery following a normotensive pregnancy and labor. Though a lesser studied condition it is responsible for more number and increased severity of maternal morbidity, mortality, and cause of post-delivery hospital admission. Its exact cause is not yet clearly defined. The incidence is 0.3-27% as noted by many authors. Patients usually present on day 7-10 with severe headaches, neurological symptoms like visual disturbances; symptoms of other organ involvement, and high blood pressure. High suspicion leads to diagnosis. Primary investigations include that for preeclampsia. The principle of management is the reduction of blood pressure, prophylactic anticonvulsants, and diuretic is considered if there are features of fluid overload. She needs constant monitoring. Post delivery women, after discharge, do not avail of home blood pressure monitoring and even the symptoms, to start with are treated with over-the-counter medication. This leads to worsening of the condition. Our patient, a primipara reported to this hospital on the 38th day of normal vaginal delivery following a normotensive pregnancy and delivery, with features of preeclampsia. The aim of publishing this case is for statistical records and create awareness of the condition. Every postpartum woman on discharge from the hospital following a normotensive pregnancy and delivery must be counseled on the significance of home BP monitoring and must consult an obstetrician on developing any new symptoms.

References

Sibai BM. Etiology and management of postpartum hypertension-preeclampsia. Am J Obstet Gynecol. 2012;206(6):470-5.

Goel A, Maski MR, Bajracharya S, Wenger JB, Zhang D, Salahuddin S, et al. Epidemiology and Mechanisms of De Novo and Persistent Hypertension in the Postpartum Period. Circulation. 2015;132(18):1726-33.

Mahajan A, Kemp A, Hawkins TL, Metcalfe A, Dowling S, Nerenberg K. Postpartum hypertensive disorders in the Emergency Department - A retrospective review of local practice in Calgary, Alberta. Pregnancy Hypertens. 2020;19:212-7.

Redman EK, Hauspurg A, Hubel CA, Roberts JM, Jeyabalan A. Clinical course, associated factors, and blood pressure profile of delayed-onset postpartum preeclampsia. Obstet Gynecol. 2019;134(5):995-1001.

Skurnik G, Hurwitz S, McElrath TF, Tsen LC, Duey S, Saxena AR, et al. Labor therapeutics and BMI as risk factors for postpartum preeclampsia: A case-control study. Pregnancy Hypertens. 2017;10:177-81.

Bigelow CA, Pereira GA, Warmsley A, Cohen J, Getrajdman C, Moshier E, et al. Risk factors for new-onset late postpartum preeclampsia in women without a history of preeclampsia. Am J Obstet Gynecol. 2014; 210(4):338.

Hauspurg A, Jeyabalan A. Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy. Am J Obstet Gynecol. 2022;226(2S):S1211-21.

Ushida T, Nakamura N, Katsuki S, Mizutani H, Iitani Y, Imai K, et al. New-onset postpartum hypertension in women without a history of hypertensive disorders of pregnancy: a multicenter study in Japan. Hypertens Res. 2023;46(12):2583-92.

Petersen EE, Davis NL, Goodman D, Cox S, Mayes N, Johnston E, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017. MMWR. 2019; 68(18):423-9.

Katsuragi S, Tanaka H, Hasegawa J, Nakamura M, Kanayama N, Nakata M, et al. Analysis of preventability of hypertensive disorder in pregnancy-related maternal death using the nationwide registration system of maternal deaths in Japan. J Matern Fetal Neonatal Med. 2019;32(20):3420-6.

Redman EK, Hauspurg A, Hubel CA, Roberts JM, Jeyabalan A. Clinical Course, Associated Factors, and Blood Pressure Profile of Delayed-Onset Postpartum Preeclampsia. Obstet Gynecol. 2019;134(5):995-1001.

ACOG Committee. Optimizing Postpartum Care. Obstet Gynecol. 2018;131(5):e140-50.

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Published

2024-04-26

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Section

Case Reports