Postnatal investigation, monitoring and treatment (including after discharge from critical care)

Blood pressure

• in women with pre-eclampsia who did not take antihypertensive treatment and have given birth, measure blood pressure:
  • at least four times a day while the woman is an inpatient
  • at least once between day 3 and day 5 after birth
    
  • on alternate days until normal if blood pressure was abnormal on days 3-5
    
    
• in women with pre-eclampsia who did not take antihypertensive treatment and have given birth
  • start antihypertensive treatment if blood pressure is 150/100 mmHg or higher
    
    
• in women with pre-eclampsia who have given birth enquire about severe headache and epigastric pain each time blood pressure is measured
  
  
• in women with pre-eclampsia who took antihypertensive treatment and have given birth, measure blood pressure:
  • at least four times a day while the woman is an inpatient
  • every 1-2 days for up to 2 weeks after transfer to community care until the woman is off treatment and has no hypertension
    
    
• for women with pre-eclampsia who have taken antihypertensive treatment and have given birth:
  • continue antenatal antihypertensive treatment
  • consider reducing antihypertensive treatment if their blood pressure falls below 140/90 mmHg
  • reduce antihypertensive treatment if their blood pressure falls below 130/80 mmHg
    
    
• if a woman has taken methyldopa to treat pre-eclampsia, stop within 2 days of birth and change to an alternative treatment if necessary
  
  
• offer women with pre-eclampsia who have given birth transfer to community care if all of the following criteria have been met:
  • no symptoms of pre-eclampsia
  • blood pressure, with or without treatment, is 150/100 mmHg or lower
  • blood test results are stable or improving
    
    
• women who have pre-eclampsia and are still on antihypertensive treatment 2 weeks after transfer to community care should be offered a medical review
  
  
• offer women who have had pre-eclampsia and who remain on antihypertensive treatment, a medical review with their GP or specialist 2 weeks after transfer to community care
  
  
• offer all women who have had pre-eclampsia a medical review with their GP or specialist 6-8 weeks after the birth

Haematological and biochemical monitoring

• in women who have pre-eclampsia with mild or moderate hypertension, or after step-down from critical care:
  • measure platelet count, transaminases and serum creatinine 48-72 hours after birth or step-down
  • do not repeat platelet count, transaminases or serum creatinine measurements if results are normal at 48-72 hours
    
    
• if biochemical and haematological indices are outside the reference range in women with pre-eclampsia who have given birth, repeat platelet count, transaminases and serum creatinine measurements as clinically indicated until results return to normal
  
  
• in women with pre-eclampsia who have given birth, carry out a urinary reagent-strip test at the postnatal review (6-8 weeks after the birth)
  
  
• offer women who had pre-eclampsia and still have proteinuria (1+ or more) at 6-8 weeks after the birth, a further review with their GP or specialist at 3months after the birth to assess kidney function
  
  
• in women with pre-eclampsia who have given birth and have stepped down from critical care level 2, do not measure fluid balance if creatinine is within the normal range
  
  
• consider referring women with an abnormal kidney function assessment at 3 months for a specialist kidney assessment in line with the NICE guideline on chronic kidney disease in adults

Reference:

• 1) NICE (June 2019). Hypertension in pregnancy - the management of hypertensive disorders during pregnancy