Postnatal pre-eclampsia: warning signs, blood pressure checks and care

The NHS explains pre-eclampsia as a pregnancy-related condition that causes high blood pressure, with protein in the urine an early sign. It says pre-eclampsia is most likely from 20 weeks of pregnancy but sometimes develops in the days or weeks after your baby is born, and that symptoms usually go away after birth but sometimes continue. NICE lists persistent or severe headache among the symptoms postnatal women should be told to report without delay, linked to possible hypertension, pre-eclampsia and other causes.

Because it can appear after you have been discharged, the symptoms below matter even if your blood pressure was normal throughout pregnancy.

The NHS lists a severe headache that does not go away with simple painkillers, vision problems such as blurred vision or seeing flashing lights, pain below the ribs, sudden swelling of the face, hands or feet, feeling very unwell, heartburn that does not go away with heartburn medicines, and being sick. Any of these can be serious and need to be checked immediately. The NHS postnatal page lists headache, changes in your vision and vomiting as signs of possible pre-eclampsia to tell your midwife, health visitor or GP straight away.

NICE says a persistent or severe headache after birth could indicate hypertension, pre-eclampsia, postdural puncture headache (after an epidural or spinal), migraine, intracranial pathology or infection, so it is never something to dismiss. If you cannot reach a professional or feel very unwell, call 999.

The NHS gives a route: if you are pregnant, call your maternity unit if you have the number; if you have recently given birth or cannot reach the unit, call 111. Because collapse and seizures are possible, severe symptoms such as a fit, loss of consciousness, severe breathing difficulty or sudden severe headache with vomiting should prompt a 999 call. Postnatal triage routes differ between hospitals and UK nations, so note the number given on discharge.

The NHS says in most cases pre-eclampsia is not severe but sometimes it can lead to serious, possibly life-threatening complications including seizures (eclampsia), HELLP syndrome (a rare liver and blood disorder) and stroke. These are the reasons for prompt checking of headache and visual changes. The NHS notes there is currently no cure other than delivery, and symptoms usually improve once the baby is born, but treatment can help manage symptoms.

NICE guideline NG133 on hypertension in pregnancy sets out postnatal care. For women with pre-eclampsia who did not take antihypertensive treatment, blood pressure is measured at least four times a day as an inpatient, at least once between day 3 and day 5 after birth, and on alternate days until normal if abnormal on days 3 to 5. Treatment is started if blood pressure is 150/100 mmHg or higher. Women are asked about severe headache and epigastric pain each time blood pressure is measured. For those who took antihypertensive medicine, blood pressure is measured at least four times daily as an inpatient and every 1 to 2 days for up to 2 weeks after transfer to community care, and treatment is reduced as blood pressure falls to certain levels.

Transfer to community care is offered when there are no symptoms of pre-eclampsia, blood pressure is 150/100 mmHg or less with or without treatment, and blood results are stable or improving. A care plan covers who provides follow-up, how often blood pressure is checked, thresholds for reducing treatment and self-monitoring for symptoms. Blood tests (platelets, liver enzymes, creatinine) are measured 48 to 72 hours after birth in some situations. Medicine choices, including during breastfeeding, are made by your team: never start, stop or alter blood pressure medicine without their advice.

NICE says to offer all women who have had pre-eclampsia a medical review with their GP or specialist 6 to 8 weeks after the birth, and a review 2 weeks after transfer to community care for those who remain on blood pressure medicine. The NHS says after leaving hospital you may need to take medicine for a few weeks to lower your blood pressure and have regular blood pressure checks. The NHS signposts Action on Pre-eclampsia for support and information. Emotional effects of a frightening birth and illness are common; NICE advises giving every woman the chance to talk about her birth experience at postnatal contacts.