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

Last edited 08/2019

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

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