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
- 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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