CHALLENGES IN THE MANAGEMENT OF POST-PARTUM PREECLAMPSIA WITH DELAYED PRESENTATION

Hypertension in the postpartum period is common in women with prior hypertensive disorders during pregnancy but can also appear newly for the first time after childbirth. Whether postpartum preeclampsia or eclampsia is distinct from its antepartum counterpart needs to be studied in future research. Definitions wise, postpartum preeclampsia should be considered in women who develop new hypertension between 48 hours and 6 weeks postpartum. This condition is understudied, with limited guidelines for diagnosis and management. Most cases present within 7 to 10 days after delivery, most commonly with headaches. New-onset hypertension with severe features should be diagnosed as postpartum preeclampsia after excluding other neurological, cardiovascular or metabolic causes, in order to institute timely management of the condition. Unlike antepartum Pre-eclampsia where delivery of the fetus remains the cornerstone of management, the treatment in postpartum period mainly involves antihypertensive agents, magnesium, and diuretics. Postpartum preeclampsia may pose a higher risk of maternal morbidity than preeclampsia of antepartum onset and delayed onset postpartum preeclampsia is associated with higher maternal complications because of unpredictable onset, variable symptoms and late recognition by healthcare providers. The aim of our review is to increase awareness about delayed onset Preeclampsia amongst clinicians and highlight the need for better understanding of the pathophysiology of this condition and guidance to reduce postpartum maternal morbidity and mortality.