Postpartum Hypertension, Pre-eclampsia and Eclampsia
The postpartum state continues to be a risk period for the development of hypertensive disorders, including pre-eclampsia and eclampsia; both can cause headaches. Continued clinical vigilance following delivery is therefore essential. Postpartum pre-eclampsia is characterised by the new development of hypertension (systolic ≥140 mm Hg or diastolic ≥90 mm Hg) and significant proteinuria (≥300 mg/24 h), occurring up to 4–6 weeks after childbirth. The combination of pre-eclampsia and seizures is referred to as eclampsia. A 10-year multicentre retrospective study reported a 5.7% incidence of postpartum pre-eclampsia.
Headache in pre-eclampsia/eclampsia may be accompanied by vomiting, visual disturbances, focal deficits, seizures and/or changes in mental status. Neurological sequelae include cerebrovascular events (either ischaemic or haemorrhagic) and posterior reversible encephalopathy syndrome.
In puerperal women with elevated blood pressure, the decision to start blood pressure-lowering treatment is often made on individual clinical grounds. The obstetric team are likely to start drug therapy at the recommended level for systolic blood pressure of ≥150 mm Hg or for diastolic pressure of ≥100 mm Hg.