Hypertension during lactation

What it is

Hypertension that was present in pregnancy does not end with the birth, and the woman who has just delivered is still the patient she was before it. The classification itself is written around the postpartum period, so the label she goes home with is decided after delivery, not before:

• Chronic HTN: present before pregnancy or diagnosed before 20 weeks gestation, or persisting beyond 12 weeks postpartum
• Gestational HTN: new hypertension at or after 20 weeks gestation without proteinuria, with BP normal by 12 weeks postpartum; it could be a harbinger of chronic hypertension later in life
• Preeclampsia: increased BP with proteinuria; eclampsia is preeclampsia with seizures
• Chronic hypertension with superimposed preeclampsia

So blood pressure typically normalizes within 12 weeks postpartum, and persistent BP elevation postpartum beyond 12 weeks suggests chronic hypertension.

How long she is watched

Monitor BP for at least 72 hours postpartum and again at 7-10 days. Continue antihypertensives if needed. Educate on the signs of postpartum pre-eclampsia, for example severe headache and vision changes. Follow up with a healthcare provider to reassess long-term cardiovascular risk.

The reason for the long watch is written twice: BP should be monitored closely in the postpartum period because gestational hypertension increases the risk of postpartum hypertension, and long-term follow-up is needed because of the increased risk of chronic hypertension and cardiovascular disease later in life.