Preeclampsia and Postpartum Warning Signs

What it is

Preeclampsia is high blood pressure that develops in pregnancy, usually with protein in the urine and swelling of the face and hands [2]. Eclampsia is preeclampsia that has progressed to seizures, and HELLP syndrome is a related, dangerous condition affecting the blood and liver [2].

Why this guide is written for Black patients

The National Institute of Child Health and Human Development lists African American ethnicity among the risk factors for preeclampsia, and adds that among women who have had preeclampsia before, non-white women are more likely than white women to develop it again in a later pregnancy [1].

The National Heart, Lung, and Blood Institute states the same thing from the other direction: during pregnancy, Black women are more likely than white women to develop preeclampsia [4]. It also notes that Black adults tend to have higher average blood pressure and to develop high blood pressure earlier in life [4], which is one of the conditions that raises preeclampsia risk in the first place [1].

Other risk factors on the NICHD list include chronic hypertension, obesity, being over 40, carrying more than one baby, a family history, diabetes and lupus [1].

What to ask a clinician

• Am I high risk for preeclampsia, and should I be taking low-dose aspirin after 12 weeks [3]?
• What is my baseline blood pressure before pregnancy, or as early in pregnancy as we have it?
• Which symptoms should make me call you rather than wait for the next visit?
• Who watches my blood pressure in the first 72 hours after delivery, and how [3]?
• What is the plan for the postpartum visit, and when is it booked for?

What good care looks like

Prevention is offered early or not at all. The US Preventive Services Task Force recommends that women at high risk for preeclampsia take low-dose aspirin starting after 12 weeks of pregnancy to prevent the condition [3]. That means the risk conversation has to happen in the first trimester, which is a reason to raise it yourself at the first visit rather than waiting to be asked.

Delivery is what resolves preeclampsia and eclampsia, and at 37 weeks or later a clinician will usually want to deliver the baby to treat preeclampsia and avoid further complications [3]. Magnesium sulfate may be given to treat active seizures and to prevent future ones [3].

The part that gets skipped is after. Clinicians should closely monitor women who had high blood pressure or preeclampsia during pregnancy for 72 hours after delivery, either at home or in the hospital, because postpartum preeclampsia can progress rapidly and seriously [3]. If you are being discharged before that, ask who is checking your blood pressure, when, and what number should make you call.

When it is urgent

Go to hospital now, at any point in pregnancy or in the weeks after birth, for any of these: a seizure, a severe headache, vision problems including blurring or temporary blindness, or abdominal pain especially in the upper right area of the belly [2]. Nausea and vomiting with those signs, or passing much less urine than usual, belongs in the same list [2].

Swelling of the face and hands, headache and blurred vision are the classic preeclampsia signs [2]. HELLP syndrome can arrive without high blood pressure or protein in the urine and can cause easy bruising or bleeding, abdominal pain, nausea, headache or extreme fatigue, and it can lead to liver failure and death [2].

Say the word preeclampsia out loud when you arrive. It gets a blood pressure cuff on your arm faster than a description of how you feel.

What to do next

If you are pregnant or planning to be, book with an OB-GYN early and ask the aspirin question at the first appointment. Find Black OB-GYNs.

If you have already given birth, keep the postpartum appointment even if you feel fine, and get a blood pressure cuff for home if anyone mentioned your pressure at any point during the pregnancy.