Postpartum Hypertension
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PREECLAMPSIA (VD GAROVIC, SECTION EDITOR)
Postpartum Hypertension V. Katsi 1 & G. Skalis 2
&
G. Vamvakou 2 & D. Tousoulis 3 & T. Makris 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Hypertension affects approximately 10% of pregnancies and may persist in the postpartum period. Furthermore, de novo hypertension may present after delivery, but its exact prevalence is not verified. Both types of hypertension expose the mother to eventually severe complications like eclampsia, stroke, pulmonary edema, and HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome. Recent Findings Until today, there are limited data regarding the risk factors, pathogenesis, and pathophysiology of postpartum hypertensive disorders. However, there is certain evidence that preeclampsia may in large part be responsible. Women who experienced preeclampsia during pregnancy, although considered cured after delivery and elimination of the placenta, continue to present endothelial and renal dysfunction in the postpartum period. The brain and kidneys are particularly sensitive to this pathological vascular condition, and severe complications may result from their involvement. Summary Large randomized trials are needed to give us the evidence that will allow a timely diagnosis and treatment. Until then, medical providers should increase their knowledge regarding hypertension after delivery because many times there is an underestimation of the complications that can ensue after a misdiagnosed or undertreated postpartum hypertension. Keywords Postpartum . Hypertension . Preeclampsia . Eclampsia . Endothelial
Introduction Hypertensive disorders of pregnancy (HDP) complicate approximately 10% of all pregnancies and cause serious complications including maternal death [1]. Under the term hypertensive disorders are found gestational hypertension, preeclampsia, and eclampsia. Delivery is still considered therapeutic for these conditions, but growing evidence suggests that postnatal persistent or de novo hypertension is more common and serious than initially believed and should be included in this group [2]. The different expressions of the maternal cardiovascular dysfunction constitute a serious threat during pregnancy and the puerperium causing up to 18% of deaths This article is part of the Topical Collection on Preeclampsia * G. Skalis [email protected] 1
Cardiology Department, Hippokration Hospital, Athens, Greece
2
Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
3
1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
worldwide [3]. Postpartum hypertension, both persistent and de novo, is a condition that can reproduce all the maternal complications and negative outcomes that are observed antenatal [4]. However, the postnatal treatment is the same as during pregnancy and even more efficient given the possibility to use every category of antihypertensive drugs if lactation is abandoned [4].
Hypertension in Pregnancy and Post
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