Synopsis
Detect new or persistent hypertension after maternity discharge, respond to neurological warning symptoms, and arrange safe antihypertensive adjustment with maternal and infant monitoring.
- Delivery does not immediately end the risk from pre-eclampsia.
- Blood pressure commonly rises again several days after birth.
- Treat severe postpartum hypertension urgently in a monitored setting.
- Magnesium sulfate treats eclampsia but is not an antihypertensive.
- Stop methyldopa within two days after birth and replace if needed.
- Prescribe a written monitoring and dose-reduction plan before discharge.
Key red flags
New seizure, altered consciousness or focal neurological deficit.
Persistent severe headache or visual disturbance after birth.
Severe hypertension, especially with upper abdominal pain or vomiting.
Breathlessness, hypoxaemia or evidence of pulmonary oedema.
Investigation priorities
Confirm severity and monitor treatment response safely.
Management branches
Severe blood pressure elevation or concerning neurological symptoms are present.
- Call senior maternity and anaesthetic help, support airway and breathing, check glucose and protect the patient during a seizure.
- Give magnesium sulfate for eclampsia and initiate urgent antihypertensive treatment using the monitored obstetric emergency regimen.
- Measure fluid balance carefully, investigate organ dysfunction and arrange critical care or neurological assessment according to response.
Key medicines
Magnesium sulfate for eclampsiaGive 4 g intravenously over 5–15 minutes, then 1 g/hour by infusion; continue for 24 hours after the last eclamptic fit. Recurrent fits may require a further 2–4 g intravenously over 5–15 minutes.Monitor respiration, tendon reflexes and urine output; renal impairment increases toxicity risk and requires specialist adjustment. Ensure the unit's magnesium toxicity response and calcium gluconate antidote are immediately available.
Enalapril for postpartum maintenance treatmentA common starting prescription is 5 mg orally once daily, titrated to blood pressure and tolerance; the adult hypertension SmPC permits up to 40 mg daily, with lower initial doses for relevant renal impairment or volume depletion.Avoid with prior ACE inhibitor angioedema or a new pregnancy. Review potassium-raising medicines and renal function after starting or dose changes; seek individual lactation advice for premature or unwell infants.