Postpartum Visit Algorithm: Preeclampsia

Remember the ABCs:

folic

cid
reastfeeding

Assess current blood pressure

at 6 weeks postpartum

Blood pressure now <140/90

ontraception

Blood pressure remains 140/90

Determine appropriate anti-hypertensive medication

in consultation with primary care physician. (see
Discuss elevated risk of recurrence during
subsequent pregnancies given patients comorbidities (if any) and gestational age at
preeclampsia onset.
Discuss contraception, including permanent
contraception if patient does not desire further
childbearing.

Postpartum Chronic Hypertension algorithm)

Discuss contraception; advise on the use of nonestrogen containing contraception; if patient has
completed childbearing, discuss permanent
contraceptive options.

Obtain an EKG.
Follow-up on any persistent abnormalities from
patients past labs.
Advise patient to be screened regularly for new onset
hypertension, diabetes, and lipid disorders.

If echocardiogram was performed, note cardiac

function parameters (e.g., ejection fraction, left
ventricular size) and use results in patients follow-up
and in counseling regarding future childbearing.
For patients with a BMI 25, recommend weight loss
to achieve a normal BMI or a loss of 10% of current
body weight (see Postpartum Overweight and Obese
algorithm); refer to intensive nutrition and exercise
program if available.

Interconception Care Project for California

Postpartum Visit Algorithm: Preeclampsia

EVERY DAY
Checklist for Healthy Women

References:

Exercise 30 minutes a day, 5 days a

Barton JR, Sibai BM. Prediction and prevention of recurrent preeclampsia. Obstetrics & Gynecology
2008;112(2 Part 1):359-72.

Vitamin 400 micrograms of Folic

Hernandez-Daz S, Toh SW, Cnattingius S. Risk of pre-eclampsia in first and subsequent pregnancies:
prospective cohort study. British Medical Journal 2009;338:b2255.

week

Acid per day

Educate yourself about medicines and

chemicals that can cause birth defects

Reproductive life planning set your

personal goals for birth control and
future children

Yearly doctor visits to discuss

Lindheimer MD, Taler SJ, Cunningham FG. ASH position paper: hypertension in pregnancy. Journal of
Clinical Hypertension 2009;11:214-25.
Lykke JA, Langhoff-Roos J, Sibai BM, et al. Hypertensive pregnancy disorders and subsequent
cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension 2009;53:944.

physical and mental wellness

Magnussen EB, Vatten LJ, Smith GD, et al. Hypertensive disorders in pregnancy and subsequently
measured cardiovascular risk factors. Obstetrics & Gynecology 2009;114:961-70.

Diet Vegetables, fruits, and whole

Smith GN, Walker MC, Liu A, et al. A history of preeclampsia identifies women who have underlying
cardiovascular risk factors. American Journal of Obstetrics and Gynecology 2009;200:58.e1-58.e8.

grains daily

Avoid tobacco, drugs, and alcohol

Your partner, friends, and family
should be sources of support

Content from everywomancalifornia.org used with permission from

the Preconception Health Council of California.

Interconception Care Project for California

A collaborative project led by ACOG District IX with funding provided by March of Dimes
Preconception Health Council of California, 2011