I was not diagnosed with preeclampsia during pregnancy but developed it postpartum. Here's what new moms need to know about the condition that can cause eclampsia or seizures after delivery.

By Emily Williams King
October 14, 2019
Getty Images (1)

My son was born on a Wednesday. I think my first words as a mother were, "He is so cute!" His delivery was quick and he was healthy, so we were soon whisked away to rest and bond in a recovery room.

My mom flew in from halfway across the country on Thursday, eager to meet her new grandson. That day was sweet and warm. A close friend of mine came to visit and was the first outside of our family to hold my son.

By Friday, it was time to go home. Since my mom was staying at our house, my husband left the hospital to pick her up. My son was in the nursey, as was custom at the time. I was alone and so grateful for a shower. I quietly sat on the edge of the hospital bed, finally clean, finally dressed in my own clothes, waiting for the nurse to bring my son down to me. That was my last memory before the seizure.

I didn't know it at the time, but I had developed postpartum preeclampsia.

Complications of Postpartum Preeclampsia

According to the Preeclampsia Foundation, postpartum preeclampsia is a serious condition related to high blood pressure that can happen to any woman who just had a baby. It has most of the same features of preeclampsia, and about 15 percent of postpartum preeclampsia patients will experience a severe aspect of this condition: eclampsia or seizures. After delivering my son, I became a part of that statistic.

A hospital employee retrieving my breakfast tray saw me seizing and called for help. When my husband and mom returned, I looked at my mother and asked, "What are you doing here?" I also asked where my father was, yet he had passed away three months earlier and I didn't remember any of it. I didn't even remember having a baby. I would later find out that my mom was deeply troubled that I didn't ask for my son much that day. The doctors reassured my husband that my memory would slowly return.

My first memory after the seizure was my husband showing me pictures on the back of our digital camera. It was 2007, before we had taken the plunge to buy smartphones. I remember staring at the tiny screen on the back of our camera. Pictures of me, holding a baby. I had a baby. I had a son. Yes, I had a son. I remember. Slowly, more details flowed back in.

"Why does my shoulder hurt?" I kept asking. In a bizarre turn, I had dislocated my shoulder during the seizure. I must have grabbed the bedrail. We will never know because I had been alone. But, I was one of the lucky ones. I was lucky that I was still in the hospital, lucky to have been in the bed when I seized, lucky that I wasn't holding my baby, lucky that I wasn't still in the shower as I had been minutes before, and lucky that I didn't have a stroke. Doctors seemed perplexed by my case as my blood pressure had only gone up to 138, while 140 is the clinical cut-off for concern. To prevent another seizure, a magnesium IV was started and mother-infant bonding took the back seat.

I had chosen this hospital carefully. A women's hospital in a large metropolitan area. Yet, this hospital did not have a neurologist or an orthopedist on staff. When a neurologist arrived, I was told my blood pressure had not been high enough to signal a preeclampsia diagnosis, however, my obstetrician said the seizure, protein in my urine, and blood pressure combined made a clear case for postpartum preeclampsia. Since I had not shown symptoms of preeclampsia during my pregnancy, I was told I had new-onset postpartum preeclampsia, which I had never heard of before.

Diagnosing New-Onset Postpartum Preeclampsia

According to Sarosh Rana, M.D., MPH, a professor of obstetrics and gynecology and section chief in Maternal-Fetal Medicine at the University of Chicago, new-onset postpartum preeclampsia is believed to be subclinical preeclampsia before delivery that persists after birth or could be triggered by a combination of factors such as intravenous fluids, loss of pregnancy-related changes in blood vessels, mobilization of fluid, presence of diabetes and high BMI, and also use of non-steroidal anti-inflammatory drugs.

"The chance of developing new-onset preeclampsia after birth is lower compared to women who already have diagnosed hypertension or preeclampsia before delivery," she says. "Not much is known why women will have new-onset preeclampsia after birth, but "At the University of Chicago," says Dr. Rana, "about 90 percent of women with some sort of hypertension prior to pregnancy end up with elevated blood pressures after delivery in the first few days, while the chances of new-onset hypertension after delivery is close to 10 percent."

Dr. Rana says that this diagnosis can be missed, especially if the providers and patients are not acutely aware of signs and symptoms. She explains that mothers under her care are provided with a tear pad sheet, educated on the signs of symptoms of preeclampsia (headache, blurred vision, and other symptoms), and asked to promptly call their doctor for evaluation if they notice any of these symptoms.

Treating and Preventing Postpartum Preeclampsia

One common misconception is that delivery cures preeclampsia. It does not, and Dr. Rana believes we need to do more to educate mothers, as well as doctors, on the risk of preeclampsia after birth.

"Many providers are not even aware of the risks associated with preeclampsia that persist after delivery," she says. "Risk of postpartum hypertension, stroke, seizures, and lab abnormalities are high within the first several days to weeks after delivery but can persist for up to 12 weeks. The old paradigm that preeclampsia is 'cured' by delivery is wrong. It can persist after delivery or even appear for the first time after delivery. Women are still at risk for short-term and long-term complications such as chronic hypertension, cardiovascular disease, stroke, and kidney disease many years after delivery."

While I was lucky to have received prompt care for my eclampsia because I was still in the hospital, new moms need to be aware of this condition so they can know what warning signs look for. Jennifer, a first-time mom from New York City, was diagnosed with preeclampsia when she went in for her routine 37-week appointment. Her blood pressure was in the 140s, with trace urinary protein. "You're getting induced today," her obstetrician told her. Jennifer began anti-seizure treatment before a seizure developed.

After induction, her blood pressure stabilized, her daughter was born healthy, and she "pretty much forgot about" her preeclampsia diagnosis, until just before she was to be discharged from the hospital a few days later. All of a sudden, her blood pressure soared to 190. She was moved to the high-risk floor and immediately administered magnesium. Her doctor came in and cheerfully said, "Good thing we caught it! I've got a patient across the hall who just seized. You should be fine." Not so reassuring. Jennifer spent the next two weeks under careful observation waiting for her blood pressure to stabilize. Multiple combinations of medications were tried until finally, doctors said it was "probably fine," and sent her home to be monitored by a visiting nurse.

How Hospitals Can Improve Postpartum Care

When I finally saw my son, my arm had been tightly fastened to my chest with Velcro in a shoulder sling akin to a straightjacket. I was able to sit up in bed with my son lying on my legs, but I was not able to hold him. I was not able to nurse. Yet, because I had access to multiple hospitals and excellent insurance, I was alive. Jennifer was also grateful for the care she received. "If I had been discharged, I probably would have had a serious stroke," she says.

Dr. Rana, who cares for mostly African American women, says it's important for new moms and doctors to know that "African American women have a higher prevalence of hypertensive disorders than white women in the United States; pregnancy-related death is four times greater among non-Hispanic black women, and preeclampsia is a major contributor to this disparity." The risk of postpartum hypertension is also much higher in African American women, she adds.

Dr. Rana is working hard to educate and make postpartum maternal care more comprehensive. A big step is to encourage new moms to attend a postpartum follow-up appointment as early as seven to 10 days after delivery to have their blood pressure checked. Pilot data collected at the University of Chicago showed that less than 30 percent of women attend this visit.

"At the University of Chicago, under my leadership, we have created a program especially for postpartum women as a form of a bundled approach," says Dr. Rana. "We are calling it systematic treatment and management of postpartum hypertension (STAMPP – HTN). We provide education to all postpartum patients and providers throughout the hospital, creating protocols for management of high blood pressures and preeclampsia before, during, and after delivery. The idea is that we empower patients and their families with knowledge and improve access to care."

Advertisement