Clinicians should be aware of the risk of late seizures and ensure that women have a careful review before discharge from hospital.

Anti-hypertensive medication should be continued after delivery as dictated by the blood pressure. It may be necessary to maintain treatment for up to 3 months, although most women can have treatment stopped before this. Women with persisting hypertension and proteinuria at 6 weeks may have renal disease and should be considered for further investigation.

Clinicians should be aware that up to 44% of eclampsia occurs postpartum, especially at term, so women with signs or symptoms compatible with pre-eclampsia should be carefully assessed. Severe pre-eclampsia or eclampsia can occur in the postpartum period. Up to 44% of eclampsia has been reported to occur postnatally, especially in women presenting at term.⁹⁴⁰¹ Women who develop hypertension or symptoms of pre-eclampsia postnatally (headaches,visual disturbances,nausea and vomiting or epigastric pain) should be referred for a specialist opinion and investigation to exclude pre-eclampsia.⁹⁸⁰²

Women who deliver with severe pre-eclampsia (or eclampsia) should have continued close observation postnatally. As eclampsia has been reported up to 4 weeks postnatally, the optimum length of inpatient postnatal stay is unclear but the incidence of eclampsia and severe pre-eclampsia falls after the fourth postpartum day.

The decision about discharge from hospital needs to take account of the risk of late seizures. Most women with severe pre-eclampsia or eclampsia will need inpatient care for 4 days or more following delivery. Careful review to ensure improving clinical signs is needed before discharge. Anti-hypertensive therapy should be continued after delivery. Although, initially, blood pressure may fall, it usually rises again at around 24 hours postpartum. A reduction in anti-hypertensive therapy should be made in a stepwise fashion. There is no reason why the woman cannot go home on treatment, to be weaned off therapy as an outpatient. After pre-eclampsia, blood pressure can take up to 3 months to return to normal. During this time, blood pressure should not be allowed to exceed 160/110 mmHg. Currently, there is insufficient evidence to recommend any particular anti-hypertensive. However, it is good practice to avoid the use of alpha methyldopa in the postnatal period because of its adverse effect profile, particularly depression. In breastfeeding
women, labetalol, atenolol, nifedipine and enalapril are currently in use, either singly or in combination.