Introduction
Hypertensive disorder in pregnancy is a common cause of maternal
morbidity and mortality. It is known to occur in 6 to 8% of all
pregnancies (1) especially in the developing countries (2). According to
National High Blood Pressure Education Program Working Group Report on
High Blood Pressure in Pregnancy, the hypertension in pregnancy is
divided into chronic hypertension, preeclampsia superimposed on chronic
hypertension, preeclampsia-eclampsia, gestational hypertension (1). If
untreated, they can lead to maternal complications like eclampsia,
placental abruption, postpartum hemorrhage, disseminated intravascular
coagulation, renal failure, cerebral oedema and HELLP syndrome
(Hemolysis, elevated liver enzymes and low platelets) (1, 3, 4). The
common fetal complications include intrauterine growth retardation,
preterm delivery and intrauterine deaths (3).
Preeclampsia is defined as presence of BP >140/90 along
with proteinuria after 20 weeks of pregnancy on two or more occasions
four hours apart. It is the most common form of hypertensive disorder in
pregnancy (5). Although, it is commonly reported during the time of
pregnancy, sometimes it can be reported as late as 4-6 weeks after the
delivery (5) where it is defined as postpartum preeclampsia. However, it
commonly occurs within the first seven days after delivery of the baby
due to absorption of extracellular fluid into the vessels (6).
Presently, there are few studies on postpartum preeclampsia. A study in
US showed the incidence of postpartum preeclampsia to be 5.7% (7). The
diagnosis of postpartum preeclampsia can be missed due to our focus
mainly on antenatal and intrapartum care. Here, we present a case of
mother who developed postpartum preeclampsia in Bhutan.