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.