Can preeclampsia, eclampsia, and/or HELLP still happen after birth? Why? What should I watch for?
Yes, preeclampsia and related conditions can worsen after birth or strike for the first time up to six weeks post partum. The risk is highest in the first three days, then the first week, and goes down from there.
Preeclampsia is caused by chemical-proteins that are released from a struggling placenta. Once the placenta is out (birth), no new chemicals can be added to your system. Sometimes a placenta will release a lot of chemicals on its way out. It then takes time for them to move around your body causing enough damage to trigger symptoms, and then more time for your body to clean them up and repair the damage. Delivery is considered the cure for preeclampsia, but it is more accurate to say that the cure is delivery plus time.
Researchers officially define post partum preeclampsia as first onset of symptoms after delivery. If you already had preeclampsia before birth, worsening symptoms would just be considered part of the ongoing preeclampsia you already had, rather than post partum preeclampsia. But doctors and patients may still call it post partum preeclampsia if you get worse after birth.
The symptoms of post partum preeclampsia are the same as preeclampsia during pregnancy. Major symptoms to watch for include blood pressure over 140/90, severe headache that does not improve with treatment, visual disturbances that do not fade away, and severe upper right side pain that does not respond to treatment. If you notice any of these, you should let your doctor know so they can evaluate you. Post partum preeclampsia requires admission to the hospital and treatment with magnesium sulfate.
All of these symptoms can have other possible causes, of course. Even high blood pressure can be "just" post partum hypertension rather than post partum preeclampsia. It is not unusual for blood pressure to fluctuate even in an uncomplicated pregnancy as we transition from pregnant to not-pregnant. But it is worth getting evaluated so you can have the right treatment for the right problem.
When preeclampsia worsens or begins post partum, it is an acute condition. It comes on quickly and goes away just as quickly. Once the symptoms of preeclampsia have peaked and started to improve, you can be reassured that the chemicals are being removed from your system and you are not likely to get severely sick again.
Full recovery can take a while, even after the acute phase of the condition is over. Blood pressure can still fluctuate during the post partum period as your body returns to being not-pregnant. This is not necessarily post partum preeclampsia. You can ask your doctor what symptoms you should watch for, including blood pressure levels, and what to do if you notice something.