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Meta-Analysis
. 2013 Apr 30;2013(4):CD004351.
doi: 10.1002/14651858.CD004351.pub3.

Prevention and treatment of postpartum hypertension

Laura Magee  1 , Peter von Dadelszen
Affiliations
Meta-Analysis

Prevention and treatment of postpartum hypertension

Laura Magee et al. Cochrane Database Syst Rev. .

Abstract

Background: Postpartum blood pressure (BP) is highest three to six days after birth when most women have been discharged home. A significant rise in BP may be dangerous (e.g., can lead to stroke), but there is little information about how to prevent or treat postpartum hypertension.

Objectives: To assess the relative benefits and risks of interventions to: (1) prevent postpartum hypertension, by assessing whether 'routine' postpartum medical therapy is better than placebo/no treatment; and (2) treat postpartum hypertension, by assessing whether (i) one antihypertensive therapy is better than placebo/no therapy for mild-moderate postpartum hypertension; and (ii) one antihypertensive agent offers advantages over another for mild-moderate or severe postpartum hypertension.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013), bibliographies of retrieved papers, and personal files.

Selection criteria: For women with antenatal hypertension, trials comparing a medical intervention with placebo/no therapy. For women with postpartum hypertension, trials comparing one antihypertensive with either another or placebo/no therapy.

Data collection and analysis: We extracted the data independently and were not blinded to trial characteristics or outcomes. We contacted authors for missing data when possible.

Main results: Nine trials are included.

Prevention: Four trials (358 women) compared furosemide, nifedipine capsules, or L-arginine with placebo/no therapy. For women with antenatal pre-eclampsia, postnatal furosemide is associated with a strong trend towards reduced use of antihypertensive therapy in hospital.

Treatment: For treatment of mild-moderate postpartum hypertension, three trials (189 women) compared timolol, oral hydralazine, or oral nifedipine with methyldopa. Use of additional antihypertensive therapy did not differ between groups (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.20 to 4.20; three trials), but the trials were not consistent in their effects. The drugs were well tolerated.For treatment of severe postpartum hypertension, two trials (120 women) compared intravenous hydralazine with either sublingual nifedipine or intravenous labetalol. There were no maternal deaths or hypotension. Use of additional antihypertensive therapy did not differ between groups (RR 0.58, 95% CI 0.04 to 9.07; two trials), but the trials were not consistent in their effects.

Authors' conclusions: For women with pre-eclampsia, postnatal furosemide may decrease the need for postnatal antihypertensive therapy in hospital, but more data are needed on substantive outcomes before this practice can be recommended. There are no reliable data to guide management of women who are hypertensive postpartum. Any antihypertensive agent used should be based on a clinician's familiarity with the drug. Future studies should include data on postpartum analgesics, severe maternal hypertension, breastfeeding, hospital length of stay, and maternal satisfaction with care.

PubMed Disclaimer

Conflict of interest statement

Peter von Dadelszen is a paid consultant to Alere International, and receives grant funding from the Bill & Melinda Gates Foundation and CIHR. These activities are unrelated to this review.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Routine postnatal oral antihypertensive therapy for prevention of postpartum hypertension, Outcome 1 Maternal death.
1.2
1.2. Analysis
Comparison 1 Routine postnatal oral antihypertensive therapy for prevention of postpartum hypertension, Outcome 2 Maternal organ failure.
1.3
1.3. Analysis
Comparison 1 Routine postnatal oral antihypertensive therapy for prevention of postpartum hypertension, Outcome 3 Severe hypotension.
1.4
1.4. Analysis
Comparison 1 Routine postnatal oral antihypertensive therapy for prevention of postpartum hypertension, Outcome 4 Severe hypertension.
1.5
1.5. Analysis
Comparison 1 Routine postnatal oral antihypertensive therapy for prevention of postpartum hypertension, Outcome 5 Postnatal antihypertensive use in hospital.
1.6
1.6. Analysis
Comparison 1 Routine postnatal oral antihypertensive therapy for prevention of postpartum hypertension, Outcome 6 Postnatal antihypertensive use at hospital DISCHARGE.
1.7
1.7. Analysis
Comparison 1 Routine postnatal oral antihypertensive therapy for prevention of postpartum hypertension, Outcome 7 Medication changed secondary to maternal side‐effects.
2.1
2.1. Analysis
Comparison 2 Oral antihypertensive therapy for treatment of postpartum hypertension, Outcome 1 Maternal death.
2.2
2.2. Analysis
Comparison 2 Oral antihypertensive therapy for treatment of postpartum hypertension, Outcome 2 Maternal hypotension.
2.3
2.3. Analysis
Comparison 2 Oral antihypertensive therapy for treatment of postpartum hypertension, Outcome 3 Need for additional antihypertensive therapy.
2.4
2.4. Analysis
Comparison 2 Oral antihypertensive therapy for treatment of postpartum hypertension, Outcome 4 Medication changed secondary to maternal side‐effects.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to other published versions of this review

Magee 2003
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