3.3 Screening for postpartum hypertension
Diastolic blood pressure is measured when the heart relaxes between heartbeats.
The hallmark of pregnancy-induced hypertension is high blood pressure, usually a diastolic blood pressure more than 90 mmHg. You learned how to take the mother’s blood pressure in the Antenatal Care Module, Study Session 9, and about hypertensive disorders of pregnancy in Study Session 19. Here we are concerned about hypertension that begins or returns in the puerperium. In order to screen for this you should ask the mother about the following symptoms:
- Severe headache, with or without visual disturbances (blurring of vision), and sometimes with nausea and vomiting.
- Convulsions/fits in the most severe cases (eclampsia). Make sure that you know the local terminology for a convulsion. It can be explained as an abnormal and uncontrollable rhythmic movement of the arms and legs, with or without losing consciousness.
- Swelling (oedema) of hands and feet, or especially the face.
- Severe pain in the upper part of the abdomen.
You should do a dipstick urine test (as you learned in Study Session 9 of the Antenatal Care Module). When urine is tested with a dipstick for the presence of protein, a woman with hypertension is likely to test positive. The positive values on the dipstick are graded from +1 up to +3 and more. If any one of the above findings is present, suspect pregnancy-induced hypertension and refer the woman urgently to the nearest health facility. Remember that postpartum hypertension can develop in any woman, even one who had normal blood pressure and was symptom-free during pregnancy, labour and delivery.