High blood pressure and low heart rate after giving birth

There are some conditions that can happen after childbirth that I explain to all my patients. They can come on suddenly and get worse quickly. Without prompt and timely treatment, they can cause serious and sometimes life-threatening issues.

The good news is that most women recover without serious problems when they and their ob-gyns recognize and treat symptoms quickly.

Three of these conditions are

• postpartum preeclampsia, a serious blood pressure disorder

• postpartum hemorrhage, heavy bleeding after delivery

• postpartum endometritis, an infection of the uterus

Here’s what to know about these conditions and the signs to watch for.

1. Postpartum Preeclampsia

Preeclampsia can affect all the organs in a woman’s body. You have preeclampsia when you have high blood pressure and other signs that your organs aren’t working normally.

Most often, symptoms of preeclampsia happen during pregnancy. But some women who develop preeclampsia do so after delivery. This includes some who had normal blood pressure during pregnancy.

Postpartum preeclampsia most often happens within a few days after delivery, but it can occur up to 6 weeks later. Untreated, preeclampsia can cause stroke, seizures, and other serious problems.

Signs to watch for

Your ob-gyn may ask you to check your blood pressure at home after you leave the hospital. A blood pressure reading has two numbers separated by a slash. For example, a blood pressure reading of 110/80 mm Hg is referred to as “110 over 80.” The first number is called the systolic blood pressure. The second number is called the diastolic blood pressure.

Call your doctor right away if you check your blood pressure and get a systolic reading of 140 mm Hg or higher and/or a diastolic reading of 90 mm Hg or higher.

Also call your doctor immediately if you have

• changes in vision (blurring, light sensitivity, seeing spots)

• a headache that won’t go away

• shortness of breath

• swelling of the face or hands

• pain in the shoulder or abdominal (belly) area, often on the upper right side

• nausea or vomiting

• sudden weight gain (2 to 3 pounds or more in a week)

Treatment

Postpartum preeclampsia can be treated with medications that lower blood pressure. Your ob-gyn may also recommend intravenous (IV) medication to prevent seizures.

2. Postpartum Hemorrhage

Some bleeding and discharge after delivery is normal. It’s called lochia. Bleeding may start as a bright red color. Within a few days it should become lighter and more pink in color.

Postpartum hemorrhage is bleeding after birth that’s much heavier than usual—meaning you’re soaking through two pads an hour for more than 1 to 2 hours.

Postpartum hemorrhage usually happens within 24 hours of delivery. But it can occur up to 12 weeks later. The most common cause is a problem called uterine atony. Uterine atony happens when the muscles of the uterus do not contract normally. Without normal contractions, blood vessels do not tighten after delivery. This can lead to bleeding.

Some women have this dangerous bleeding because small pieces of their placenta stay attached to their uterus after delivery. Blood clotting disorders and tears in the uterus, cervix, or vagina can also cause postpartum hemorrhage.

Signs to watch for

The main sign is heavy or gushing blood from the vagina. You may pass large blood clots. Other signs include

• low blood pressure

• pale or clammy skin

• feeling faint, dizzy, or weak

• confusion

• rapid heart rate

• pain and swelling near the vagina or perineum (the area between the vagina and the anus)

Call your ob-gyn right away if you have any of these symptoms.

Treatment

You may need medication or abdominal massage to help the uterus contract. If needed, still-attached pieces of placenta may need to be removed. You also may need blood and fluids to replace what you’ve lost.

Some women need procedures to put pressure on the inside of the uterus to stop bleeding. You may need surgery to find the cause of bleeding and stop it. Rarely, the uterus may need to be removed (hysterectomy) to stop life-threatening bleeding.

3. Postpartum Endometritis

If bacteria get into the lining of the uterus during childbirth, it can cause infection. This is called endometritis. If it’s not treated quickly, it can cause sepsis, shock, and organ failure.

Endometritis usually happens 2 to 10 days after delivery. But some women develop it up to 6 weeks after childbirth.

Signs to watch for

Call your ob-gyn immediately if you

• have fever and chills

• feel tired or sick

• have abdominal pain or tenderness

• notice foul-smelling vaginal discharge

Treatment

Endometritis is treated with antibiotics, usually given through an IV line.

Listen to your body

These conditions can come on suddenly, so it’s important to know and be alert to the signs. Your family and friends should learn the signs too, so they can help notice if there’s a problem.

If you have any warning signs, call your ob-gyn right away. If you can’t reach your ob-gyn, or if you feel you need immediate care, call 911 or go to the hospital. (Health care professionals should listen to you and take your concerns seriously. You can use these tips to help speak up for yourself.)

Women who get timely and appropriate treatment usually recover completely. Acting quickly could save your life.

Published: January 2022

Last reviewed: January 2022

Copyright 2022 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

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