Abstract

Introduction: Most maternal deaths occur during the postpartum period, either within 24 hours of birth (approximately 17% in the United States) or within the first 6 weeks postpartum (approximately 40% in the United States). 4 in 5 of these deaths are preventable, with leading causes during the postpartum period such as venous thromboembolism (VTE), sepsis, and postpartum hemorrhage (PPH). A commonality in these diagnoses is abnormal vital signs. And yet, normal vital sign reference ranges during the postpartum period, a time of natural hemodynamic changes, have not been adequately defined in the US populations. An objective, accessible screening for these hemodynamic changes is blood pressure.

Methods: This study followed the Joanna Briggs Institute (JBI) guidelines for evidence synthesis, utilizing a rapid review approach to systematically identify, screen, and analyze research on postpartum vital signs and reference ranges. The process adhered to JBI’s stages of identification, screening, eligibility assessment, and data extraction, synthesizing findings from 70 studies examining postpartum blood pressure (BP) norms, hypertension classification, and clinical management protocols.

Results: There is a lack of a standardized definition for "normal" postpartum BP (PBP), with existing thresholds varying across studies. Moreover, approximately 60% of delayed-onset postpartum preeclampsia (PE) cases occur in women without prior hypertensive diagnoses, emphasizing the need for improved screening.

Conclusions: While PBP monitoring practices remain inconsistent, emerging strategies, such as home BP monitoring and quality improvement initiatives during newborn visits, show promise for earlier detection and intervention. These findings underscore the need for standardized PBP reference ranges, enhanced postpartum monitoring protocols, and interdisciplinary provider education to improve hypertension management in the postpartum period.

Keywords: intrapartum; postpartum period; fourth trimester; venous thromboembolism; postpartum hemorrhage; Pulmonary hypertension; American Heart Association; blood pressure; hypertensive disorders; maternal morbidity; socioeconomic factors; national health policies; maternal deaths; postpartum hypertension

Introduction

The intrapartum and postpartum period are naturally marked with a high rate of hemodynamic changes, where increases in cardiac output, blood pressure, heart rate, and plasma volume, occur during birth, the hour immediately after, and during the postpartum, or “fourth trimester” period [1]. In fact, it is believed that the postpartum body only returns to pre-pregnancy hemo­dynamic levels 3 to 6 months postpartum. In parallel, when ex­amining maternal mortality data, most maternal deaths occur during the postpartum period, either within 24 hours of birth (approximately 17% in the United States) or within the first 6 weeks postpartum (approximately 40% in the United States) [2]. The leading causes of these deaths diagnosed as venous thromboem­bolism (VTE), sepsis, and postpartum hemorrhage (PPH) during the postpartum period overwhelmingly exhibit abnormal vital signs [2]. Improving detection of such physiological deterioration during the postpartum period has been grossly under researched.

Pulmonary hypertension, and other hypertensive disorders, are one of the highest risk disorders during pregnancy [1]. Both a rising cause of pregnancy-related mortality and morbidity, (with associated rates of mortality ranging from 25% to 56%), hypertension-related hospitalizations have risen substantial­ly in pregnant women; delays often occur in diagnostics, due to unspecified thresholds for vitals during pregnancy [1]. Despite a much higher prevalence, only 24% of cases are diagnosed during pregnancy due to their congenital nature [1]. Maternal deaths due to hypertensive disorders and other such complications are largely preventable. With rising maternal deaths occurring in the United States, it is imperative that interventions to prevent them are put in place.The maternal cardiovascular system is drastically changed by pregnancy, due to the increased cardiac burden [3]. These changes impact blood volume, with a 60 to 80% increase in cardiac output immediately after delivery, yet it is unclear how these ranges vary later into the postpartum period [3]. Change in postpartum vital signs influenced by pregnancy physiology can be a utilized for early detection and thus prevention; and yet, normal ranges for vital signs in the postpartum period have been inad­equately defined and researched. One study even examined how the mean time to return to normotensive values was 5.7 ± 3.7 weeks after delivery for women in preeclampsia or diagnosed hy­pertension during pregnancy [4]. Moreover, there remains debate around thresholds for concern [5]. Currently, only two studies, a prospective longitudinal cohort study in the UK and in Nigeria, respectively, have attempted to characterize these postpartum vital ranges with any sense of granularity [2,6]. Looking at blood pressure, heart rate, oxygen saturation, temperature, and respi­ratory rate, for two weeks postpartum, [2] found that there were day-specific changes in the reference ranges for these vital signs, suggesting that more specificity will help obtain earlier diagnoses of abnormal or elevated blood pressure. [6] was focused on pre­venting postpartum hemorrhage by redefining these metrics in a low-resource setting; they collected data on BP, HR, mean arterial pressure (MAP) to redefine the obstetric shock index (SI). Both co­horts, while they moved the needle forward on more comprehen­sive reference ranges during the postpartum period, looked at it in a limited capacity. [6], only examined vital signs one hour after de­livery, whereas [2], only collected data for two weeks postpartum. Both cohorts are not representative of the diversity present in the United States population. With differences over vital thresholds continuing between the American Heart Association (AHA) and the American College of Obstetricians and Gynecologists (ACOG), more clearly defined clinical guidelines for these vital signs during the postpartum period are necessary [7]. Thus, this scoping re­view attempts utilize a wider net to identify all pertinent stud­ies globally that have examined the role of postpartum vitals, in specific relation to blood pressure, as well as overall postpartum health.

Methods

Literature Review

The Joanna Briggs Institute (JBI) guidelines for evidence syn­thesis was utilized in the design of this study, employing a rapid review approach to systematically identify, screen, and analyze relevant research related to postpartum vital signs and reference ranges. The review process included the following phases: identi­fication, screening, eligibility assessment, and data extraction.

To ensure a comprehensive identification of relevant litera­ture, searches were conducted in two major databases: PubMed and Web of Science. The search strategy was designed to capture research specifically addressing postpartum vital signs, associat­ed reference ranges, and physiological parameters during preg­nancy. The search terms included:

a) “postpartum”

b) “fourth trimester”

c) “postpartum reference ranges”

d) “postpartum vital signs”

e) “vital signs during pregnancy”

f) “hypertensive disorders of pregnancy”

g) “pregnancy cardiovascular changes”

h) “blood pressure during pregnancy”

i) “postpartum blood pressure”

Boolean operators (e.g., AND, OR) and database-specific filters were applied to refine the search and minimize irrelevant results. No publication date restrictions were imposed, ensuring the in­clusion of both foundational and recent studies, and studies could be of any design-type or methodology, so long as they were pub­lished in English originally (or a suitable translation was readily accessible). The initial search yielded 330 abstracts, which were imported into a reference management tool to remove duplicates. Abstracts were screened based on predefined inclusion and exclu­sion criteria:

review stage. Following abstract screening, 84 articles were iden­tified as relevant for further analysis. The full-text review stage in­volved a detailed assessment of the 84 selected articles. Key con­siderations included: study design and methodology, population characteristics and demographics, vital signs data, and were re­quired to explicitly address the postpartum period, with a partic­ular focus on the fourth trimester. Following this stage, 14 articles were excluded due to issues such as insufficient relevance to the postpartum period, a focus on exclusively prenatal or intrapartum women, lack of original data, or lack of methodological rigor. The final selection consisted of studies that met all inclusion criteria, resulting in a total of 70 articles.

Results

Geographic Variations in Postpartum Blood Pressure Monitoring and Management

Analysis of included studies reveals significant geographic dis­parities in postpartum blood pressure (BP) monitoring and man­agement. Studies conducted in high-resource settings, such as the United States and the United Kingdom, implement structured fol­low-up protocols for high-risk patients [8], whereas low-resource settings often lack standardized postpartum monitoring, likely due to a confluence of factors such as staffing, resources, and patient follow-up [4]. For instance, a study conducted at Erasmus Medi­cal Center in the Netherlands [9] highlights reliance on home BP monitoring due to healthcare accessibility constraints, while re­search from Newark, New Jersey [10] emphasizes hospital-based postpartum BP assessments. These variations underscore the role of healthcare infrastructure and resource availability in shaping postpartum hypertension care. It, however, also highlighted how, when available, these resources were directed almost exclusively to high-risk patients. Those deemed ‘low-risk’ and lacked an offi­cial diagnosis at any point during pregnancy were unlikely to be closely monitored. Further evidence from studies in Canada and Australia [11] suggests that nationalized healthcare systems fa­cilitate more consistent postpartum BP follow-up compared to fragmented care models in the U.S. Canadian studies highlight structured postpartum hypertension screening integrated within maternal health clinics, ensuring more timely detection of post­partum preeclampsia. Conversely, research from rural settings in sub-Saharan Africa [12] and South Asia [13] reveals that limited access to postpartum care leads to higher rates of undiagnosed and unmanagedhypertensive disorders, contributing to increased maternal morbidity. In Latin America, studies from Brazil and Mexico [14,15] emphasize the role of community health workers in postpartum monitoring, leveraging local outreach programs to improve hypertension screening. However, these programs of­ten struggle with inconsistent funding and lack of standardized BP thresholds, creating disparities in patient outcomes. Similar­ly, research from India [16] highlights significant regional varia­tion, with urban tertiary hospitals implementing postpartum BP protocols, whereas rural districts rely primarily on home-based self-monitoring, leading to delayed recognition of hypertensive complications.

Influence of Study Design on Reported Outcomes

A variety of study designs were included, each contributing unique insights. Prospective cohort and feasibility studies [17,4] provide longitudinal data on postpartum BP trends, identifying a delayed onset of hypertension up to 3 months postpartum. These studies highlight how the postpartum period is severely neglected when it comes to clinical oversight. Retrospective cohort studies [10] reveal gaps in follow-up care and disparities in patient out­comes based on race and socioeconomic status, which is in line with national data on maternal morbidity and mortality. Ran­domized control trials [8] evaluate the effectiveness of self-man­agement strategies, demonstrating that home BP monitoring is a viable intervention to improve and enhance early detection. How­ever, literature reviews [18] highlight inconsistencies in defining normal postpartum BP, suggesting that thresholds for interven­tion vary widely across studies, and thus, lead to fragmented and inconsistent levels of care being provided.

Population Characteristics and Risk Stratification

Postpartum hypertension is inherently influenced by multi­ple patient-level factors, including age, comorbidities, and prior hypertensive disorders. But, studies also indicated that approxi­mately 60% of delayed-onset postpartum preeclampsia (PE) cases occur in women without a prior hypertensive diagnosis [4]. This once again suggests that a large population of women at risk are not included in the ‘high-risk’ and therefore monitored popula­tion, if monitoring is available. Population-based analyses [17] show that younger women and Black patients face higher risks of postpartum hypertension but receive less consistent follow-up care. Studies conducted in East Asia [19] highlight that postpar­tum hypertension risk is increased among women with a history of gestational diabetes, further complicating follow-up care. In contrast, research in Scandinavian countries [20] suggests that comprehensive maternal health policies contribute to lower rates of undiagnosed postpartum hypertension due to structured, rou­tine postpartum screenings.

Furthermore, socioeconomic factors have been identified as significant determinants in postpartum hypertension disparities. Research in the U.S. [21] and South Africa [22]. points to financial barriers and healthcare access limitations as primary contribu­tors to poor postpartum follow-up, particularly among margin­alized communities. Additionally, studies focusing on lactation and postpartum BP regulation [9] have been explored, suggesting a possible protective effect of breastfeeding on BP stabilization, though findings remain inconclusive. Studies from Germany and Japan [23,24] indicate that prolonged breastfeeding may have a protective effect in stabilizing BP, though the evidence remains mixed.

Policy Solutions and Interventions

Several studies suggest interventions to improve postpartum hypertension detection and management. Home BP monitoring programs have been shown to facilitate early detection, partic­ularly in settings where hospital-based follow-ups are inconsis­tent [8]. However, adherence remains a challenge, necessitating integration with telemedicine support systems to ensure timely clinical oversight [4]. Policy recommendations include expand­ing postpartum BP screening beyond traditional obstetric visits by integrating assessments into pediatric check-ups [10]. This approach ensures that women who might otherwise miss post­partum follow-ups receive BP evaluations. Additionally, some institutions have implemented quality improvement initiatives aimed at educating primary care providers and pediatricians on postpartum hypertension warning signs [18]. In terms of medi­cation management, studies highlight the need for standardized antihypertensive treatment protocols to ensure uniform clinical decision-making [17]. A lack of clear guidelines has led to vari­ability in when and how treatment is initiated postpartum. Future policy efforts should focus on developing universal postpartum BP monitoring guidelines, ensuring equitable access to care, and leveraging technology to improve follow-up adherence.

Standardization Challenges and Areas for Improvement

One of the most critical findings is the lack of a universally accepted postpartum BP threshold, making clinical decision-mak­ing challenging. Some studies define hypertension as BP ≥140/90 mmHg [18], while others use more stringent cutoffs for postpar­tum intervention [8]. The inconsistency in follow-up protocols further complicates early diagnosis, with postpartum visits rang­ing from 2 to 6 weeks postpartum [10]. Studies from France and Italy [25,26] highlight how postpartum hypertension screening is integrated into national maternal care guidelines, offering a struc­tured approach to follow-up. Meanwhile, research from India and China [27,28] points to a reliance on home BP monitoring due to limitations in healthcare access, demonstrating the need for better standardization across healthcare systems. Furthermore, studies from Norway and Sweden [29,30] showcase the effectiveness of comprehensive maternal health tracking programs in ensuring consistent postpartum BP assessments, suggesting that similar models could be adopted in other regions.

Discussion

The findings of this review underscore notable healthcare infrastructure, national health policies, socioeconomic factors and geographic disparities in the monitoring and management of postpartum blood pressure (PBP), resulting in inconsistencies in defining normal PBP and presenting challenges in establishing universally accepted diagnostic thresholds. Central to this inquiry is the conundrum of “what is normal?” With no properly defined blood pressure and vital sign ranges for the postpartum period, the variation in treatment is heavily influenced by the aforemen­tioned variables of geography, race, resources, socioeconomics, and healthcare system infrastructure. What further complicates this, from a clinical discretion standpoint, is that if and when re­sources are made available for additional monitoring, it remains almost entirely exclusive to high-risk patients [31-35]. In high-re­source settings like the U.S. and the U.K., structured follow-up protocols for high-risk patients have been implemented, ensuring more consistent monitoring of PBP. However, given data that sug­gests that an overwhelming percentage of women without any pri­or history of hypertension or other blood pressure disorders can develop some form of postpartum hypertension, these “low-risk” and otherwise healthy patients are provided with no clinical over­sight or care. It is known that healthcare infrastructure, coupled with accessibility of follow-up care, is crucial to promoting mater­nal health outcomes and mitigating maternal mortality and mor­bidity [36-40]. However, natural clinical variation must be better accounted for, thus necessitating a standardized postpartum vital sign range to help reduce the number of preventable maternal deaths that occur in the 4th trimester [41-45].

Furthermore, the inclusion of various study designs in the lit­erature—ranging from prospective cohort studies to randomized controlled trials—provides valuable insights into the effectiveness of different monitoring approaches, including home-based BP monitoring and hospital follow-up [46-50]. However, this diver­sity in study designs also reveals inconsistencies in defining nor­mal postpartum BP and highlights the challenge of establishing universally accepted diagnostic thresholds. The variation in these thresholds complicates the clinical decision-making process and creates discrepancies in patient outcomes, especially in settings where resources are limited [51-55]. The need for standardized guidelines and protocols is evident, as inconsistent follow-up schedules and monitoring practices hinder timely detection and management of postpartum hypertension [56-60].

Conclusion

The general range of geographic variation in blood pressure measures, coupled with the broad challenges associated with clinical decision-making, makes the management of postpar­tum blood pressure (PBP) particularly complex [61-65]. These disorders are influenced by a range of factors, including socio­economic status, access to healthcare, cultural practices, and re­gional differences in healthcare infrastructure [66-70]. The lack of a standardized definition for PBP as well as inconsistencies in implementation of a proper screening system for the timely de­tection and management of these conditions, further exacerbates the problem [71-73]. Additionally, the absence of early detection and appropriate management often results in missed opportu­nities to mitigate risks and prevent complications amongst ‘low-risk’ populations, such as postpartum preeclampsia, and maternal morbidity and mortality [74-76]. Given the varied approaches to managing postpartum blood pressure across the world, it is criti­cal to examine and learn from the diverse models that have been successful in different contexts. This review offers an opportunity to identify and adapt best practices that are effective in improving maternal health outcomes. By exploring successful strategies from various regions—whether through the implementation of univer­sal screening, community-based healthcare models, or advanced clinical guidelines—healthcare providers and policymakers can work toward developing more standardized, timely, and effec­tive systems for managing PBP. [77] In conclusion, addressing the challenges of PBP requires a multifaceted approach that combines the strengths of regional models, improved healthcare systems, and a commitment to developing standardized, evidence-based guidelines. Only through collaboration, data sharing, and the in­tegration of global best practices can we ensure that all pregnant individuals have access to the care they need to reduce the burden of hypertensive disorders and improve maternal and fetal health outcomes worldwide [78].

References

1. Green LJ, Pullon R, Mackillop LH, Gerry S, Birks J, et al. (2021) Postpartum-Specific Vital Sign Reference Ranges. Obstet Gynecol 137(2): 295-304.
2. Ouzounian, JG, Elkayam U (2012) Physiologic changes during normal pregnancy and delivery. Cardiology clinics 30(3): 317-329.
3. Nathan HL, Cottam K, Hezelgrave NL, Seed PT, Briley A, et al. (2016) Determination of Normal Ranges of Shock Index and Other Haemodynamic Variables in the Immediate Postpartum Period: A Cohort Study. PLoS One 11(12): e0168535.
4. Nwafor JI, Obi CN, Onuorah OE, Onwe BI, Ibo CC, et al. (2020) What is the normal range of obstetric shock index in the immediate postpartum period in a low-resource setting? Int J Gynaecol Obstet 2020 Oct;151(1):83-90.
5. Sisti G, Williams B (2019) Body of Evidence in Favor of Adopting 130/80 mm Hg as New Blood Pressure Cut-Off for All the Hypertensive Disorders of Pregnancy. Medicina (Kaunas) 55(10):703.
6. Kitt J, Frost A, Mollison J, Tucker KL, Suriano K, et al. (2022) Postpartum blood pressure self-management following hypertensive pregnancy: protocol of the Physician Optimised Post-partum Hypertension Treatment (POP-HT) trial. BMJ Open 12(2): e051180.
7. Hoppe KK, Williams M, Thomas N, Zella JB, Drewry A, et al. (2019) Telehealth with remote blood pressure monitoring for postpartum hypertension: A prospective single-cohort feasibility study. Pregnancy Hypertens 15:171-176.
8. Rugina I Neuman, Aveline MJ Figaroa, Daan Nieboer, Langeza Saleh, Koen Verdonk AH Jan Danser, et al. (2021) Angiogenic markers during preeclampsia: Are they associated with hypertension 1 year postpartum? Pregnancy Hypertension 23: 116-122.
9. Romagano MP, Williams SF, Apuzzio JJ, Sachdev D, Flint M, et al. (2020) Factors associated with attendance at the postpartum blood pressure visit in pregnancies complicated by hypertension. Pregnancy Hypertens 22: 216-219.
10. Tucker KL, Bankhead C, Hodgkinson J, Roberts N, Stevens R, et al. (2018) How Do Home and Clinic Blood Pressure Readings Compare in Pregnancy? Hypertension. 72(3): 686-694.
11. Countouris ME, Schwarz EB, Rossiter BC, Althouse AD, et al. (2016) Effects of lactation on postpartum blood pressure among women with gestational hypertension and preeclampsia. Am J Obstet Gynecol 215(2): 241.e1-8.
12. Feldman DM (2001) Blood pressure monitoring during pregnancy. Blood Press Monit 6(1): 1-7.
13. Li J, Zhou Q, Wang Y, Duan L, Xu G, et al. (2023) Risk factors associated with attendance at postpartum blood pressure follow-up visit in discharged patients with hypertensive disorders of pregnancy. BMC Pregnancy Childbirth 23(1): 485.
14. Sharma KJ, Kilpatrick SJ (2017) Postpartum Hypertension: Etiology, Diagnosis, and Management. Obstet Gynecol Surv 72(4): 248-252.
15. Albadrani M, Tobaiqi M, Al-Dubai S (2023) An evaluation of the efficacy and the safety of home blood pressure monitoring in the control of hypertensive disorders of pregnancy in both pre and postpartum periods: a systematic review and meta-analysis. BMC Pregnancy Childbirth 23(1): 550.
16. Berger PK, Plows JF, Jones RB, Pollock NK, Alderete TL, Ryoo JH, et al. (2019) Maternal blood pressure mediates the association between maternal obesity and infant weight gain in early postpartum. Pediatr Obes 14(11): e12560.
17. Borovac-Pinheiro A, Pacagnella RC, Morais SS, Cecatti JG (2016) Standard reference values for the shock index during pregnancy. Int J Gynaecol Obstet 135(1): 11-5.
18. Borovac-Pinheiro A, Ribeiro FM, Morais SS, Pacagnella RC (2019) Shock index and heart rate standard reference values in the immediate postpartum period: A cohort study. PLoS One 14(6): e0217907.
19. Bouthoorn SH, Gaillard R, Steegers EA, Hofman A, Jaddoe VW, van Lenthe FJ, et al. (2012) Ethnic differences in blood pressure and hypertensive complications during pregnancy: the Generation R study. Hypertension.
20. Brown MA, Robinson A, Bowyer L, Buddle ML, Martin A, et al. (1998) Ambulatory blood pressure monitoring in pregnancy: what is normal? Am J Obstet Gynecol 178(4): 836-42.
21. Brown MA (2014) Is there a role for ambulatory blood pressure monitoring in pregnancy? Clin Exp Pharmacol Physiol 41(1): 16-21.
22. Campbell A, Stanhope KK, Platner M, Joseph NT, Jamieson DJ, et al. (2022) Demographic and Clinical Predictors of Postpartum Blood Pressure Screening Attendance. J Womens Health (Larchmt) 31(3): 347-355.
23. Choi E, Kazzi B, Varma B, Vaught JA, Lewey J, et al. (2022) The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care. Current Cardiovascular Risk Report 16(12): 219-229.
24. Deshpande SS, Gadappa SN, Badgire SA, Sholapure AS, et al. (2022) Study of Feasibility of Blood Pressure Monitoring in Postpartum Women by Teleconsultation in COVID 19 Pandemic Situation. J Obstet Gynaecol India 72(Suppl 1): 186-191.
25. Ferguson JH, Neubauer BL, Shaar CJ (1994) Ambulatory blood pressure monitoring during pregnancy. Establishment of standards of normalcy. Am J Hypertens 7(9 Pt 1): 838-43.
26. Gaillard R, Bakker R, Steegers EA, Hofman A, Jaddoe VW (2011) Maternal age during pregnancy is associated with third trimester blood pressure level: the generation R study. Am J Hypertens 24(9): 1046-53.
27. Garovic VD, Dechend R, Easterling T, Karumanchi SA, McMurtry Baird S, et al. (2022) Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement from the American Heart Association. Hypertension 79(2): e21-e41.
28. Gat R, Hadar E, Orbach-Zinger S, Shochat T, Kushnir S, Einav S (2019) Distribution of Extreme Vital Signs and Complete Blood Count Values of Healthy Parturients: A Retrospective Database Analysis and Review of the Literature. Anesth Analg 129(6): 1595-1606.
29. Grindheim G, Estensen ME, Langesaeter E, Rosseland LA, Toska K (2012) Changes in blood pressure during healthy pregnancy: a longitudinal cohort study. J Hypertens 30(2): 342-50.
30. Groer MW, Jevitt CM, Sahebzamani F, Beckstead JW, Keefe DL (2013) Breastfeeding status and maternal cardiovascular variables across the postpartum. J Womens Health (Larchmt) 22(5):453-459.
31. Haas DM, Parker CB, Marsh DJ, Grobman WA, Ehrenthal DB, et al. (2019) Association of Adverse Pregnancy Outcomes with Hypertension 2 to 7 Years Postpartum. J Am Heart Assoc 8(19): e013092.
32. Hacker FM, Jeyabalan A, Quinn B, Hauspurg A (2022) Implementation of a universal postpartum blood pressure monitoring program: feasibility and outcomes. Am J Obstet Gynecol 4(3): 100613.
33. Harrington CM, Sorour N, Troy S, Botros M, Ciuffo M, et al. (2021) Postpartum Hypertension and the Role of Postpartum Clinics and Digital Health. Curr Treat Options Cardio Med 23.
34. Hauspurg A, Countouris ME, Catov JM (2019) Hypertensive Disorders of Pregnancy and Future Maternal Health: How Can the Evidence Guide Postpartum Management? Curr Hypertens Rep 21(12): 96.
35. Hauspurg A, Lemon LS, Quinn BA, Binstock A, Larkin J, et al. (2019) A Postpartum Remote Hypertension Monitoring Protocol Implemented at the Hospital Level. Obstet Gynecol 134(4): 685-691.
36. Hermida RC, Ayala DE, Iglesias M (2001) Predictable blood pressure variability in healthy and complicated pregnancies. Hypertension 38(3 Pt 2): 736-741.
37. Hermida RC, Ayala DE, Mojon A, Fernandez JR, Alonso I, et al. (2000) Blood pressure patterns in normal pregnancy, gestational hypertension, and preeclampsia. Hypertension 36(2): 149-158.
38. Hermida RC, Ayala DE (2005) Reference thresholds for 24-h, diurnal, and nocturnal ambulatory blood pressure mean values in pregnancy. Blood Press Monit 10(1):33-41.
39. Hirshberg A, Zhu Y, Smith-McLallen A, Srinivas SK (2023) Association of a Remote Blood Pressure Monitoring Program with Postpartum Adverse Outcomes. Obstet Gynecol 41(6): 1163-1170.
40. Hoppe KK, Williams M, Thomas N, Zella JB, Drewry A, et al. (2019) Telehealth with remote blood pressure monitoring for postpartum hypertension: A prospective single-cohort feasibility study. Pregnancy Hypertens 15: 171-176.
41. Ibáñez-LorenteC, Casans-Francés R, Bellas-Cotán S, Muñoz-Alameda LE (2021) Implementation of a maternal early warning system during early postpartum. A prospective observational study. PloS one 16(6): e0252446.
42. Kalafat E, Benlioglu C, Thilaganathan B, Khalil A (2020) Home blood pressure monitoring in the antenatal and postpartum period: A systematic review meta-analysis. Pregnancy Hypertens 19: 44-51.
43. Kitt JA, Fox RL, Cairns AE, Mollison J, Burchert HH, et al. (2021) Short-Term Postpartum Blood Pressure Self-Management and Long-Term Blood Pressure Control: A Randomized Controlled Trial. Hypertension 78(2): 469-479.
44. Kolovetsiou-Kreiner V, Moertl MG, Papousek I, Schmid-Zalaudek K, Lang U, et al. (2018) Maternal cardiovascular and endothelial function from first trimester to postpartum. PLoS One 13(5): e0197748.
45. Loerup L, Pullon RM, Birks J, Fleming S, et al. (2016) Trends of vital signs with gestational age in normal pregnancies: a systematic review protocol. BMJ Open Jan 6(1): e008769.
46. Lopes Perdigao J, Hirshberg A, Koelper N, Srinivas SK, et al. (2020) Postpartum blood pressure trends are impacted by race and BMI. Pregnancy Hypertens 20: 14-18.
47. Lovgren T, Connealy B, Yao R, Dahlke JD (2021) Postpartum management of hypertension and effect on readmission rates. Am J Obstet Gynecol MFM 4(1): 100517.
48. Moodley J (2008) Maternal deaths due to hypertensive disorders in pregnancy. Best Pract Res Clin Obstet Gynaecol 22(3): 559-567.
49. Myers MC, Brandt DS, Prunty A, Gilbertson-White S, Sanborn A, et al. (2022) Effect of positioning on blood pressure measurement in pregnancy. Pregnancy Hypertens 27: 110-114.
50. Ngene NC, Moodley J (2020) Postpartum blood pressure patterns in severe preeclampsia and normotensive pregnant women following abdominal deliveries: a cohort study. J Matern Fetal Neonatal Med 2020 (18): 3152-3162.
51. Okonofua FE, Balogun JA, Amiengheme NA, O'Brien SP (1992) Blood pressure changes during pregnancy in Nigerian women. Int J Cardiol 37(3): 373-379.
52. Parker SE, Ajayi A, Yarrington CD (2023) De Novo Postpartum Hypertension: Incidence and Risk Factors at a Safety-Net Hospital. Hypertension 80(2): 279-287.
53. Quesada O, Scantlebury DC, Briller JE, Michos ED, Aggarwal NR (2023) Markers of Cardiovascular Risk Associated with Pregnancy. Curr Cardiol Rep 25(2): 77-87.
54. Rajkumar T, Hennessy A, Ali Y, Makris A (2023) Clinical characteristics and sequelae of intrapartum hypertension - a retrospective cohort study. BMC Pregnancy Childbirth 23(1): 146.
55. Rebelo F, Farias DR, Mendes RH, Schlussel MM, Kac G (2015) Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian Cohort Arq Bras Cardiol 104(4): 284-91.
56. Rhoads SJ, Serrano CI, Lynch CE, Ounpraseuth ST, Gauss CH, et al. (2017) Exploring Implementation of m-Health Monitoring in Postpartum Women with Hypertension. Telemed J E Health 23(10): 833-841.
57. Samways JW, Vause S, Kontopantelis E, Eddleston J, et al. (2016) Maternal heart rate during the first 48h postpartum: a retrospective cross sectional study. Eur J Obstet Gynecol Reprod Biol 206: 41-47.
58. Sawyer MR, Jaffe EF, Naqvi M, Sarma A, Barth WH Jr, Goldfarb IT (2020) Establishing Better Evidence on Remote Monitoring for Postpartum Hypertension: A Silver Lining of the Coronavirus Pandemic. AJP Rep 10(3): e315-e318.
59. Smithson SD, Greene NH, Esakoff TF (2021) Risk factors for re-presentation for postpartum hypertension in patients without a history of hypertension or preeclampsia. Am J Obstet Gynecol 3(2): 100297.
60. Smith V, Kenny LC, Sandall J, Devane D, Noonan M (2021) Physiological track-and-trigger/early warning systems for use in maternity care. Cochrane Database Syst Rev 9(9): CD013276.
61. Steele DW, Adam GP, Saldanha IJ, Kanaan G, Zahradnik ML, et al. (2023) Postpartum Home Blood Pressure Monitoring: A Systematic Review. Obstet Gynecol 142(2): 285-295.
62. Suresh SC, Duncan C, Kaur H, Mueller A, Tung A, et al. (2021) Postpartum Outcomes With Systematic Treatment and Management of Postpartum Hypertension. Obstet Gynecol 138(5): 777-787.
63. Tallmadge M, Livergood MC, Tvina A, Evans S, McIntosh J, et al. (2023) Characteristics of Patients Who Attend the 7- to 10-Day Postpartum Visit for Blood Pressure Evaluation. Am J Perinatol 40(14): 1579-1584.
64. Taylor D, Fleischer A, Meirowitz N, Rosen L (2017) Shock index and vital-sign reference ranges during the immediate postpartum period. Int J Gynaecol Obstet 137(2): 192-195.
65. Thomas NA, Drewry A, Racine Passmore S, Assad N, Hoppe KK et al. (2021) Patient perceptions, opinions and satisfaction of telehealth with remote blood pressure monitoring postpartum. BMC Pregnancy Childbirth 21(1): 153.
66. Too GT, Hill JB (2013) Hypertensive crisis during pregnancy and postpartum period. Semin Perinatol 37(4): 280-287.
67. von Versen- Höynck F, Häckl S, Selamet Tierney ES, Conrad KP, et al. (2020) Maternal Vascular Health in Pregnancy and Postpartum After Assisted Reproduction. Hypertension 75(2): 549-560.
68. Yeh PT, Rhee DK, Kennedy CE, Zera CA, Lucido B, et al. (2022) Self-monitoring of blood pressure among women with hypertensive disorders of pregnancy: a systematic review. BMC Pregnancy Childbirth 22(1): 454.
69. Zuspan FP, Rayburn WF (1991) Blood pressure self-monitoring during pregnancy: practical considerations. Am J Obstet Gynecol 164(1 Pt 1): 2-6.