Based on: Lopes Perdigao et al., Hypertension 2021;77:1517–1524
Greater Atlanta Women’s Healthcare OB Call Group • Protocol Effective March 2026
The Problem
Postpartum Hypertension: A Leading Cause of Readmission
Blood pressure rises days 3–6 postpartum as fluid mobilizes from the interstitium back into the intravascular compartment
18%
of maternal deaths worldwide attributable to hypertensive disorders of pregnancy
27%
of postpartum readmissions caused by persistent hypertension
Days 3–6
peak BP rise from postpartum fluid mobilization
💡
BP initially decreases in the first 48 hours after delivery, then rises as sodium mobilizes into the vascular space — creating a critical window for diuretic intervention.
WHO, 2006 • ACOG Practice Bulletin, 2020 • Hirshberg et al., J Perinatol 2016
women treated to prevent 1 case of persistent HTN at day 7
60%
reduction in elevated BPs at 7 days postpartum (aRR 0.26)
2 d
faster resolution of hypertension (8.5 vs 10.5 days)
No
increase in severe maternal morbidity or adverse events
⚠️
Effect most prominent in non-severe HDP — aRR 0.26 (95% CI 0.10–0.67) • aHR 1.62 (95% CI 1.22–2.15) for time to BP resolution. Effect attenuated in severe HDP subgroup.
Lopes Perdigao et al., Hypertension 2021 • Table 2 • Adjusted for mode of delivery and antihypertensive use
Primary Endpoints
Key Outcomes — Non-Severe HDP
Primary endpoints adjusted for mode of delivery
Furosemide
5%
Persistent HTN at 7 days postpartum
Placebo
16%
Persistent HTN at 7 days postpartum
Furosemide
8.5 d
Median days to BP resolution (<140/90)
Placebo
10.5 d
Median days to BP resolution (<140/90)
✔
aRR 0.26 (95% CI 0.10–0.67) aHR 1.62 (95% CI 1.22–2.15)
✔
No difference in readmission rates, potassium levels, or severe maternal morbidity between groups
Lopes Perdigao et al., Hypertension 2021 • Table 2
Call Group Protocol
The Postpartum Lasix Protocol
Greater Atlanta Women’s Healthcare OB Call Group — Effective March 2026
Gestational HypertensionPreeclampsia (w/ or w/o severe features)Chronic HTN with Superimposed Preeclampsia
Medication
Dose
Route
Duration
Furosemide (Lasix)
20 mg
PO once daily
5 days
Potassium Chloride (K-Dur)
20 mEq
PO once daily
5 days
Greater Atlanta Women’s Healthcare OB Call Group Protocol, March 17, 2026 • Based on Lopes Perdigao et al., Hypertension 2021
Implementation
Order Entry & Safety Checklist
Enter furosemide and KCl with postpartum orders, specifying number of days or doses. At discharge, the order automatically updates to reflect remaining doses.
Verify a current Comprehensive Metabolic Panel (CMP) is on file — confirm potassium (K) and creatinine (Cr) are within acceptable range before initiating.
Continue postpartum BP monitoring via HeartSafe Motherhood text program through 7–10 days postpartum.
📱
HeartSafe Motherhood — text-based BP surveillance program. Enroll all patients with HDP prior to discharge to capture late postpartum hypertension.
⚠️
Call Protocol — For BP ≥ 160/110 at any point, initiate severe-range hypertension management per ACOG Practice Bulletin. Do not delay for oral medications.
Greater Atlanta Women’s Healthcare OB Call Group Protocol, 2026 • Lopes Perdigao et al., 2021 • ACOG Practice Bulletin, 2020