Predicting Postpartum LOS in Pre-Eclampsia: Clinical and Pharmacologic Drivers

A recent systematic review in BMC Pregnancy and Childbirth consolidates findings from eight observational studies examining predictors of prolonged postpartum length of stay (LOS) after pre-eclampsia. The analysis underscores the implications of prolonged LOS for discharge planning and inpatient bed utilization, particularly in maternity units managing hypertensive disorders of pregnancy.

Cesarean delivery and drug-related problems (DRPs) emerged as the most consistently reported and actionable inpatient factors associated with longer postpartum hospitalization. DRPs—particularly those compromising blood pressure control—were highlighted as frequent contributors to extended monitoring and treatment duration. One included multicenter study reported a statistically significant association between DRPs and prolonged LOS, though pooled estimates were not provided. Cesarean delivery also conferred increased procedural complexity, including wound management, venous thromboembolism prophylaxis, and mobility support, all contributing to longer inpatient recovery.

The review also noted signals suggesting associations between longer LOS and laboratory markers such as liver enzymes (ALT, AST), fibrinogen, and urea. However, the authors caution that the current biochemical evidence is sparse and heterogeneous, with no consistent biomarker profile yet validated for LOS prediction in this population. Notably, total bile acids and metabolomic profiles were not evaluated in the included studies, representing a clear data gap.

Local quality improvement initiatives may consider embedding biochemical sampling protocols and metabolomic substudies alongside targeted interventions to reduce DRPs and streamline cesarean recovery. Such programs could strengthen predictive capabilities and help optimize postpartum discharge planning while maintaining safety.