Optimizing the Transition of Care for Postpartum Preeclampsia: A Scoping Review of Management Strategies and Missed Opportunities

Hypertensive disorders of pregnancy remain a primary driver of preventable maternal morbidity, specifically during the high-risk transition from hospital discharge to long-term primary care. This scoping review maps the "transition gap" within the fourth trimester to determine why traditional management strategies often fail to protect patients at risk for late-onset postpartum preeclampsia. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, a systematic search of PubMed, the Cochrane Library, and Google Scholar was conducted for peer-reviewed literature published between January 2010 and December 2025. A two-stage screening process involving independent reviewers led to the inclusion of 52 studies from an initial identification of 14,577 records. Findings indicate that conventional office-based follow-up models suffer from significant patient attrition and frequently overlook "masked" hypertension or de novo blood pressure spikes occurring after the initial discharge window. While remote patient monitoring (RPM) shows high feasibility for maintaining engagement, its clinical success is often hampered by structural and systemic barriers, including racial disparities, neighborhood-level socioeconomic disadvantage, and the loss of insurance coverage in the late postpartum period. To optimize outcomes, healthcare systems must transition toward specialized multidisciplinary transition clinics and standardized pharmacological protocols. By leveraging extended Medicaid coverage, integrating RPM technology, and adopting more stringent blood pressure targets of <130/80 mmHg, clinicians can bridge current fragmentation and transform the postpartum period into a vital window for lifelong cardiovascular health optimization.