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Congestive heart failure after pregnancy? Update #53


Kerileanne99
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First off, i am trying REALLY hard not to get freaked out or panic. I am hoping others have seen this and have had it turn out to be much less serious than it sounds.

 

As many of you know from the picture I posted of my sweet baby boy, I just gave birth via csection after a very difficult pregnancy. After I left the hospital on Tuesday my lower half started to swell. No big deal right, all that IV fluid. Except this is extreme. Literally from my belly button to my toes became grossly swollen.

I phoned the doctor's office and was basically told what I knew. They were not worried as long as my bp was not elevated (it isn't) and that edema in extremities is very common post-partum. But there really isn't a way to convey the extent or the fact that I would never panic over a bit of hands, feet, face swelling after birth!

 

But everything has continued to swell! I went to the OB/GYM this morning to have staples removed and had to wear hubby's pants and slippers. My entire legs are literally twice their size, painfully tight and rigid, and any indentations you make actually stay like a memory foam pillow. When I was weighed I came in at 132 lbs--7 lbs more than when I was pregnant!

 

Long story, but doctor took one look and became worried about congestive heart failure. Unfortunately the blood test to confirm would be elevated post-partum anyway. He sent me for other tests and started me on HCTZ to try to get rid of some of the swelling, and if not will admit me to hospital. Apparently the lungs can fill with the same fluid very quickly. I have been short of breath and have had a constant headache, but just thought it was part of recovery.

 

Anybody had problems with massive swelling like that? Or know anything about it? I am in limbo waiting to see if the meds work and have the heart and kidney tests. Very frightening:(

 

Also, of course this is secondary, but the HCTZ can apparently dry up milk supply. Anybody have any tried and true ways to boost production? Assuming it will even still be a possibility?

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I was told with my first dd that I would have this issue, spent a lot of time in the hospital prior to delivery, and they scared me silly. I ended up lucky and didn't have issues but I remember the fear and worry. I have no advice or words of wisdom, but I am sending good thoughts and prayers your way. :grouphug:

 

 

ETA: I do want to say because of above advice that I was advised to watch my fluid intake closely. I wasn't allowed very much and was told it could make things worse. I hope you can get clarification on this issue but I wanted to point it out. :grouphug:, again!

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 I've had 3 c-sections, but no, I've not had this problem.   I'd be panicked too.  :grouphug:  :grouphug:  :grouphug:

 

My only advice is to rest with your feet up. Let everyone around you do everything you can't do.  Don't worry about putting someone out or that they aren't doing it right.  Just.Let.Them.Do.It.  Not you.  You and the baby - that's what you worry about.  And that's it.  

 

If anything seems amiss, go the ER.  

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I am friends with someone had heart problems and symptoms like what you're describing.  They admitted her right away and started some sort of treatment (I don't know the details), but her baby is a year old now and she's fully recovered.  She also had a c-section at 30 weeks because of pre-ecclampsia, and had troubling symptoms with her heart while pregnant before it got bad after delivery.  So they didn't make her wait and see like you are, but they already knew something was up before the baby came.  But, like I said, they were able to treat her and she's fully recovered.

 

You might call the infant risk center about the HCTZ and see if they have any information for you.  I know a couple people who have used them for an info source (and had their doctor call as well!) and they have been very helpful.

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I have a homeschooling friend, six children, and after her last, she developed congestive heart failure. It was a few months after delivery that she was diagnosed after having some odd post-natal symptoms. It's a life long, and life-threatening thing...she goes in for checkups regularly and was told not to have any more children. Apparently there's a whole group of women out there that develop this...I forget the actual official name for it. She recently lost an online friend from some online support group...a mother who developed this...and later died due to it. It's rare but it's real.

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BTW: How long are you having to wait for tests to tell whether or not you are having postpartum heart issues? I would think that they need to run an echocardiogram on you very soon. Like as in tomorrow. I wouldn't wait.

The tests are scheduled for tomorrow. They took blood today to rule out HELLP...

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I had exactly the same thing happen after #1. I labored an excessively long time and wound up having a c-section. My doc said it was a combo of the two- the prolonged labor plus the section. I still have broken veins where I pushed in my skin to show how bad the swelling was to various people (don't do that too much). I was 20 pounds heavier than when I was admitted for delivery. In my case, everything turned out okay. Recovery was closer to 3 months even though I had to return to work at 2 months. It is not normal but sometimes it's not the worst case scenario.

On the other hand, as I have grown older and wiser, I have become more of an advocate for my health and if I had to contend with the same symptoms again, I would insist on hospital monitoring until the swelling started to subside.

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The tests are scheduled for tomorrow. They took blood today to rule out HELLP...

 

Okay.  And an echo is one of them, right????  

 

Just know that me and about a 1,000 of your best hive friends are going to be worrying about you and thinking about you.  Let us know what they say, okay?

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I did have postpartum swelling after my scheduled c/s, but it wasn't anywhere near what you described and it was only on one side. They suspected DVT in my case and did an u/s to rule it out. It went away on its own.

 

 

Definitely give your doc a call if you have any concerns and go in if anything changes.

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I've not read the replies yet, so hopefully you're in a better state by the time I am posting this.

 

I experienced this after my first pregnancy, which was an unplanned c-section. I gained almost 15 lbs (if memory serves... it has been a while) AFTER the baby was born with water weight. My FIL was there for the delivery and had to drive back home that evening. He came to see us that weekend (about 4 days later) and nearly dropped everything he was carrying when he saw me at the doorstep. Took dh aside and urged him to take me to the ER immediately.

 

I refused to go - I consulted midwives and they assured me this level of fluid retention was "normal." I had ZERO stretch marks from the pregnancy (even though I gained a LOT of water weight with preeclampsia) but the after-affects gave me me plenty of stretch marks.

 

In a years-later-non-sleep-deprived-hindsight state of mind, I wish we'd consulted another doctor, because now, after four births (although the first was the only c-section) and more experience with other mothers' stories, I am certain it is NOT a normal experience. I look at pictures now (in my older and wiser state of life) and gape - it's that alarming. If it happened NOW, dh and I would both be much more assertive about it.

 

At the time, we just sort of thought it was another of the "ugly pregnancy and delivery facts" that no one ever gave us the nitty-gritty about until after dd was born (that's when all the horror birth stories came out of the woodwork...)

 

With all that said, however, I was eventually fine and am fine. The recovery after the first birth took me MUCH longer than the following three, and I am pretty certain that whatever my issues were were certainly had a hand in that. But no long-term ill effects.

 

I hope that you are well and whatever tests that are being done come back with healthy results.

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It sounds a bit like eclampsia. I know in rare cases it can affect after birth. But your bp is not elevated? So glad you are getting tests and care!!

That was what I was thinking. I have a friend who just developed this and her blood tests were negative for protein for a WEEK while she had every other symptom. Do ask them to draw again if symptoms persist, it doesn't always show up immediately.

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It sounds like you are getting monitored and treated, which is good. Please keep tabs on your bp and be aggressive advocating for yourself. I think it was at the week and a half point that I was at the ER. Folks only seemed to have HELLP on the radar. You are in good hands given that you are already scheduled for the echo. Wishing you full recovery and good health!

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I'll be thinking of you and remembering you in my prayers.

 

Don't hesitate to go to the ER if you feel uneasy, but don't overly worry now that you are having tests and being monitored. The time after birth, especially a cesarean, is a crazy time of adjustment for the body.

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I wonder if they're not taking you as seriously because you're so petite?  A weight of 132 would make most postpartum moms jump up and down with joy; perhaps they're not taking into account what that represents in relation to your pregnancy or pre-pregnancy weight.  I hope you get answers (and relief!) soon.

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First off, i am trying REALLY hard not to get freaked out or panic. I am hoping others have seen this and have had it turn out to be much less serious than it sounds.

 

As many of you know from the picture I posted of my sweet baby boy, I just gave birth via csection after a very difficult pregnancy. After I left the hospital on Tuesday my lower half started to swell. No big deal right, all that IV fluid. Except this is extreme. Literally from my belly button to my toes became grossly swollen.

I phoned the doctor's office and was basically told what I knew. They were not worried as long as my bp was not elevated (it isn't) and that edema in extremities is very common post-partum. But there really isn't a way to convey the extent or the fact that I would never panic over a bit of hands, feet, face swelling after birth!

 

But everything has continued to swell! I went to the OB/GYM this morning to have staples removed and had to wear hubby's pants and slippers. My entire legs are literally twice their size, painfully tight and rigid, and any indentations you make actually stay like a memory foam pillow. When I was weighed I came in at 132 lbs--7 lbs more than when I was pregnant!

 

Long story, but doctor took one look and became worried about congestive heart failure. Unfortunately the blood test to confirm would be elevated post-partum anyway. He sent me for other tests and started me on HCTZ to try to get rid of some of the swelling, and if not will admit me to hospital. Apparently the lungs can fill with the same fluid very quickly. I have been short of breath and have had a constant headache, but just thought it was part of recovery.

 

Anybody had problems with massive swelling like that? Or know anything about it? I am in limbo waiting to see if the meds work and have the heart and kidney tests. Very frightening:(

 

Also, of course this is secondary, but the HCTZ can apparently dry up milk supply. Anybody have any tried and true ways to boost production? Assuming it will even still be a possibility?

 

The posters who have suggested that Eclampsia can present after pregnancy are correct and that could explain the swelling (although usually blood pressure will not be normal with this).  Another consideration (and what it sounds like your doctor is more concerned about) is postpartum cardiomyopathy.  This is where the heart doesn't function (or squeeze) the way it should and as a result fluid does build up and this can lead to pulmonary edema (where fluid accumulates in the lungs which interferes with gas exchange so patients can present with breathing difficulties and hypoxia).  Diagnosis of Postpartum Cardiomyopathy is supported by an elevated BNP and evidence of decreased systolic function on the echocardiogram.  Stronger diuretics (ie Furosemide as opposed to HCTZ) can be used to manage fluid and medications to help the heart squeeze better (ie. ACE inhibitors, certain B-blockers, aldosterone agonists etc) can be used to treat.  In more severe cases IV medications like Dobutamine or other pressors can be used for unstable patients.

 

The prognosis with PostPartum Cardiomyopathy is variable. Some women do get back to having completely normal heart function (although the problem can recur with subsequent pregnancies and the outcome may be much worse a second time around so this is generally to be avoided) so even if your doctor's concerns are completely correct it is still very possible for you to have a good outcome.

 

I've been on HCTZ.  Drink lots (if your doctor says that you can).  Actually drinking lots can help with the edema too.  I haven't had it post-partum but I have lots of edema at other times.  

 

If you have edema as a result of renal failure, congestive heart failure, and or liver failure that lead to volume overload states drinking lots will not help with the edema. It will increase the volume overload and thus increase the likelihood of developing pulmonary edema.

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Goodness, that sounds scary! Sending prayers that things go back to normal.

 

For the milk supply, you can try More Milk Plus capsules, several a day. They have fenugreek and other herbs, and some moms find dramatic improvement with them. Just check with so,some first because of interactions with other meds.

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How harrowing. I am so sorry that you are going through this. I can't offer any medical advice, but I can tell you that More Milk Plus in tincture form doubled my milk supply. I second the advice to make sure it is safe with your medication before using it. Praying for you.

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I've been worried about you ever since I saw your post this morning. Checking in to see what happened with your appointment today. :grouphug:

 

Same here - and hoping we get an update soon.

 

Thanks to those who have explained things too.  I'll admit to knowing absolutely nothing about it, but learning new things still is a major interest even if I'll probably never have to use the knowledge.

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