Postpartum pre-enclampsia

[gardenmom5]

This was written by my friend's niece, and is her first-hand experience.  And how easily it was almost missed, despite her own medical background.  Even the dr's in the ER  just thought it was weird, and only when a maternal-fetal medicine guy saw her "textbook case" did anyone even know what it was or what to do about it.  She did recall having heard about it *once* on a lecture about preeclampsia during an obstetrics unit.

Even postpartum moms need careful observation.

No one asks me about my post-birth story. | by Alexandra Houston-Ludlam | May, 2021 | Medium

[kbutton]

Pre-eclampsia can put you at risk for blood pressure/cardiovascular issues later in life. Another thing they don't tell you. 

[denarii]

I developed preeclampsia with my twins

All the doctors I saw during that pregnancy said it was not necessary to test unless I was symptomatic so they refused to do a simple test just incase. I was put on bed rest at 33wks, delivered at 36 wks when my water broke, my bp skyrocketed, and I had an emergency section.

After I delivered not a single dr that monitored my pregnancy would see me for a follow up appointment. I was lucky I had a family Dr at the time who monitored me for 6mo but I hate to think what could have happened if I hadn't had that.

Edited May 25, 2021 by denarii
edited out personal information

[Faith-manor]

It is another disturbing aspect of maternal care in the US. Birth and turf, we will see you in six weeks. And women really just are not listened to. I shudder to think what would have happened to me without my CNMs who were sooooo much better than the OBGYNs.

It is something all pregnant woman should be educated about by their health care professionals. But I also blame insurance because it often dictates how much time a doctor can spend in the room, how long after birth a mother can stay, how many prenatal appointments she can have, and how much pregnancy and birth education she can have in a formal setting. My dd says it is really bad in Alabama.

We simply need to find some way to convince the ridiculous powers that be that the state of maternal affairs in this country are abysmal, dangerous, and an embarrassment.

[ktgrok]

1 hour ago, gardenmom5 said:

This was written by my friend's niece, and is her first-hand experience.  And how easily it was almost missed, despite her own medical background.  Even the dr's in the ER  just thought it was weird, and only when a maternal-fetal medicine guy saw her "textbook case" did anyone even know what it was or what to do about it.  She did recall having heard about it *once* on a lecture about preeclampsia during an obstetrics unit.

Even postpartum moms need careful observation.

No one asks me about my post-birth story. | by Alexandra Houston-Ludlam | May, 2021 | Medium

Wow. With my home births there is a 2 day postpartum visit, and a 2 week postpartum visit, and you are given a checklist of what to monitor for after birth as well. Any elevated blood pressure or other signs are addressed. 

I think in many countries women are visited by nurses after hospital discharge? But not here. 

[happypamama]

I'm a postpartum PE survivor!  I had it and delivered number six at 26 weeks, and then I had it postpartum six days after my 39 week delivery with number seven. I was well informed and knew to check my BP at home and knew when to call in, and I have a rockstar MFM who doesn't mess around with me. It is definitely not talked about enough for most women. 

 

When I used midwives, they saw me a couple of times within the first three days, and then not again until 10-14 days later. That would have missed my PP PE.  Since my VBAC with number seven was easy and uncomplicated, and my BPs were fantastic, I was released a day after birth, and even my MFM didn't think she'd need to see me before 13 days unless something changed.

 

A basic Omron costs $30 at WalMart and Amazon and has saved my life twice. 

 

Also, most of the time, if you're within the first six weeks postpartum, you should be seen in L&D, not the regular ER. If you can't go to L&D, insist that someone from OB come evaluate you in the ER. 

 

We would love to have any of you who are concerned about preeclampsia or its future health effects at https://www.facebook.com/groups/preeclampsia/?ref=share

 

 

 

Edited May 18, 2021 by happypamama

[matrips]

2 hours ago, kbutton said:

Pre-eclampsia can put you at risk for blood pressure/cardiovascular issues later in life. Another thing they don't tell you. 

Really?  I never heard that.  What kind of issues should I look out for?

[matrips]

I hope I remember this information when my daughter and future dils are pregnant.  (Many many years from now.)

[matrips]

16 minutes ago, happypamama said:

I'm a postpartum PE survivor!  I had it and delivered number six at 26 weeks, and then I had it postpartum six days after my 39 week delivery with number seven. I was well informed and knew to check my BP at home and knew when to call in, and I have a rockstar MFM who doesn't mess around with me. It is definitely not talked about enough for most women. 

 

When I used midwives, they saw me a couple of times within the first three days, and then not again until 10-14 days later. That would have missed my PP PE.  Since my VBAC with number seven was easy and uncomplicated, and my BPs were fantastic, I was released a day after birth, and even my MFM didn't think she'd need to see me before 13 days unless something changed.

 

A basic Omron costs $30 at WalMart and Amazon and has saved my life twice. 

 

Also, most of the time, if you're within the first six weeks postpartum, you should be seen in L&D, not the regular ER. If you can't go to L&D, insist that someone from OB come evaluate you in the ER. 

 

We would love to have any of you who are concerned about preeclampsia or its future health effects at https://www.facebook.com/groups/preeclampsia/?ref=share

 

 

 

I just requested to join.  Thank you for the information m.

[ktgrok]

Oh, I forgot that I also was monitoring my blood pressure at home daily post partum. But I don't know if my midwife has everyone do that - I have pregnancy hypertension, not high enough for meds, and never spilled protein and had clear labs (we checked!) but I was under directions to take it every day for the first 6 weeks I think? If it went up I was to call immediately. And that was in addition to list of symptoms to watch for (not just pre-e symptoms, but infection, too much bleeding, mastitis, etc. It was a significant list, lol). 

I do think there should be nurse visits as part of public health for new moms. 

Edited May 18, 2021 by ktgrok

[Faith-manor]

2 hours ago, ktgrok said:

Wow. With my home births there is a 2 day postpartum visit, and a 2 week postpartum visit, and you are given a checklist of what to monitor for after birth as well. Any elevated blood pressure or other signs are addressed. 

I think in many countries women are visited by nurses after hospital discharge? But not here. 

According to my sister, prenatal and postnatal care is much more robust in France with home visits often. They are big believers in mama well being so many more services and benefits are covered than here.

[bookbard]

I had two or three home visits in the week after having a baby in a public hospital (Australia). They did the heel prick test (to check for a range of genetic disorders), checked baby, and checked your wounds as well as mental health. A neighbour developed post-partum depression and so they visited more frequently over the first few months. I don't know whether that is standard across the country, though - I will never forget that poor woman with an intellectual disability who went to hospital, had the baby, left with the baby and threw it down a public drain (afraid her family would find out). When the baby was retrieved (someone heard it crying) and the mother taken to the police etc, she asked innocently if she could have the baby back now. Poor thing! 

[Faith-manor]

3 minutes ago, bookbard said:

I had two or three home visits in the week after having a baby in a public hospital (Australia). They did the heel prick test (to check for a range of genetic disorders), checked baby, and checked your wounds as well as mental health. A neighbour developed post-partum depression and so they visited more frequently over the first few months. I don't know whether that is standard across the country, though - I will never forget that poor woman with an intellectual disability who went to hospital, had the baby, left with the baby and threw it down a public drain (afraid her family would find out). When the baby was retrieved (someone heard it crying) and the mother taken to the police etc, she asked innocently if she could have the baby back now. Poor thing! 

Oh my goodness, that is so sad! 

[happypamama]

3 hours ago, matrips said:

Really?  I never heard that.  What kind of issues should I look out for?

Keep up with your yearly screenings for BP, diabetes, etc.  Your PCP can decide if you should see a cardiologist or nephrologist (sometimes nephros manage chronic high BP as well).  It's more that you want to be aware of the risks so that you and your PCP can mitigate the things you can, like working on dietary and lifestyle changes as needed, getting on BP or other meds as needed, and so on.  I get CBC and CMP done at least once a year, plus kidney panels since I do have chronic hypertension, and a1c/fasting glucose.  I do check my BP at home some as well and know that if it hits a certain point, I'm to let my nephro know so he can adjust my meds.

[happypamama]

3 hours ago, matrips said:

I just requested to join.  Thank you for the information m.

Awesome!  I'm a mod over there.  It's my other passion, besides homeschooling small blond boys, lol.

[Selkie]

4 hours ago, ktgrok said:

Wow. With my home births there is a 2 day postpartum visit, and a 2 week postpartum visit, and you are given a checklist of what to monitor for after birth as well. Any elevated blood pressure or other signs are addressed. 

I think in many countries women are visited by nurses after hospital discharge? But not here. 

The hospital where I gave birth sent nurses for home visits. There was one visit during pregnancy and then another within a day or two of getting home from the hospital with baby. My oldest had jaundice and the nurse came to our house every day to do his jaundice treatment, until he no longer needed it. It was so nice, because we live about an hour away from the hospital and it saved us from having to make trips back and forth.

[sweet2ndchance]

I developed pre-eclampsia with my last child. He was my 6th child and I had never had pre-e with any of my other kids. I wasn't considered advanced maternal age yet (I was 33/34 at the time). But I can remember being 33 - 34 weeks at the time and just crying with my feet up in the air because they were so swollen. My blood pressure had been slowly creeping up every visit. I would mention it to the dr and he would blow me off. I went in to the hospital when he wasn't the dr on call and the on call doctor wanted to confer with my OBGYN before he did anything. I got sent home from the hospital despite the high blood pressure readings. I asked if there was something they could give me for the high blood pressure and all the related symptoms like the pitting edema and grogginess. I was told to drink more water and rest. Finally, at my 36/37 week appointment my blood pressure was through the roof (190 something over 110 or 120 if I remember right, it was scary high) and I had put on 10lbs since my last appointment a week and a half earlier.

Can you believe he still didn't want to induce me? The nurse had to talk him into it and then he would only agree to it if we went straight to the hospital right then because he had evening plans...   So of course we went straight to the hospital. He broke my water and put me on pitocin (despite my objections and explanations as to why we should try at least a couple hours without the pitocin first) I ended up delivering with just the nurses in the room because even when they called him to tell him I was fully dilated, he didn't think it was possible because it had only been two hours since he broke my water and he was getting ready to go to dinner. When he walked in, ds was being tended by the nurses and he had a deer in the headlights look. After he got a sense of what had happened, he had the gall to say, "Well at least we beat pre-eclampsia!" I wanted to punch him in the teeth.

During my entire 3 day hospital stay, my blood pressure never went down. The nurses kept telling the OB that I needed attention but he kept saying it was fine, it would go down eventually. At 2 weeks post-partum, it was still 175ish/100ish. I begged him to prescribe me something or send me to someone who would. He told me it was because I was fat and that when I lost the weight my blood pressure would go down.... I ended up at an urgent care that finally prescribed me blood pressure medication and told me if it didn't start going down in the next 24 hours, go to the ER in another town away from this OB. Thankfully, it did go down and stayed down. After two months, on blood pressure meds I was able to wean off them. Oh and I am still overweight for my height but my blood pressure has stayed normal for over 8 years despite what that ******* OB told me. The only other time in my life I've had blood pressure issues was when I had placental abruption with a different pregnancy and my blood pressure bottomed out from internal bleeding. But that also didn't dissuade the stupid OB from saying it was my weight.

While this OB was a bit of an extreme case, I do think maternal post partum education and care in this country is deplorable at best. Now that I think about it, the home birth I had with my second to last child, I had a 2 day, 2 week and 6 week post partum appointment with the midwife. I think that would largely be a step in the right direction.

[Momto6inIN]

I felt awful my whole last pregnancy, but I thought it was just because I was old (45). I had borderline high BP, and trace in my urine, but my OB (a woman this time - not my regular OB because he died and I didn't think I'd be pregnant again so I just picked her almost at random when I got pregnant unexpectedly) didn't act concerned so I didn't either. Usually I have unusually low BP (nurses always ask if that low is normal for me), so even borderline high was unusually high for me. I'd never had to worry about PE before, my BP always stayed low throughout my other pregnancies.

During labor my BP crashed and then went back up and I felt like crap, but I was progressing very quickly as I always do and everybody acted liked as soon as I delivered it would be fine. And it did go down a bit, but not back to normal. I went to our regular NP for the baby's 1 week checkup and asked them to check it for me and it was still borderline high. At her 1 month checkup it was back to normal.

During much of that first month, I felt awful and was convinced every night I might die, but I thought that was just post partum hormones/anxiety. By her 1 month checkup I felt "normal" again and when she said my BP was back to my normal again, it all kind of clicked that my awful feeling and my BP were related. No one told me that ... They all just said it would be fine, and that I felt bad because I was old and pregnant, and I believed them.

Reading this thread makes me realize how thankful I should be that I survived it 😳

[ktgrok]

7 hours ago, sweet2ndchance said:

 

During my entire 3 day hospital stay, my blood pressure never went down. The nurses kept telling the OB that I needed attention but he kept saying it was fine, it would go down eventually. At 2 weeks post-partum, it was still 175ish/100ish. I begged him to prescribe me something or send me to someone who would. He told me it was because I was fat and that when I lost the weight my blood pressure would go down.... I ended up at an urgent care that finally prescribed me blood pressure medication and told me if it didn't start going down in the next 24 hours, go to the ER in another town away from this OB. Thankfully, it did go down and stayed down. After two months, on blood pressure meds I was able to wean off them. Oh and I am still overweight for my height but my blood pressure has stayed normal for over 8 years despite what that ******* OB told me. The only other time in my life I've had blood pressure issues was when I had placental abruption with a different pregnancy and my blood pressure bottomed out from internal bleeding. But that also didn't dissuade the stupid OB from saying it was my weight.

While this OB was a bit of an extreme case, I do think maternal post partum education and care in this country is deplorable at best. Now that I think about it, the home birth I had with my second to last child, I had a 2 day, 2 week and 6 week post partum appointment with the midwife. I think that would largely be a step in the right direction.

Ugh, that's terrible! Mine was only 135/80, a few times up to 140/80, and that was enough to buy me labwork to check kidneys and such, daily blood pressure monitoring, etc. And if it went up more, or was not normal at 6 weeks, I'd be referred to a doctor for medication to control it. Thankfully it was just Pregnancy Induced Hyptertension, not Pre-E, but they were taking it seriously. Hormones just hit my blood pressure hard. 

In fact, DH had his vasectomy yesterday mostly so I can go off my hormonal birth control, as my blood pressure is back up to that range, and we realized that the timing corresponds with me starting the birth control. It might just be I've developed chronic hypertension, which PIH can be a precursor for, but I'm very curious to see if it is caused by the hormones, since the only other time it has happened is when pregnant.

[kbutton]

14 hours ago, matrips said:

Really?  I never heard that.  What kind of issues should I look out for?

https://www.preeclampsia.org/heart-disease-stroke

 

[kbutton]

10 hours ago, happypamama said:

Keep up with your yearly screenings for BP, diabetes, etc.  Your PCP can decide if you should see a cardiologist or nephrologist (sometimes nephros manage chronic high BP as well).  It's more that you want to be aware of the risks so that you and your PCP can mitigate the things you can, like working on dietary and lifestyle changes as needed, getting on BP or other meds as needed, and so on.  I get CBC and CMP done at least once a year, plus kidney panels since I do have chronic hypertension, and a1c/fasting glucose.  I do check my BP at home some as well and know that if it hits a certain point, I'm to let my nephro know so he can adjust my meds.

It helps if your doctor cares. My BP was flaky for about three years after my second pregnancy and then has been high for about 10 years. My doctor called it white coat-itis all that time. 

I just started BP meds from a new family doctor--I was incredibly grateful to finally have someone's attention on this. 

Do you (or anyone else) know what happens to the liver with preeclampsia? I have elevated liver enzymes. Not scary high, but persistently high.

My story...my second pregnancy, I felt amazing--like better than not pregnant--up until about week 26 when my BP spiked really high. We checked it at home, and it was something north of 160 on top. My BP up that that point had been something like 115/75 consistently. I always had low BP when not pregnant or on birth control. It never read that 160 or so in the office, and the doctor cast major doubt on those readings even though it was still a lot higher than it had been--140s. I did have protein in my urine. At that time, there were hard and fast numbers to hit for both BP and protein, and I was just shy of both. From what I can gather in my reading, I would meet more updated criteria. The rest of my pregnancy was miserable. It was like I had hit a wall at 90 mph after feeling so good until then. I had migraines (including vision changes), swelling, fatigue, and just generally feeling bilious and awful. I have a history of migraines outside of pregnancy too.

I hemorrhaged after that birth also, but it wasn't obvious (all internal) until quite a long time after birth--I was in a regular post-partum room by the time the nurse noticed that my individual symptoms that were trading places with each other were getting closer together and added up to hemorrhage. I guess I narrowly missed being wheeled into the OR. My labor was short and uneventful otherwise, but I felt terrible while pushing (only pushed through one contraction), and it felt like the baby was being ripped out--I didn't want to push at all. With my first child, pushing felt like something I needed to do badly.

I had no special follow-up afterwards. 

I tend to be under-symptomatic for most things that end up being wrong with me until suddenly things are urgent. 

[kbutton]

14 hours ago, happypamama said:

We would love to have any of you who are concerned about preeclampsia or its future health effects at https://www.facebook.com/groups/preeclampsia/?ref=share

Thanks!

[kbutton]

Interesting article: https://www.acc.org/latest-in-cardiology/articles/2021/02/09/19/44/preeclampsia-is-an-independent-risk-factor-for-early-onset-cac

Quote

This new study by Benschop et al. is the first study to shed light on the timing of early onset subclinical CVD in women with a history of preeclampsia. It makes a strong argument for earlier cardiovascular risk assessment for this population. Women with a history of preeclampsia would likely benefit from establishing care with a cardiologist before age 45 to optimize modifiable risk factors.

Additionally, this study stresses the importance of soliciting a thorough reproductive history for female patients in order to risk stratify patients more effectively. Prior preeclampsia, along with other adverse pregnancy outcomes including preterm birth and small for gestational age pregnancies, should be accounted for in risk assessment when initiating primary prevention strategies to reduce CVD.13 Among women with a history of preeclampsia, the presence of CAC may serve to identify those at a particularly high cardiovascular risk and should be the subject of future studies.

 

[kbutton]

https://heart.bmj.com/content/105/16/1273

 

[happypamama]

2 hours ago, kbutton said:

It helps if your doctor cares. My BP was flaky for about three years after my second pregnancy and then has been high for about 10 years. My doctor called it white coat-itis all that time. 

I just started BP meds from a new family doctor--I was incredibly grateful to finally have someone's attention on this. 

Do you (or anyone else) know what happens to the liver with preeclampsia? I have elevated liver enzymes. Not scary high, but persistently high.

My story...my second pregnancy, I felt amazing--like better than not pregnant--up until about week 26 when my BP spiked really high. We checked it at home, and it was something north of 160 on top. My BP up that that point had been something like 115/75 consistently. I always had low BP when not pregnant or on birth control. It never read that 160 or so in the office, and the doctor cast major doubt on those readings even though it was still a lot higher than it had been--140s. I did have protein in my urine. At that time, there were hard and fast numbers to hit for both BP and protein, and I was just shy of both. From what I can gather in my reading, I would meet more updated criteria. The rest of my pregnancy was miserable. It was like I had hit a wall at 90 mph after feeling so good until then. I had migraines (including vision changes), swelling, fatigue, and just generally feeling bilious and awful. I have a history of migraines outside of pregnancy too.

I hemorrhaged after that birth also, but it wasn't obvious (all internal) until quite a long time after birth--I was in a regular post-partum room by the time the nurse noticed that my individual symptoms that were trading places with each other were getting closer together and added up to hemorrhage. I guess I narrowly missed being wheeled into the OR. My labor was short and uneventful otherwise, but I felt terrible while pushing (only pushed through one contraction), and it felt like the baby was being ripped out--I didn't want to push at all. With my first child, pushing felt like something I needed to do badly.

I had no special follow-up afterwards. 

I tend to be under-symptomatic for most things that end up being wrong with me until suddenly things are urgent. 

I'm sorry you went through all of that. 

 

Regarding the liver enzymes, as we understand it, in PE/HELLP, when the placenta doesn't implant deeply enough, it can't draw nutrients across properly, so it sends chemical proteins into your system, which lead to wear and tear on blood vessels and certain organs. Most women will see their bodies repair themselves by six weeks postpartum, but for some of us, the whole experience unmasks our genetic tendencies toward certain conditions, so that may be why you are seeing high liver enzymes. It isn't necessarily related to PE and is often a sign of fatty liver, so you can ask for a liver ultrasound. 

[matrips]

I’ll have to mention this to my PCP. Not sure if I ever mentioned pre-eclampsia to her; many years and another state ago. But I typically have very low blood pressure.  And my pre-e was due to a triplet pregnancy, and they caught it super fast since they monitored me so closely, so maybe not quite the same.  But thank you because I will look into it, and have my doctor aware!