Who to see?

November 29, 2009 12:20 AM

What kind of specialist should my daughter consult? She has post-partum hpertension. Following a c-section at 37 weeks because of pre-eclampsia (welcome to our first beautiful grandchild!) her blood pressure has been quite volatile, from 140/89 to 179/98. Her normal is 120ish over 90ish. She has been rehospitalized twice in the nine days since her delivery. Put on a magnesium sulfate drip and is on Labetalol (now 300mg 2x a day). Additionally, she has had a few episodes of supraventricular tachycardia that took her to a cardiologist a few years ago.

Her OB seems ready to pass her along to an internist. I guess I wonder if there is a specialist that would be more experienced in this area. SHe lives in Fairfield County, CT. WHat kind of doc should she go to that would be most expert in this type of situation? If someone has a recommendation of a specific doc, that would be great, too. Also anyone who has experienced postpartum hypertension and has tips for managing this problem, we would welcome them.

posted by mmf to health & fitness (10 comments total)

My feeling is that due to her being postpartum, this is an issue of the hormones (you didn't mention her being hypertensive prior to pregnancy, so I'm assuming this is related to the pregnancy itself). Therefore she should see an endocrinologist to establish if there is a thyroid problem or any other hormonal influxes that could be the primary cause of the heart and blood issues that are presenting.

Just the humble opine of someone studying medicine.
posted by watercarrier at 12:55 AM on November 29, 2009 [1 favorite]

Was just logging on to say exactly the same thing as watercarrier. An endocrinologist without a shadow of a doubt. And quickly. Congratulations on your new grandchild. And all the very best with your daughter's blood pressure.
posted by taff at 1:47 AM on November 29, 2009

Women can experience pre-eclampsia by definition up to six weeks after giving birth. I believe this would most appropriately be an issue for a high-risk obstetrician (someone boarded in Maternal Fetal Medicine).

Being in CT, I'm pretty sure you're close to major academic centers where you'd find one easily.
posted by archofatlas at 3:37 AM on November 29, 2009

Just wanted to come back to say, unless I'm mistaken, you're close to University of Connecticut, a large academic center that has a fellowship program in MFM.

Your daughter's issues are yes, due to an endocrinologic derangement, but it's one that resulted directly from her pregnancy. People who deal with high-risk pregnancy are the most prepared to deal with this issue.
posted by archofatlas at 3:59 AM on November 29, 2009

This is a good start for us. I had never even heard of Maternal Fetal Medicine before as a specialty, and we are near both UConn and Yale-New Haven. I'll see if her doc can recommend a specific practice or if she says endocrinologists are in order.
Thanks!
posted by mmf at 5:13 AM on November 29, 2009

You might want to check out www.bestdoctors.com. They can review your case and recommend a specialist in your area.
posted by speedoavenger at 6:01 AM on November 29, 2009

It has been over seven years now since I experienced the same thing only at 32 weeks. I seem to remember that I was told the bp weirdness could last up to 8 weeks. I was not put on any bp control medications but that is up to the attending physician. After that postpartum period, I had no more issues. My second pregnancy went full-term with no pre-eclampsia or blood pressure problems. A maternal-fetal specialist would probably be the best starting point for her as they will have the most experience with high-risk pregnancy and post-partum.

Congrats to you and the new family.
posted by Talia Devane at 9:58 AM on November 29, 2009

I had my first baby in February, and also experienced pre-eclampsia (which resulted in HELLP Syndrome), a c-section at 37 weeks, and post-partum hypertension. I am still taking Labetalol twice daily, and have issues with a higher pulse rate/palpitations rather frequently. I was given every test under the sun to see what was going on, and there is no explanation (other than genetics) to explain my crazy blood pressure 10 months after my son's birth. The things that have helped me keep it under control, however, are getting enough sleep (I know, easier said than done with a new baby), eating a proper diet, and taking my Labetalol at the same time every day. Staying away from highly caffeinated beverages also made a huge difference.

Best of luck to your daughter! I know SO WELL how frustrating the blood pressure issue can be.
posted by I_love_the_rain at 1:14 PM on November 29, 2009

Thanks so much to all. This is very helpful to us in addressing a problem we had never experienced and most people have never even heard of.
It is great to hear from those who have gotten through the worst of it and know what to recommend.
BTW, I meant to add in the OP, it's a beautiful redheaded girl!
posted by mmf at 7:04 PM on November 29, 2009

Congratulations to you and to mom on the new baby.

I had pre-eclampsia and delivered at 32 weeks. My BP stayed high (over 120/80) until about 3 months post-partum. I had no history of hypertension prior to my pregnancy. In the hospital I was given a beta-blocker but then I insisted on a calcium channel blocker upon discharge (I have asthma and beta-blockers are bad for asthmatics). I took the meds for about a month and then stopped. I also exercised as I could, and watched my sodium intake. 18 months later, my BP is now back to 120/80 or below.

I also gleaned a wealth of knowledge from other ladies with pre-e, many worse than me, who have had ongoing blood pressure problems (defined by me as more than a few months after pregnancy). I never heard of anyone going to an endocrinologist for BP problems after pregnancy unless the endo is treating diabetes. I also never heard of a non-pregnant woman going to a MFM specialist after pregnancy, unless the woman had questions about a future pregnancy. These ladies all go to cardiologists or PCPs for hypertension. Either are well-suited to take care of high BP; it's endemic in our society and lifestyle. Hopefully, though, this is a temporary issue, as it often is, and things will be better in a matter of weeks. Much of pre-eclampsia is a mystery. It's frustrating, as I know you have all discovered. Please encourage relaxation and happiness :)
posted by FergieBelle at 6:03 AM on November 30, 2009