Did anyone see a maternal-fetal med specialist?

[lalemma]

So - I had full blown eclampsia without any real warning signs in my 33rd week, and had a crash c-section. We are nowhere near planning our next baby, but I'm starting to think a little bit about what we might do to prepare for a better pregnancy (and, fingers crossed, a HBAC) next time.

Has anyone seen a maternal-fetal medicine specialist after eclampsia/pre-eclampsia/PIH/etc? Was it helpful in planning a future pregnancy? I guess mostly I'd like someone who knows about this stuff to sit down and review my records - I like my OB-GYN and the hospital staff were great, but I was basically the only eclamptic person they'd ever seen. I could use some help understanding what happened, and if there were steps I could take to make a recurrence less likely, or anything like that. I am open to other kinds of practitioners (I saw midwives last time and hope to in future), but it seems like a maternal-fetal medicine specialist is most likely to have seen similar cases...?

I know about ICAN, but otherwise I am just starting to emerge from the fog of newbornhood, and don't know where to start collecting info. Thanks!

PS: I followed the high-protein diet that shall not be named, and still had eclampsia. No need to recommend it.

[sharr610]

I see one for our ultrasounds. They are a good group.

In addition to seeing one, I might also call around to the local HB midwives or female care naturopaths / acupuncturists. They might be able to give you some ideas going into the next round regarding alternative care remedies. When my BP started to creep up a bit at the end of my last pg, I saw an acupuncturist and it helped out a lot. I hear that seeing one from the beginning of pg. can really even things out.

GOOD luck!!

[AlexisT]

I'm seeing one for a preconception consult in a few weeks. I wasn't sure about doing that, but my RE strongly recommended that I do it as he feels I will be a high risk pregnancy. (I have chronic hypertension and had severe preeclampsia at 37 weeks with my first.)

The Society for Maternal-Fetal Medicine has a physician finder and many of the MFMs have particular areas of interest listed, so if you don't have a personal recommendation you could look there to find one whose area of interest is hypertensive disorders of pregnancy.

[shruley]

I also had severe PE in my first pregnancy. You could see a MFM, but I'm not fully understanding the purpose. Doctors really have no idea what causes PE or how to prevent it, so I'm not sure if you are going to get any of the answers you are looking for. Except for people who have hypertension before pregnancy, other than maternal history or having had it in a previous pregnancy there aren't any clear cut risk factors, nor any way to prevent it. Chances are the doctor will tell you that PE is most common in first time moms, and even if 2nd time moms get it again it tends to come later and not as severe, and that they will simply monitor you closely next time. THe medical community can offer to do things like a baseline 24 hours urine, monthly ultrasounds (to check for IUGR) and put you on bedrest if they see your BP start to rise. That's really all they can do for you. And any (good) midwife or doctor will notice signs of PE on you in time without the above additional measures.

www.preeclampsia.org is a great resource to understanding PE, but it looks like the site is down right now but should be back up.

I can tell you with my second, my BP did creep up at the end, but my labs and urine remained good and with some supplments and swimming and modified bed rest (only working 1/2 days the last week or two) it made a difference I believe. I always kept my BP just low enough to not raise too many concerns. My first was delivered by c-section at 36 weeks but my second was a hospital VBAC, at almost 40 weeks.

As for the diet....several people on the preeclampsia.com boards have tried that diet and it failed for them as well. I did have a friend with previous PE who followed a strict diet by her midwife the last 2 weeks and that did seem to lower her BP, even when it had risen on bedrest. Her diet was simply no sugar and nothing processed...no juice, no dressings, no nothing! She ate basically steak or chicken, veggies, protein shakes, eggs maybe? She said it sucked but that you can do anything for 2 weeks. She also went on to have a VBAC! Good luck.

[lalemma]

Interesting - thanks! I'm mostly interested in talking to a specialist because I felt like my OB-GYN was pretty cavalier about his attitude toward subsequent pregnancies. But I take your point that it's not like a specialist would have a magic answer about that, either.

Thanks for the link to the pre-eclampsia boards! I'll check them out.

[Bokonon]

I think a consult with an MFM is a good idea. They understand what happens in a hypertensive pregnancy better than OBs, and one might have some reassurance for you as far as a plan of care in a future pregnancy. No, it wouldn't prevent the condition for recurring, but may make a difference in outcome vs. a more laid-back approach.

I know that with my second pregnancy, in which I developed severe pre-e again, I had to really be on top of my OB with regards to things like 24 hour tests, requesting bloodwork for underlying disorders, and even hospitalization. I wanted to be under an MFM's care, but she didn't think it was necessary - and then proceeded to dismiss my symptoms like severe headache, floaters, rapid weight gain, and waited until my BPs were 190s/100s on meds and mag. sulfate before delivering. It was so confusing to me, considering with my first, she sent me to the hospital when my BP was 170/100 not on meds, and then 4 years later, 180/100 was fine while on bedrest and meds? I really had to be assertive and advocate for my care.

I'm not saying that an MFM would have handled things differently, but I often hear of women saying that their OBs assured them that pre-e only happens in first pregnancies, so they attribute classic preeclampsia symptoms to anything else, with frequently near-tragic results.

[mrsfru]

Another benefit of the MFM's is while you are pregnant next time--I am now monitored during each pregnancy after the issues w/my first pregnancy.

There are basic blood tests that can be interpreted differently (the Quad screen, etc) that can help clue docs in to the greater or lesser likelihood of pre-e or eclampsia developing. Really, only the MFM's are going to practice that way. Plus, they are more qualified to evaluate other tests as well--I did a 24 hour urine test at the very beginning of when my fluid began to bottom out last time, so that we would have a baseline of normal/fairly normal to compare to. My regular doc's didn't offer that, but when I requested it at the MFM's, they agreed it was prudent.

Don't be afraid to request the MFM consult now, before you TTC again, and again next time you are pregnant.

Best wishes!!!

mrsfru

[shruley]

Yikes, reading some of the last posts, is that what OB care is like in some places??? I probably don't see a need for MFM because my OB did do a 24 hour urine baseline for me, did lots of extra monitoring of baby's growth, did take any of my questions or concerns seriously, and I think if anything, overtreated my symptoms and didn't waste any time inducing me when they felt things were approaching dangerous, even though I didn't have any of the classic symptoms like headache, floaters, pain, etc. While they told me I was much less likely to get PE again, they were never dismissive of anything. Some of those things described above do not sound like good medicine, and you shouldn't have to go to a MFM just to be listened to and get good care for PE!!!

[_ktg_]

Originally Posted by lalemma

So - I had full blown eclampsia without any real warning signs in my 33rd week, and had a crash c-section. We are nowhere near planning our next baby, but I'm starting to think a little bit about what we might do to prepare for a better pregnancy (and, fingers crossed, a HBAC) next time.

Has anyone seen a maternal-fetal medicine specialist after eclampsia/pre-eclampsia/PIH/etc? Was it helpful in planning a future pregnancy? I guess mostly I'd like someone who knows about this stuff to sit down and review my records - I like my OB-GYN and the hospital staff were great, but I was basically the only eclamptic person they'd ever seen. I could use some help understanding what happened, and if there were steps I could take to make a recurrence less likely, or anything like that. I am open to other kinds of practitioners (I saw midwives last time and hope to in future), but it seems like a maternal-fetal medicine specialist is most likely to have seen similar cases...?

I know about ICAN, but otherwise I am just starting to emerge from the fog of newbornhood, and don't know where to start collecting info. Thanks!

PS: I followed the high-protein diet that shall not be named, and still had eclampsia. No need to recommend it.

My sister we believe developed HELLP with her 1st pregnancy. She was managed by her PCP (just a family doc) at first and then as things got worse - she was bumped over to be followed by a MFM too. Now with her 2nd pregnancy - she started with a MFM along with an OB/GYN too and they are working as a team to managing her through her pregnancy. Again she has started to develop her PE symptoms, but between the management of these 2 offices she being relayed information and next steps quite well.

For you - I would say its a comfort level of you and your provider. Question their comfort and expertise. They as physicians may prefer for you to also be followed by MFM.

[Monkey Keeper]

Forgive me if this was mentioned already, but a pre-conception consult would be a great idea considering the severity of your case. Testing exists for underlying conditions such a clotting disorders and immune issues--if anything is uncovered before you conceive, measures can be taken to help improve outcomes in a subsequent pregnancy.

Also, with your history, you should be managed as high risk--either with a high risk OB or an MFM only. Early onset eclampsia is at the 'very severe' end of the spectrum. Having an MFM at least oversee your maternity care is an asset because the level of monitoring they provide gives them the ability to intervene before things become nearly as severe.

Someone mentioned above that many providers write off the lesser symptoms of a hypertensive pregnancy too quickly, and I tend to agree. Those little clues plus a lot of monitoring will allow a dr who specializes in complicated pregnancies to help you make good decisions about your health and the health of your baby.

Bottom line, I would insist on seeing a MFM, at least for a review of your records and some preconception testing.

Best of luck!

[AlexisT]

FWIW, I had my consult yesterday, and it was a TOTAL bust. They can't prevent preeclampsia so there's nothing they can do, and they don't handle chronic hypertension--he considers it my internist's job. I was really p*ssed at wasting my time.

[Monkey Keeper]

Alexis, that sucks. Seriously. My SIL has chronic hypertension, and it is being managed during her pregnancy cooperatively between her OB (who handles both regular and high risk cases) and her internist, and she has monthly consultations with a perinatologist which include growth u/s. And this is her first--so no history of severy pre-e!

If I were you, I'd talk to your OB and find out how their office plans to manage a subsequent pregnancy. Anyone who is chronic and on meds needs close monitoring to ensure baby is growing appropriately, the meds are working, and you aren't on that slippery slope to pre-e again.

I'm so sorry the MFM was a waste of time--it really shouldn't be for someone in your situation.