Speaker 1: 0:10

Hi guys, welcome back to Preview Alliance podcast. And so this month, guys, is the month of May and we know it's Maternal Mental Health Month, but it also is preeclampsia awareness. You may be going what is preeclampsia? That is, high blood pressure, all the kinds of things that we do want to avoid. So I have brought our MFM expert, dr Kevin Trista, on again. You guys are going to meet him over and over throughout this series that we're kind of going to be talking about what is complications of pregnancy from an OB-MFM standpoint. So, kevin, welcome and thank you for being with us. Thanks for having me back.

Speaker 2: 0:47

I'm excited that you asked me to do the preeclampsia episode. It is something that you see time and time again in pregnancy, so it's something that affects a lot of women, so excited to talk about it today.

Speaker 1: 0:57

So let's dive right into it. So what is preeclampsia For someone who's never heard of it? Break it down for us. Tell us also kind of when we would expect it to show up pregnancy and postpartum and give us kind of some of that fun medical knowledge you've went for so long about, like what's actually going on in our body.

Speaker 2: 1:17

Yeah. So how I describe preeclampsia kind of at its bare bone things is it is a disease of pregnancy that can cause high blood pressure and possibly some other effects like organ damage and other effects to baby. It can be dangerous and can have some effects that need to be monitored and watched, especially if it's not detected. That's when we kind of see these things take off, but very manageable when caught early. Usually we think of preeclampsia showing up after 20 weeks of pregnancy. In a very small number of patients less than 10% it can happen after you give birth, but traditionally we say it's within that 20-week and onward.

Speaker 2: 1:55

From a pregnancy standpoint and as far as what's happening in preeclampsia, I think if you were to ask five different MFMs you may get all sorts of answers. We don't exactly know what causes preeclampsia. We think it's sort of a multifactorial process, has some contributions from the environment, maybe some genetic information that we haven't figured out yet. Things specific to each pregnancy is in a host of other things. But kind of thinking about what's going on in the body. What we see is that blood vessels in the placenta almost don't form correctly and with that they don't function correctly and this causes a bunch of different effects in the body, from abnormal blood flow to and through the placenta, your body releasing a ton of hormones in response to that, causing the effects that we see. So your high blood pressure, potentially some organ damage and the placenta not functioning well, and that can affect both mom and baby too.

Speaker 1: 2:47

So this is really mom and baby situation here, that more times than not, we're worried about both of them being healthy.

Speaker 2: 2:55

Exactly, and that's really what I try to stress because, you know, a lot of times moms are concerned about baby primarily. Right, they do everything, they sacrifice everything for their child, but preeclampsia truly is one of those diseases of pregnancy that affects both. So it's important to pay attention to not only baby, but moms as well.

Speaker 1: 3:12

What are some signs and symptoms that let's say early versus late, because we want to talk through this. So it's such important because we go and you guys check our blood pressure, which you know more times than not might be totally fine, right, but then it seems to be. It's that kind of silent killer as well. It's like you're going to the symptoms may be starting and it could be, you know, when we're not seeing you guys every week, right, that 20 weeks we're not seeing you every week.

Speaker 2: 3:40

Yeah, exactly, and some of the things are very apparent from a symptom standpoint. But exactly like you said, so much of the symptoms can be silent and really not cause you anything to be concerned about or really give you any sign that something could be going wrong at home. But primarily, like you said, high blood pressure is one of the most common things that we see. Other things are abnormal swelling. So especially when you have swelling in your face, your hands, around the eyes that's not where we typically see the swelling of pregnancy we think of gravity pulling all that fluid down to your legs, which happens especially more so as you go on. But in those abnormal places is what we can sometimes see Sudden weight gain and really that's kind of giving a clue that there may be extra fluid in other places your skin, your lungs and some of those areas as well.

Speaker 2: 4:28

Headaches that seem to not go away, and these are different than what a patient may explain what her typical headaches are, if she's someone that has migraines or other things and usually don't get better with medications. Other changes in your visions, like spots, blurred visions, any pain in your especially kind of your right upper belly, that's right around where your liver is, and then feeling shorter breath or chest pain and really the thing I tell patients at the end even if you feel off or if you feel something's not right, you just don't can't really put a word on it. Sometimes that can be kind of the first thing that we see as well.

Speaker 1: 5:03

How are you guys screening, besides checking blood pressure, for a preeclampsia or her risk, because someone's going? Okay, wait, I don't want this. How do I kind of not be this?

Speaker 2: 5:12

Yeah, so blood pressure is the biggest thing. That's key and oftentimes can be one of the first indicators that we see, because, like you said, that may be the first thing you see but we don't catch any other symptoms because they haven't necessarily developed yet Other things. Is we kind of, like you were saying, look for different risks for patients, right? We know there are patients who are more likely to develop preeclampsia. Those are things like having preeclampsia in a prior pregnancy or any family members who may have had that. Women with conditions such as high blood pressure, kidney disease, diabetes, autoimmune conditions like lupus, those are kind of the more strong ones. But even things like moms who are in their first pregnancy can be a risk factor. Older moms above 35 years of age, or if you have more babies, twins, triplets, those sorts of things.

Speaker 2: 5:57

So we kind of use and say all right of the risk factors that we know can increase your chance of developing preeclampsia. We will talk about this later. Ron can do some preventative measures. We'll screen you more closely with blood pressure and things, and then it's kind of talking about the general other things. So how are you doing? Is your baby moving well? Are you having headaches or swelling or anything else kind of alluding to some of these symptoms that we were talking about.

Speaker 1: 6:25

You know, I think the key here too is people going okay, so what if it's not caught early? What's the risk for mom-baby? We preterm birth, but what else can occur?

Speaker 2: 6:32

Yeah. So not catching preeclampsia early can really kind of separating it into mom and baby. So from a mom standpoint, preeclampsia kind of comes in a couple of different flavors, if you will. There's classically what we have. Preeclampsia kind of comes in a couple of different flavors, if you will. There's classically what we have preeclampsia without severe features, and then we have almost a severe form, so we call it with severe features that can cause things like seizures or we call that eclampsia in this setting strokes. We have risks of organ damage like liver or kidney failure. Thinking about baby now, we have risks of stillbirth, unfortunately. We have risks of growth restriction or growing small, preterm birth, like you alluded to, and early deliveries. So truly going across the entire spectrum, and what you know?

Speaker 1: 7:16

preterm birth. So let some people go. So what does that mean? So how early could she have to deliver if she has a severe form of preeclampsia?

Speaker 2: 7:31

That's a great question and there's no answer as far as when that timing is.

Speaker 2: 7:33

But I've delivered patients as early as 20, 21 weeks, when it gets really, really bad, right, and that's a very, very tough discussion because you're so close to having what we call like the take-home baby, right, a baby that has a chance to survive on the outside, which for some women who have been through many difficult pregnancies, that's kind of their big goal of getting to that point and having that discussion of saying, hey, this preeclampsia has gotten so bad to where now we're seeing fluid in your lungs or your liver getting damaged or your kidneys getting damaged, to where this could worsen if we keep you pregnant and potentially be lifelong changes that you have to deal with for the rest of your life.

Speaker 2: 8:10

And those discussions have ended with the decision of proceeding with delivery at 21 weeks, so it can be very, very early. Now the usual timing of delivery, let's say kind of taking out of that worst case scenario, is for preeclampsia without severe features. Our goal is to get you to 37 weeks, so 37 weeks and zero days, which is full-term baby, the preeclampsia with severe features, because of those risks being higher again, not only for mom but for baby as well, we pull that delivery timing up by three weeks. So 34 weeks is the latest that we would go for preeclampsia with severe features and again, if there were other signs of worsening from a baby standpoint or a mom standpoint, that could be any time before then. So 30 weeks, 32 weeks, 28 weeks, just kind of depending on how that pregnancy goes.

Speaker 1: 9:01

I hear a lot of moms say I feel like a ticking time bomb, and you may feel like you're taking care of a ticking time bomb in some cases. If she is diagnosed preeclampsia, what can she do? What is your advice to your patients of like okay, now we have this diagnosis, how are we going to manage this from like a physical standpoint, mental health standpoint and safety standpoint?

Speaker 2: 9:21

That's a great question and it's a hard answer for patients and really for me the biggest thing is are you stable enough to be managed in the clinic or outpatient setting, to be at home with your family and everything else coming to clinic often? Or is your preeclampsia severe enough that you have to be managed in the hospital until delivered? Because for some patients that is the case and usually that's with the severe form. For patients at home, what I advocate a lot is for having a home blood pressure cuff. A lot of times you can get that for discounted or covered with insurance and clinics and there are different programs I think that different states may have, but that can be.

Speaker 2: 9:58

One of the best things that you can do is routine, regular blood pressure checks at home and I always tell patients you don't have to go crazy and do it six times a day or anything like that. Doing it once or twice a day, just kind of regular, routine things when you're calm sitting down, not like rushing back and forth just to get an idea of what your blood pressures are doing, to be able to detect when it goes or if it goes up into a more dangerous or worrisome range. Right, other than that it's kind of doing the things that we always advocate for in pregnancy. So if you're working, making sure you're taking breaks and not overexerting yourself from a stress level, from a lifting or weight level at work, keeping regular exercise, walking, eating, a balanced diet those sorts of things can help as well. But ultimately, preeclampsia is not something that we have learned how to prevent or keep away right, something that we try to detect and then kind of manage as it comes.

Speaker 1: 10:53

So really kind of even a log, of saying okay to your days, to state this is my blood pressures, this is what I ate, this is what I felt you know, or this was my stress level Because I always say sometimes I do this myself, even being a nurse is coming into the doctor's appointment, I kind of get like white coat syndrome. I'm like I don't even know what's been going on. But if you have kind of a notebook and you can write it down and you guys can objectively look at patterns of the blood pressure or see if we can say, okay, when you're going to this job and you're on your feet for 12 hours your blood pressure skyrockets, or the swelling's worse, or hey, kfc's chicken is really a lot of sodium, that we're also seeing issues. So just really, I think I always advocate for when I was a VA nurse for my little veteran guys I'd be like write it down so we can both be on the same page. So that's something personally I've found that's helped me.

Speaker 1: 11:45

What would you say mentally? Because that is, you know, how can they with their anxiety right, and even depression comes into play and then the odds of the birth going not how they want it planned. How do you talk to patients about that, because you know we're core maternal mental health here, of saying this is awful. Like you know, I'm on blood pressure medicine now. I'm worried about kidney failure. I'm my baby. How do I manage that?

Speaker 2: 12:15

Yeah, and we have these discussions all the time and it goes back to it being one of those things where you just kind of state what's going on, you state that it sucks right, and we can go back and forth on being in this unlucky position and having to do all these extra visits and blood pressure check things and it being a hard road. I think acknowledging that is a big thing that a lot of moms try not to do because they want to seem like they're being tough and that it's not a big deal. But preeclampsia is a big deal and it is a hard road to go through. So I think the biggest thing is being honest with yourself about how difficult things are for you, for your family, kind of the life situation that you're having because we unfortunately have to tell some patients that their preeclampsia is high risk enough to take them away from their home and work, setting and other children and stick them in the hospital until delivery. And that's hard. That's hard for everybody, for the mom being in the hospital, for her kids and her family and everything else. So part of that comes from just accepting and saying what it is right and that's, I think, can be therapeutic, just in general, just talking about it and having that open discussion.

Speaker 2: 13:23

The other thing is part of that worrying process of you know is this coming on? Is this preeclampsia? Is my baby okay? And that's where these regular checks come in, with going to your doctor and if you do have something like preeclampsia, that you're being managed in the clinic. You're getting labs, you're getting your blood pressure checked, they're checking on baby, and all of these things are there to one, see if your preeclampsia is still safe enough to be in the clinic and not need to be in the hospital. And then two and this is sort of something I tell patients is, every time I walk into a room, the question that I have in the very back of my mind, whether I say it or not is it safe for you to keep going in this pregnancy for both you and baby? Right, Most of the time that answer is yes, but sometimes and this is what all those visits and checks and labs and things are for is, when will that answer be no?

Speaker 2: 14:08

Because there's going to be a time where that answer is going to be no. And coming to those checks and sort of saying, all right, we have a plan for this, we have a plan to find something. If it could be going wrong with me, could be going wrong with baby, and trusting in that plan. And I think the biggest thing, the last part of that as well, is when you feel bad, when you feel off, if you feel something isn't right, going into getting evaluated. And that's the last part that is almost kind of there as a fail safe Because, like you said at some point in pregnancy, you're not going to be going as frequently. You know, once a week visits are often, but they're not often enough, sometimes right. So that's that last key of if you feel something's wrong, you go in and get evaluated.

Speaker 1: 14:49

I think one thing people maybe don't realize is what percent of your high risk patients have preeclampsia, then eclampsia? Like is this a majority of your high-risk patients have preeclampsia, then eclampsia? Like is this a majority of your practice? And do you think there's enough advocacy and awareness in patients and their families and in like ER staff? Like, do you think this is known, how serious this is, especially in like our state, or do you think it's again, part of the reason why it's a silent killer is just we're not talking about it enough?

Speaker 2: 15:17

Sometimes it seems like everybody has preeclampsia. I'll be very honest with you. I mean it can be that common, right. But I think, like you're alluding to, I sort of see a subset of higher risk patients than what a generalist OBGYN may see out in the community and so if you look at the overall percentage of things, it is not as common as probably what I see. I definitely have a jaded view of it. But that being said, you know it can't happen to anybody in pregnancy, whether you have zero risk factors and it's your first pregnancy and you're the epitome of health or if you have all the risk factors that we read about in textbooks.

Speaker 2: 15:49

So I think part of it comes from a couple different things. You know we're having more awareness and patient-focused interactions, like yourself, and something called the preeclampsia invitation and things to get the word out for patients. But a lot of patients have some idea or they've heard about it before because it may have affected their family member or their friends. They've had it before, their mother had it. We used to call it toxemia of pregnancy. So it kind of has common, different flavors, but the general idea of blood pressure swelling, early delivery, like that picture a lot of patients actually come in with a good bit of experience or knowledge beforehand.

Speaker 2: 16:28

I do think sometimes when we have pregnant patients see our colleagues and friends in ERs and other places. When they're not pregnant anymore, that pregnancy brain of all right, what do I need to look out for? Almost switches off right and that's no fault to them. They're seeing a ton of other patients, they're seeing males, they're seeing women who are, you know, 12 years old to 72 years old, and so there's no fault in anybody for that. Like they're having to look at so many more things.

Speaker 2: 16:56

But one thing that I think could be looked at a little bit more is that postpartum period right, because, like we said, preeclampsia for the most part affects you in pregnancy but it can happen afterwards and that can be with severe form. So that's severe kind after delivery and that's really something where you know, blood pressure of 170 over 100 for someone who's not pregnant, like myself. It's not necessarily the biggest emergency for somebody, because that's where I've been, that's where I will be and I'll go to a clinic and I'll get my blood pressure meds Right. But for someone who doesn't have blood pressure issues, who recently delivered, that is an emergency for them and they really need to be evaluated with medications and kind of go and go the whole thing.

Speaker 1: 17:40

What is that timeframe? So we're now talking to our postpartum moms. They're like okay, kevin, I made it through pregnancy. You know, where is this postpartum period where the same Simon Sensen's the headaches, the blood pressure she's feeling off right, the swelling? Where do we typically see that time frame of postpartum preeclampsia? Or is it called clampsia there? Or is it preeclampsia Because it's? What is that called during that time?

Speaker 2: 18:05

Yeah, and that's a good point with the different terminology.

Speaker 2: 18:08

So preeclampsia is what we have been talking about, right, the blood pressure disease with the swelling and the organ damage and the effects to mom and baby. Eclampsia is if you have seizures in the setting of the high blood pressure and kind of similar we say pathophysiology, but similar process going on in the body. Right, you don't always have to have preeclampsia for eclampsia. So sometimes the first time you present and again this is very, very uncommon kind of the point, whatever percent, but it is the eclampsia, so the pre is almost a little bit misleading. Usually you can't see that.

Speaker 2: 18:45

So that's a good point about the terminology between the two to rarely a couple of weeks after delivery. Now, looking at like the entire postpartum period, you know we typically say we'll see you at a six week visit and then we sign off. But now we're learning that that postpartum period really should extend anywhere from six to 12 months after your delivery where your body is still kind of recovering for those effects in pregnancy. But specifically when we talk about the blood pressures and the headaches and the symptoms, we're usually looking at days to a couple or a few weeks after delivery.

Speaker 1: 19:21

Okay. So our postpartum moms give yourself at least, I would say, in the first two months, if you are feeling blood pressure is high. If you're taking blood pressure oh my gosh, I'm dizzy, I've got these headaches, I'm swelling, I'm feeling off. You're not out of the woods Always go back to the ER, call your OB and follow up there. You know the theme. Actually, this year's campaign for preeclampsia awareness foundation was ask me about preeclampsia. So I'm going to ask you is there a story or is there a couple of patient experiences with preeclampsia or eclampsia that's impacted you, that you're like gosh, that got scary really quick, or you know, kind of just created this new mission of how you're treating these moms.

Speaker 2: 20:04

Yeah, I think the ones that stick with me is when a patient comes in and says I just feel off or I don't feel like myself, and I guess the reasons that those stick with me is, you know, classically we think about headaches and vision changes and shortness of breath, like these are the things that your textbook says. All right, there's something going on there, that feeling of feeling off or unwell or just not. Something's not right. Sometimes you see those patients and once you get their vitals and you get their labs and you put the baby on the monitor, like it seems like everything is blowing up at that moment and it's truly amazing how the lack of a specific symptom can be a symptom. Right, I just don't know what's going on, but I don't feel like myself.

Speaker 2: 20:45

You check their blood pressures they're sky high. Their baby doesn't necessarily look the happiest when you put them on for their monitors and they have abnormal labs. And those are the ones I always remember. And now what I've started telling and talking to patients about is sometimes that can be your clue. And again, you probably were seen in clinical two weeks ago blood pressure symptoms, baby was fine and you're in this gap period, right, where we're not going to see you again for another week or two, but coming in telling us what things are going on allows us to check, find something and then act on it, and that doesn't always mean delivery at that time, but it's stabilizing you and making sure that we can do what we call expectant management or get more time out of the pregnancy.

Speaker 1: 21:28

And so I think that's important part is, you know, if you are asked to come into the hospital, say I need to manage you in the hospital, right, and it's to that critical point is that you are going to be doing everything as a provider to keep me and my baby healthy, baby in the womb as long as possible, and me okay, and kind of just quickly talk through what may she have to experience if she's in the hospital and you're trying to keep baby and her okay. We're having IVs, we're having blood pressure checks, what else is going on?

Speaker 2: 21:57

Yeah, and again it sort of depends on two situations. So is this right when you come in, or have we sort of transitioned to say, all right, you're stable and now we're just going to be watching you until delivery? So when you come into the hospital, a lot of that's going to be looking at your blood pressures, seeing if it's high enough to give you IV medication to get it down quickly because it's in an unsafe range. Another part of that is, like you said, starting IVs, getting magnesium, which we can talk about later on as something that we use to protect moms from some of the bad effects from preeclampsia, specifically seizures, monitor baby and prepare for an early delivery in case baby or mom don't stabilize and things look for the worst, right. So, going back to magnesium, that is one of the best things that we can do for moms to help reduce their risk of eclampsia or having seizures as well. It also gives us the benefit of helping reduce the risk of cerebral palsy for very early babies, specifically before 32 weeks. The other thing that some moms get is a shot or two shots of steroids and that really helps a number of different things for preterm babies. One of the biggest things is lung development and lung maturity, but also helps reduce things like hemorrhage or brain bleeds in the brain, things like necrotizing enterocolitis or sort of gastrointestinal intestine issues as well. So truly, when a baby doctor looks at the baby, one of the best things they can have on board is the steroids as well.

Speaker 2: 23:23

A lot of monitoring kind of goes into that too.

Speaker 2: 23:25

So monitoring baby's heartbeat to make sure we're doing okay, monitoring mom's symptoms and blood pressure too, and let's say we do all of that. Blood pressure looks great, baby looks good and we say, all right, our preeclampsia I don't want to say flare, for lack of a better word, but it's sort of calmed down as being managed right now. Right Now we're transitioning to the stable portion of saying, all right, let's do expectant management, let's keep you in the hospital until we think it is no longer safe for you and for baby to be pregnant. And that comes with similar to what we're doing, just more spread out. So instead of blood pressures all the time, it's blood pressures kind of. At that routine monitoring they do in the hospital checking your labs to make sure that there's no sign of liver or kidney or any other form of damage, and then getting testing on baby a couple of times to make sure that baby's doing okay, and then at some point whether that's you hitting your delivery date or do the monitoring if we catch something, then we talk about delivery.

Speaker 1: 24:24

I think it's important to just talk about. If you say it's time for delivery, are you taking her for C-section or are you going to let her have labor and deliver? Kind of prepare, listeners, let's just. It is that, let's go. There's something on your labs, there's something with baby, there's something with you. I need to take you to delivery. What is that going to look like for her?

Speaker 2: 24:44

Yeah, nothing specific to preeclampsia usually says that you need to have a C-section right then and there, so overwhelming majority of my patients, if they have preeclampsia, we still plan for, and try to do, a vaginal delivery, whether it's induction or anything else. There can be consequences of preeclampsia, though that may need us to talk about or do a C-section. Part of that comes in looking at how baby tolerates labor, how moms tolerate labor. So we were talking about some of the severe things. Sometimes that placenta is not working well, really at all, and labor is very stressful, like we've been talking about, as that uterus constricts, it kind of reduces some of the blood flow that goes to the placenta, and if that placenta already is not functioning well, that baby's really not getting what it needs to. And so if you think about doing that throughout the entire labor process which sometimes and your listeners will know better than me can take a long time that baby's not going to tolerate labor well and at some point be in distress. So sometimes it's because babies can't tolerate labor well. On the other side, sometimes it's because moms don't tolerate labor well.

Speaker 2: 25:50

Some moms can get critically sick with either fluid on their lungs, that affecting their heart and some other parts of their body to where they may not tolerate the stress or kind of the entire labor process, where a C-section may be a better decision, and those are thankfully a few number of patients in general so overwhelming majority vaginal delivery. Very rarely do we need a C-section. And again, there are other things right. So the general stuff. If baby's upside down going breech or feet first, if you want a C-section because you've had C-sections in the past, those sorts of things also play into account too.

Speaker 1: 26:26

Yeah, you know. I remember specifically one of my friends from high school. I saw a picture of her on. It was like I think it was before Instagram days, it was Facebook, and she was pregnant but she had blown up, her face was swelling. I looked her hands. I remember going, oh my gosh, she looks like she's not okay. She ended up having eclampsia then. Because she did.

Speaker 1: 26:49

She had a seizure and a stroke and they had to have C-section and then she had to actually be in rehab from her stroke, so and she's super healthy. It was her first pregnancy kind of came out of nowhere and I remember that's kind of stayed in the back of my head. Thankfully I've never experienced that, but I think that's a point to listeners is back of my head. Thankfully I've never experienced that. But I think that's a point to listeners is if it's not you just being aware of this, you know the signs. And if you're a pregnant friend or postpartum friend goes oh I have that headache, or you look at it and you're going, you're really swelling more than you know. The pregnancy swell, right, like it's your face, it's your hands or she's acting off.

Speaker 1: 27:26

So it's an everybody conversation, right. It's like we need to know this. It's like we know heart attack. If I grabbed my chest and I was like you know I can't breathe and my chest is hurting, you're gonna call 911. It's the same kind of thing. We want awareness here. What about baby aspirin? There's been some talk about preeclampsia and baby aspirin, along with kind of like standardizations of lifestyle changes. What's your thoughts about that?

Speaker 2: 27:49

Yeah, baby aspirin is one of the few things that we have that we know can help reduce the risk of preeclampsia. So for a lot of my patients who have risk factors like we've talked about, we do recommend starting on a baby aspirin, usually around 12 weeks or so, so pretty early in the pregnancy, and continuing that on through delivery, and it does help reduce the risk of developing preeclampsia for those patients so fully on board.

Speaker 1: 28:15

Is there anything else that you recommend to your patients that say a listener has this and they're like okay, what else would you? What would you tell your sister? What would you tell your wife about preeclampsia, if she had it, and how to manage it? Give us that insider what would you do?

Speaker 2: 28:30

Unfortunately, there's no secret to preeclampsia. I really wish there was. But, like we have kind of focused on again and again, making your prenatal visits is the utmost important thing. I am a big supporter of home blood pressure cuffs to kind of get an idea of what your blood pressures and your symptoms are doing. Active exercise so you know what we always say get 30 minutes of moderate intensity exercise a day. Walking definitely counts. Eating, a balanced diet, kind of decreasing as much stress as you can. Those are the big things that I think really that we can do for our patients and tell our patients about managing preeclampsia, trying to detect preeclampsia early, because we have not found a surefire way to prevent it right, but we do have a lot of ways to manage it.

Speaker 1: 29:16

I think that's a encouraging note. Is that why it's very scary diagnosis, just like any diagnosis you get during pregnancy or postpartum or even life? Right, I think pregnancy is hard because it's you and your baby. So it's now two, so you know two of everything that you're trying to manage two hearts. You know the lungs, the blood flow. That is what it's about Listening to this episode, being aware, advocating for yourself.

Speaker 1: 29:40

And I always say I always had a gut feeling as a nurse about patients before things went wrong and then I had them about myself in pregnancy. And I think that's my biggest advice, like you said, is just be open and honest and say I don't feel right and if the first person you say that to doesn't take the appropriate steps, go to the next person. That is my personal like raise the flag is like keep saying it and have someone look into it. Take your blood pressure check on baby. I always used to tell my VA patients too I would rather you call me or come in and let's check it out than you not. And you know we can always deal with a good checkup Everything's fine versus a negative outcome.

Speaker 2: 30:20

Oh my God, I completely agree. I would take 10,000. I thought something was wrong. We checked your blood pressure and your baby. Things look great. We go home visits, right. Then that one time where you say I don't feel right but I don't want to bother them, or I don't feel like going in, or I don't know if they're going to take this seriously and we have something bad happen. That's the thing that I struggle with, right? I would much rather do. Hey, you're fine. There's a lot of stress going on, totally get that, but things look really good for both of you guys.

Speaker 1: 30:50

I think that's a wonderful way to end this, but where else would you advise your patients, or where do you look or say they want more education? Besides, obviously, talking to their OB or MFN, where could they learn more? Is there any resources that you have that you share with your patients?

Speaker 2: 31:03

There are, yeah, one of the best kind of organizations I think is called the Preeclampsia Foundation, which I mentioned early on, and they do a lot of patient-focused educations, handouts. I believe they also have a blood pressure cuff program as well in case patients have trouble with insurance or things like that. Our society, so ACOG, which is our OB-GYN society, has a lot of patient education handouts as well to kind of learn not only about preeclampsia but other things as well, and your physician and your midwife and your doula and the patients who are taking care of you in this pregnancy know a lot about preeclampsia and be able to kind of talk to you about what to expect if you have it, if you don't have it, what to look for and kind of signs like that.

Speaker 1: 31:45

Perfect. Well, this is a wonderful education episode and I'll link all these links that we just mentioned on the show notes. But, guys, we really appreciate you tuning into these. Share it, get informed and advocate for yourselves. Kevin, thank you. As always, we appreciate you being with us.

Speaker 2: 31:59

Thanks for having me Hope to be back.

Speaker 1: 32:01

All right, Thank you guys. I'll see you next week.

Speaker 3: 32:06

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