Helen Dandurand (Host): Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand, and today I'm going to be joined by Abby Banter, Riverside Family Birthing Center, night shift team lead, to shed some light on the topic of preeclampsia.

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Helen Dandurand (Host): And we're back with Abby. Thanks for joining me today.

Abigail Banter, BSN, RNC-OB, C-EFM: Hi, thanks for having me.

Host: Of course. So you've never been on the podcast before, could we start by having you tell us just a little bit about yourself, your background?

Abigail Banter, BSN, RNC-OB, C-EFM: I have been a labor and delivery nurse for the last 19 years and the last 10 of which have been here at Riverside. I obviously have a nursing degree and then I also have two certifications specific to obstetrics.

I'm one of the teachers for the new beginnings childbirth class here at Riverside as well. And on top of all of that, I am a mom of two sets of twins.

Host: Oh, wow. I didn't know that. Yeah. That's crazy. That's awesome. How old are they?

Abigail Banter, BSN, RNC-OB, C-EFM: They are 5 and 11 as of right now.

Host: That's wild. Cool. The more you know. Yep. And so much experience in every way. Yep. So, let's start by jumping into the topic. Could you maybe briefly explain what preeclampsia is and why it's a concern during pregnancy?

Abigail Banter, BSN, RNC-OB, C-EFM: So, preeclampsia is a persistent hypertension or high blood pressure that develops during or soon after pregnancy, usually occurring somewhere between 20 weeks of pregnancy and up to 6 weeks after delivery. Preeclampsia affects about 5 to 8 percent of all pregnancies. What makes preeclampsia a significant concern is a potential risk for a buildup of fluid in the lungs, seizures, and stroke. These symptoms are what makes preeclampsia one of the leading causes of maternal death in the United States. And in addition to this, there are also some complications that would affect the baby as well.

Host: Got it. Got it. I guess for people to be on the lookout, what are the early signs and symptoms of preeclampsia that pregnant women should be aware of?

Abigail Banter, BSN, RNC-OB, C-EFM: So some of the common early symptoms are a blood pressure that's persistently higher than 140 over 90, headaches that don't go away with taking Tylenol or hydration, resting, any blurred vision or spots in your vision, swelling in your hands, feet, or face that are a little bit more than what's normal in pregnancy, a sudden weight gain. So you'll go to the doctor more frequently towards the end of your pregnancy and a sudden weight gain of more than five pounds in a week, we get concerned about. Nausea and vomiting out of the ordinary. Right sided abdominal pain that's kind of just like under your ribs on the right side, shortness of breath, and then you may just not feel right in general.

Some of these symptoms are things that may happen in pregnancy and can be normal and are not related to preeclampsia like the nausea, vomiting, swelling, and shortness of breath even. But if you're experiencing any of these symptoms, it's always good to discuss them with your doctor. Some more severe symptoms of preeclampsia may include chest pain, increasing shortness of breath with trouble breathing, and seizures. And these symptoms obviously need to be evaluated immediately at the hospital.

Host: Got it. Would you say there are specific risk factors or groups of women who are more likely to develop preeclampsia?

Abigail Banter, BSN, RNC-OB, C-EFM: In general, we still aren't entirely sure of what causes someone to develop preeclampsia. There's a lot of different theories and whatnot but there are some risk factors that put someone at a higher risk of developing preeclampsia. Mothers having their very first baby, or if it's your first pregnancy with your current partner. So if you've had children with a previous partner, and then this is our first time partner that can also put you at a higher risk, someone with a history of having high blood pressure, kidney disease, or diabetes.

If you have a family history of preeclampsia or if in a previous pregnancy you've had preeclampsia, that can also put you at a higher risk. Black and indigenous women, women over the age of 40, if you've had pre pregnancy obesity, some autoimmune conditions like lupus, and then if you're pregnant with more than one baby.

So if you've got twins or triplets in there, it also puts you at a higher risk.

Host: Interesting. So it sounds like a lot of different things, but not necessarily like a super pinpointed thing. Correct. Correct.

Abigail Banter, BSN, RNC-OB, C-EFM: Correct. It's kind of a broad range and then women that are seen to have like moderate to high risk factors, they can be started on aspirin early in their pregnancy. This can sometimes help to prevent preeclampsia from happening, but please don't take any medications that your doctor hasn't discussed with you first in your pregnancy. We always want to do what's safest for you and baby, but sometimes that can also help.

Host: Got it. Do you have any insight on, you've mentioned that, if it's your first time with that partner. So how does that, do you know anything about how that works? I

Abigail Banter, BSN, RNC-OB, C-EFM: I think the reason for that is it's a different type of DNA. Um, when, obviously when you're pregnant, you have two types of DNA in your body. And so if you've had a pregnancy with a previous person and then now you're having it with a different person, I think it's something with that like new introduction of different DNA that can sometimes lead to that.

Host: That's wild. Would have never thought that. How is preeclampsia typically diagnosed and what tests are typically like performed to confirm it?

Abigail Banter, BSN, RNC-OB, C-EFM: For most women, as just as like a kind of background with high blood pressure, as you begin your pregnancy, you're kind of normointensive, meaning your blood pressure is going to be the same as what it is when you're not pregnant.

Then as you get to the end of the first trimester and into the second trimester, you're going to have a decrease in your blood pressure, actually, where it's going to be what we would consider maybe a little bit low for where you normally run. Then as you're coming out of the second trimester and going into that third trimester, your blood pressure is going to come back up to a normal range.

However, this is when some women start to have signs or symptoms of a pregnancy induced hypertension or a preeclampsia at this point. If you are noted to have a high blood pressure, a lot of times you've been to your doctor's office and they do your blood pressure and they notice that it's high or if you're having any symptoms of preeclampsia, like we mentioned earlier; you may be sent over to labor and delivery to have a little bit more testing done. Usually with that, what it's going to look like is we are going to do a non stress test. So we're going to put some monitors on your belly. We're going to look at baby's heart rate and see if there's any contractions going on.

So we can kind of see how baby's doing. And then we're also going to monitor your blood pressure over a period of time. So we're going to do it, periodically for a little while. And then we're going to run some lab tests, what we refer to as kind of like a PIH panel. This includes urine tests and some blood tests. Along with this increase in blood pressure that we might notice in the office, women are also likely to have protein in urine, which is why we do that urine test. And then there might be some other changes that are happening with your blood work that's related to like your liver and kidney issues potentially. Some women have elevated blood pressure and then don't have protein in their urine.

And when this happens, we kind of, and they're not, also having other symptoms; we consider it to be a pregnancy induced hypertension. So a lot of times we will help with the blood pressure by giving like a medication to help bring your blood pressure down and kind of monitor you more closely. And then if you were to develop like signs and symptoms or if the blood work was a change or you're getting protein in your urine, then they're going to kind of change up what they're going to be doing.

Host: Got it. So it sounds like people are going to be very well taken care of by having a lot of different testing and really know what's going on. So even if, I mean, it seems a little bit you know, like, oh, well, there's so many different like potential risk factors and also none at all, at least once you think that might be happening, like you can really confirm that. So that's, I feel like comforting to know that you can actually know. Is this happening? And then be monitored for it.

Abigail Banter, BSN, RNC-OB, C-EFM: And definitely, if we notice that someone's having like these higher blood pressures or, you know, any kind of symptoms that could be related and maybe you're not having that like high, high blood pressure yet, we definitely keep a very close eye on any women that fall within that category.

Host: Awesome. We're going to take a quick break to talk about finding a primary care provider.

Riverside knows that health is your greatest asset and that your primary care provider is your partner in health. Find a primary care provider that fits your needs at riversidehealthcare.org /primarycare.

And we are back. So we were just talking about the different ways you can get diagnosed. And then once you are diagnosed, what are the common management and treatment options?

Abigail Banter, BSN, RNC-OB, C-EFM: So the goal is to get someone as close to the delivery date, so like 39, 40 weeks as possible with a pregnancy. If we're able to keep blood pressures within a normal range and you're not developing other signs and symptoms of preeclampsia, then we're able to do this. However, if you're having blood pressures that we're not able to control with medications and you're seeing some changes in symptoms or getting more severe or changes in your blood work, then we might need to deliver before 39 weeks.

Your blood pressure readings and lab work findings guide your care through labor and delivery as well as postpartum. In some cases, we continue to monitor pressures, like I said, and give them blood pressure medication and just kind of see how things go. Other times, during labor and then even after delivery, we give a medication called magnesium sulfate.

What that is, it's an IV infusion that we give. It's kind of a continuous infusion. And then we keep you on that, like I said, during labor and for about 24 hours after delivery. The goal of the magnesium is to relax your neurologic system to prevent seizures from happening because that's one of the biggest, scariest things that we would see with preeclampsia.

If you are on magnesium, during or after delivery anytime in there, you're considered high risk, obviously, and so we monitor baby and mom very, very closely during that time.

Host: Got it. So, if people don't get, or if, you know, folks don't get medication during that time, is it just monitored? That's just what you can do? Or how does that differentiate who gets it?

Abigail Banter, BSN, RNC-OB, C-EFM: Some people, so some people kind of have borderline blood pressures, but you'll have some that maybe are elevated, but then over time, like, in general, they're not, like, treatable. So we kind of just will monitor. Some people will have higher blood pressures and then have other symptoms going on.

The provider takes into account all of those things and kind of determines if they want to manage with just the blood pressure medication, monitoring, or if they feel like they need to do the magnesium.

Host: Got it. You've mentioned as we've been talking here a little bit about what some of the complications could be, but could you maybe go into a little more detail of what the complications could be for mom and for baby?

Abigail Banter, BSN, RNC-OB, C-EFM: So some of those complications, preterm birth why this would happen for preterm delivery would be if mom is developing preeclampsia and you're not to your due date yet and you're, you know, still kind of early and the severity of your symptoms or what's happening, it's better to just deiver mom than unfortunately, sometimes we have to deliver a little bit early. So that's why preterm birth would be a complication.

There is a risk for fetal growth restriction. So that means that basically baby's not growing as well as it should in utero. Kind of why that happens is because the placenta's not getting as much blood circulation and whatnot because of the hypertension and then other factors that kind of go along with preeclampsia.

And then that can lead to a low birth weight for baby as well. There's also a risk of placental abruption. This is where the placenta pulls away from the side of the uterus again related to hypertension. And this is considered an emergent situation. You would see like vaginal bleeding or really bad abdominal pain potentially in this, if this were to happen. HELLP syndrome is a continuation of preeclampsia.

So in preeclampsia, maybe symptoms are vague or, you know, things haven't been caught quite early enough. Sometimes you can go into something called HELLP syndrome. You have like a breakdown of red blood cells, changes with your liver enzymes, and then you can end up with a low platelet count.

So when this happens, this is also something that's kind of more urgent and would need to be taken care of in the hospital. And then one other complication, kind of like we mentioned earlier, was the risk for seizures. So just like with a preeclampsia, you're going to get extra swelling in your feet and hands and face and everything like that. You can sometimes have swelling that affects your brain. And then that is what, in addition to the hypertension, can also lead to having seizures potentially if it's left untreated.

Host: Got it. How does preeclampsia affect the postpartum period then? Like what follow up care is necessary for mothers who've had it?

Abigail Banter, BSN, RNC-OB, C-EFM: So, just because you delivered and didn't have any blood pressure issues during your pregnancy and potentially during your hospital stay, doesn't mean that you can't develop preeclampsia after you have baby. Oh, wow. Um, Yeah. So yeah, lucky, lucky um, for those who have this happen to them, I guess. So even in that first, like, six to eight weeks after delivery, keeping an eye on these signs and symptoms is really important because you can actually develop preeclampsia after you've delivered.

And so it's very important to notify your physician or if you're having any more severe symptoms to come in and be evaluated for it. In general, all women get a follow up appointment with their physician. The purpose of this visit is actually relatively new in the last few years is to earlier identify any postpartum issues and that includes high blood pressure.

If you've had high blood pressure during the pregnancy or during your hospital stay, a lot of times they'll even schedule you even sooner than that appointment so you can come in and have a check in the office and they can make sure that your blood pressure is doing okay. If at any point during or after pregnancy you start to have symptoms of preeclampsia, it's always best to notify your provider and to have an evaluation done, even if you have already delivered.

You will come into the hospital and to be evaluated in the emergency room first. They're going to do all the same blood work and tests and all that kind of thing as what we would do in labor and delivery. And then if they decide that you need to be admitted for like magnesium sulfate or any other treatment, then usually you get admitted to labor and delivery because we are the experts in taking care of preeclampsia.

And so we're the ones who are going to take care of even our postpartum delivered patients as well.

Host: And you want to be with the experts. So that's great. What resources or support systems are available to those who are dealing with preeclampsia during or after pregnancy?

Abigail Banter, BSN, RNC-OB, C-EFM: Obviously um, your OB provider is going to be your main advocate for diagnosing and treating preeclampsia. So there is always someone available in the office to talk to. Even after hours, they have an answering serviceso you can call the office number and then they can get ahold of whatever provider is on call. They also might just tell you depending on your symptoms, go into the hospital and be evaluated. And there's always someone staffed in labor and delivery as well. So we are here 24/7, 365 for questions and whatnot, as well.

As I mentioned earlier, we have that standard follow up visit after delivery so that we can be checking on patients after delivery sooner, make sure that we're keeping an eye on their blood pressure and other issues that potentially could be happening. And then as of recently over the last few months, Riverside also is participating in a program which we're able to supply patients with a blood pressure monitor for at home use during and after delivery. So basically when you're at the hospital, we have a cuff that we're able to give to you. We fill out forms that have to do with the insurance and whatnot, and the company takes care of everything with the insurance for us, which is really nice. Along with the cuff, we have education on preeclampsia, instructions on how to use it, when to take your blood pressure and a log to keep track of your blood pressures as well. So you can report them to your doctor.

There's a lot of different online resources like the Preeclampsia Foundation but make sure it's a reputable source online. Obviously, you can find some kind of interesting, sources as well. Just make sure the source that you're getting is a reputable one as well.

Host: Yeah. I mean, that kind of sounds like you've got it really covered. I mean, just a lot of support, obviously, having a team there 24 seven, if you need anything or have questions. And then also just, it sounds like all of the materials that you give and all of, I mean, that blood pressure cuff, that's really great to really help people out. Is there anything else that you can think of that you didn't add that you'd like to?

Abigail Banter, BSN, RNC-OB, C-EFM: So Riverside, of course, offers a couple different classes just in general to help prepare for childbirth and for taking care of newborn. We have a childbirth class, breastfeeding class, newborn care.

They have a support group for moms and well, families after having babies that you can be a part of as well. Again, if you have any questions or concerns or anything like that, we want you to talk to your provider and make sure that you're getting an evaluation done if you need to. We would much rather you come in and have us figure out if everything is okay or not rather than something be wrong and you not come in.

So we just always want you to, advocate for yourself and make sure that you're getting the care that you need.

Host: That is so important. So important. And it's great that all of those classes are offered too. And you can meet, some of the team there, Abby would be there and, you know, they have all the information too.

So it's not, I mean, the content there is great. And then also you know, if you just have kind of random questions, you know, that's a good way to get looped in and, get those answered for you.

Abigail Banter, BSN, RNC-OB, C-EFM: Yep. For sure.

Host: Well, great. Thanks for joining me today.

Abigail Banter, BSN, RNC-OB, C-EFM: Yeah. Thank you for having me.

Host: Of course. And thank you listeners for tuning into the Well Within Reach podcast brought to you by Riverside HealthCare.

For more information, visit RiversideHealthcare.org.