Northside Hospital: Bridging the Gap Between Maternal and Cardiac Care

Preeclampsia poses an immediate and all-too-common threat to pregnancy, but it is also associated with later-life cardiovascular (CV) disease in the women it affects.

Northside Hospital will introduce a preeclampsia clinic this fall to educate women about their risk factors and screen them to detect the early development of CV disease before it progresses. The clinic will augment Northside Hospital’s ongoing expert care for patients with preeclampsia.

Plans for the clinic involve a multidisciplinary team. Cardiologists, nurse practitioners, exercise physiologists and nutritionists will work closely with perinatologists and obstetricians to treat preeclampsia during pregnancy and provide follow-up care and management after patients deliver.

“When an expectant mother develops high blood pressure or other symptoms related to preeclampsia, the focus is on the safety of the mother,” says Lee B. Padove, MD, FACC, board-certified cardiologist at Northside Hospital. “But that doesn’t address future risks associated with preeclamptic pregnancies. That’s why treatment for this condition should be conducted in two phases.”

Phase One

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In 2013, the American College of Obstetricians and Gynecologists published Hypertension in Pregnancy, a comprehensive overhaul of treatment guidelines and definitions associated with hypertensive disorders that can arise during pregnancy.

Among the changes it suggests is a shift in preeclamptic diagnostic criteria. The new guidelines eliminate the “mild” designation of preeclampsia and eschew diagnostic dependence on proteinuria. Diagnosis can be made in the absence of proteinuria when hypertension is associated with thrombocytopenia, impaired liver function, or development of renal insufficiency, pulmonary edema, or cerebral or vision problems.

“In the past, preeclampsia was classified as mild or severe, and the care was straightforward and standardized — if severe, you deliver the baby immediately; if mild, you try to hold delivery off until 37 weeks,” explains Larry Matsumoto, MD, Sitting Chair of the Department of Obstetrics and Gynecology at Northside Hospital. “It was almost like an individualized flowchart of care. But you have to exercise caution because any form of preeclampsia can progress quickly.”

The formal designations are now preeclampsia and severe preeclampsia — part of an evolving understanding of the threat the disease poses to mothers. The Preeclampsia Foundation estimates that the disease can affect as many as one in 12 pregnancies and is responsible for 18 percent of all maternal deaths.

“Women who have had preeclampsia need more aggressive screening for heart disease and better education for lifestyle modifications that can reduce their risk of developing cardiovascular complications. Our clinic will provide evaluation and follow-up for patients in their 30s and 40s — important measures not often taken to prevent heart disease.”
— Lee B. Padove, MD, FACC, cardiologist at Northside Hospital

Specialists at Northside Hospital have the expertise to accurately diagnose this nuanced disorder.

“The challenge is detection,” Dr. Matsumoto says. “Providers unfamiliar with preeclampsia may let some complaints slide without doing a thorough evaluation, which should consist of blood pressure readings and lab tests — to ensure liver, kidney and platelet counts are in the correct range — as well as urine analysis. These tests should be conducted immediately to detect preeclampsia because the longer a patient has the condition, the worse it gets.”

Dr. Matsumoto recommends prompt referral of any expectant mother who develops gestational hypertension, elevated blood pressure or elevated urine protein levels.

Phase Two

Although the only definitive cure for preeclampsia is delivery, effects of the disorder can linger long after childbirth. Following a preeclamptic pregnancy, women are at nearly double the risk for heart disease or stroke in the subsequent five to 15 years, according to the Preeclampsia Foundation. For certain subgroups, the risk is even greater.

“Patients who develop eclampsia, preeclampsia early in pregnancy — before 34 weeks — or severe preeclampsia, in which they had heart failure and required support, need more active surveillance than looking for protein in urine,” Dr. Padove explains. “These are the patients who are at a sevenfold increased risk for heart disease later in life. Our clinic can help them through education about lifestyle adjustments and aggressive monitoring for future risks. We also initiate earlier screening when women are in their 40s.”

“Often, new mothers focus on caring for their children instead of themselves. Northside Hospital’s preeclampsia clinic will shift the emphasis back on the mother taking better care of herself so she will be there to take care of her family in the long term.”
— Jaimie Chausmer, FNP–C, nurse practitioner at Northside Hospital

Northside Hospital’s multidisciplinary approach to preeclampsia management makes Northside a critical partner for providers who may want specialized assistance in addressing preeclamptic pregnancies, as well as for physicians who would benefit from having a dedicated team provide long-term follow-up care for this patient population.

“We’re looking to collaborate with community physicians to ensure the best outcomes possible and prevent irreversible damage,” Dr. Matsumoto says. “The expertise in our clinic allows referring physicians to use us as a resource and obtain a second opinion in the care and management of their patients.”

The clinic will also empower women to take ownership of their health, says Jaimie Chausmer, FNP–C, nurse practitioner at Northside Hospital.

“Not all women are familiar with preeclampsia, yet it’s a huge concern,” Chausmer notes. “I have a child and also had preeclampsia, so it is great for me to be able to educate women and help them understand what they need to do to live long lives so they can be there for their children. That’s what the clinic is all about.”

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According to the clinic’s operational blueprint, Chausmer — under the supervision of Dr. Padove and Kimberly Champney, MD, FACC, MSCR, cardiologist at Northside Hospital — will conduct office visits, oversee nutritional and exercise consultation, and evaluate the need for more aggressive risk prevention. Drs. Padove and Champney will follow up with patients and individualize CV disease prevention plans.

Exercise physiologists, dietitians and nutritionists will all contribute to educating patients about lifestyle modifications, including how to exercise appropriately and how to implement a low-sodium diet.

Above all, the aim of the preeclampsia clinic is not only to take care of patients during pregnancy, but also to provide them with comprehensive cardiovascular care for the rest of their lives. Equipped with the right knowledge of this disorder in its early stages, our patients can lead healthy and productive lives.

For more information or to refer a patient, call 404-303-3320.

Source: MD News June 2014, Metro Atlanta Edition



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