Late term/post partum preeclampsia ?

[fatherof4]

Good day everyone,
My wife carried our fourth child full term and delivered him,
all 11 lbs. 4 oz, on September 5, 2006. The last few weeks of the pregnancy, her BP was elevated slightly, and no excessive protiens in the urine. During labor, she was closely monitored by our midwife. After delivery, her BP did not settle back to her traditional 120's/80's. It remained 150ish/90's.Six days after delivery, she went back for a 1 week check up. The night before, she had been up all night with a severe headache and had noticed vision alterations. At the check up, her BP was measured and recorded as 190/160. The midwife referred us to a physician, who measured my wife an hour later at 160/90. The physician prescribed Labetalol....My wife is an avid believer in breastfeeding and after reading the prescrition insert, has chosen not to take it. (It states that Labetalol is transferred into breastmilk and can cause adverse reactions to an infant) We have been monitoring her BP at home and combatting this new ailment with rest, and calcium/magnesium supplements. Her BP is
holding steady at 135-150/80-90....She has not "officially" been diagnosed with post partum preeclampsia(we are awaiting lab work results), but after reading on this forum, it sure sounds like it to me....My question is, can this condition be expected to be a long term
problem? If not, what is an average recovery time? Preeclampsia is something I'm just learning about. What are some of the things I, as an uneducated husband, should be on the look out for?

[fiona]

Hello and welcome,

pe can occur up to 6 weeks post partum, but as there is no baby to be taken into consideration, treatment should be easily managed. I am, however very concerned that your wife has chosen to not take her meds - and from what you have said - without discussing this with her doctor. As far as I understand it, labetalol is considered compatible with breast-feeding, but if your wife is not happy with the drug, I would urge her to discuss alternatives asap. Headaches accompanied by visual disturbances are very serious as is very high BP - if she does have pp pe, unmanaged it is possible that she might develop eclampsia and have a seizure.

In the long term, high BP that continues past 6 weeks post partum is considered essential or chronic hypertension.

Please let us know how the labs go, and be sure to get your wife seen immediately if any of her symptoms worsen.

[gordon k]

Congratulations on the birth of your son

My wife's preeclampsia bouts were both post-partum (one and five weeks after childbirth).

If I were you, I would continue to watch out for your wife's blood pressure, and look out for any signs & symptoms. What to look out for can be found on our signs and symptoms page: http://www.preeclampsia.org/symptoms.asp


I am not a doctor, but post-partum preeclampsia can be diagosed up to six weeks post-partum. The pregnancy may have unmasked chronic hypertension, should she have problems with it longer than six weeks post-partum--this is something that your wife and you should discuss with a physician you trust.

My wife was on many meds (atenolol, lisinopril, lasix, and nifedipine) while breastfeeding, and the twins were and are fine. If I were you, I would discuss the pros and cons of being on labetalol during breastfeeding with a physician. Our perinatologist told us straight up that although we were told by others that the meds might not be good for breastfeeding, if my wife got so sick that she was deathly ill ~ that would not be good for breastfeeding either. Her wonderful perinatologist, and the medications he put her on, saved my wife's life.

Having a knowledgeable physician who you and your wife truly trust with not only her life, but the life of your son, is priceless.

Wishing you the best,

[angelkat]

Hi and welcome. I would speak to the doctor about your concerns. I was on Labetalol the whole time I breastfed my son. And today he is a healthy growing 2 year old.

Good luck in your decisions...

[caryn]

Welcome to the forums.

Many of us are also avid believers in breastfeeding -- my son is still nursing at the age of almost four, and I know we have a moderator who is an Internationally Board-Certified Lactation Consultant (IBCLC.)

During my first four to five months postpartum my high bp was treated with labetalol. That drug was chosen because it is considered safe for breastfeeding, despite the package insert.

Dr. Thomas Hale's _Medications and Mother's Milk_ says labetalol is safe even in preemies. Here's two links to his forum (locked so only health professionals can post) discussing the use of labetalol:

http://66.230.33.248/discus/messages/45/499.html?1106947197
http://66.230.33.248/discus/messages/45/3754.html?1128003617

(You will note that the only time they suggest to "pump and dump" is when they are concerned about the small amount of labetalol that might pass through the milk to a severely cardiac-compromised premature baby, because it might cause hypotension in the baby, and that in all the other questions labetalol is considered safe -- in fact, there is some speculation that it might increase supply at the bottom of the second link.)

There are also Pubmed citations available for this, but Pubmed appears to be hanging today... I will try to pull them up later.

PE does indicate a raised risk for future chronic hypertension; the fact that your wife has developed it in her fourth pregnancy suggests that she may have developed some sort of underlying disorder (like an autoimmune disease) that would have predisposed her to develop it in this pregnancy. Here's a link to our Experts discussing postpartum PE:

http://www.preeclampsia.org/forum/viewtopic.php?t=224

Welcome again.

[sweetiesuzy]

Congratulations on the birth of your new baby! I am concerned about your wife at this point though from what you have shared with us. I experienced preeclampsia with three of my pregnancies and went on to exclusively breastfeed two of my children and I pumped and fed for 6+ weeks with my last child. I took labatelol with all three pregnancies as well as post partum while I was breastfeeding. I have had no effects from this with any of my children. The first 6 weeks following a preeclamptic pregnancy are still very risky. You can develop high blood pressures which can lead to seizures. Caryn has posted lots of solid medical information for you which is valuable in making an educated decision. I seriously urge your wife to talk to your provider about treatment options. I would hate to hear of anything happening to her.

Congratulations again and good luck.

Hugs,

[anathor21]

Hello and welcome... Guess I'm slow to get to the forum today [:)]

Congratulations on your new baby.

Like so many others, we too experienced post partum PE. Our last pregnancy my wife held on very well throughout her last couple months with a diagnosis of mild PE. However, about a week post partum, her BP shot up, and she started having visual disturbances etc (sounds a lot like your story actually). She too was prescribed labetol, and also read the insert and became concerned about the potential breast feeding risks. After discussion with our doctors (both our OB for DW's side of things and our baby's doctor) we were far more comfortable having my wife take the medication than risk further PE complications. We did not notice any adverse effects on Isaac or any impact to her ability to sucessfully breastfeed.

Obviously each of our situations is unique. However, I do suggest that you consider carefully the risks of allowing the symptoms your wife is experiencing to untreated - remind her that the medication is not just to treat what she is experiencing, rather it is to prevent a far worse event that can occur if untreated.

"Toughing out" what she is experiencing may seem like a good idea, but may be a more dangerous course of action - often times it is hard to really appreciate the importance of the preventative side of these treatments, especially since we cannot really feel the high blood pressure.

[fatherof4]

Received word back on the lab results today. The physicians office said the blood and urine tests were "perfect". Her BP
has not improved, in fact, it was a little higher yet....She's upset with me and that I've won (since she reluctantly started taking the Labetalol), saying I'm only concerned with myself...Physician's office says we should see someone who can diagnose and treat this condition....Is it still possible to still be pp pe with "perfect" lab results?

[caryn]

Yes -- it is still possible to have elevated bp because of damage from the pregnancy, even with no proteinuria and good bloodwork. Postpartum my proteinuria resolved much more quickly than did my bp -- about four months faster. It is also possible that this pregnancy "unmasked" chronic hypertension... watchful waiting to see how her bp behaves will let you know. Mine took longer than is usual to resolve, which my care providers believe is an indicator of future problems with chronic hypertension.

Postpartum I transfered care to an internist, who monitored my bp and weaned me off the meds once bp had dropped sufficiently. A perinatologist would likely also be able to provide such care, and would likely be better placed to counsel you and your wife with respect to any possible underlying disorders which might have triggered the bp and the cerebral "events", and about any future pregnancies you might plan.

I'm glad to hear your wife is taking her medication. I understand perfectly her concern about possible effects on the baby -- but none have really been found yet as I understand things, and lasting high bp does damage the body, and seizures are just no fun at all...

[heather j]

I was mad with my husband after all of the hospital stuff (bp meds, too); I guess it helps to have someone to be mad at even if it's unfair and misdirected - you poor husbands! I believe I told my dh the same thing; in fact, after I was readmitted I blamed him and told him I didn't want him to visit me. I know...shameful and cold. But I was a different person during those days postpartum and he forgave me ;). My situation was like Caryn's; I transfered care to an internist and was weaned off meds by four months postpartum. All of my labs normalized, but I still had the high pressures. I'm glad you've convinced her, however reluctantly, to take her meds!