Preeclampsia, in all of its forms, can mean a lot of testing, both during and after pregnancy. Have you ever wondered why your healthcare provider is running so many tests? Or what those tests mean? This guide explains what tests may be done during and after pregnancy, when, and why.
Preeclampsia symptoms can also appear for the first time after delivery, sometimes even without having symptoms before the birth of your baby. You should tell your provider if you experience any symptoms such as a severe headache, visual changes, stomach pain, difficulty breathing or chest pain, or nausea. A medically complicated delivery may also require you to stay in the hospital for at least two or three days longer than normal, until the symptoms begin to go away and other indicators are trending toward normal (even if they aren’t normal yet).
Blood pressure changes can vary. In some patients, blood pressure may drop quickly, or be highest about three to six days after delivery, or take a few weeks to become normal. The American College of Obstetricians and Gynecologists recommends that your blood pressure be checked three days and then 10 days after delivery – this can be done at home or in the hospital or healthcare provider's office. If your blood pressure is high three months after delivery, you should see a doctor who provides regular care for women who develop chronic hypertension (e.g., an internist, a maternal-fetal medicine subspecialist, or an OB/GYN specialist).
Many women choose to take their own blood pressure at home with a personal cuff, and to record the numbers in a chart for their providers to see. If you do this be sure to record the date and time of each reading. Remember, preeclampsia can appear up to six weeks after delivery even if you haven’t had symptoms during your pregnancy.
After pregnancy, you and your provider may decide to pursue additional tests to uncover underlying conditions that may have contributed to you developing preeclampsia.
Some women show symptoms of autoimmune conditions after delivery, where the woman's immune system responds to her own healthy cells as if they are threats. If you develop chronic symptoms like fever, tiredness, headache, swelling, aches, clammy skin, rashes, abrupt weight gain or loss, or if you develop a blood clot, follow up with your doctor and mention that your pregnancy history might be related to your symptoms. However, you can have these symptoms and a history of preeclampsia, and not have any autoimmune conditions.
If you develop autoimmune thyroid problems, they need to be treated. If you have symptoms such as a racing pulse or anxiety, your provider can run a thyroid panel blood test and analyze your numbers. Thyroid-stimulating hormone (also known as TSH) is a pituitary hormone that stimulates the thyroid gland to produce thyroxine (T4), and then triiodothyronine (T3) that stimulates the metabolism of almost every tissue in the body. After an evaluation of your symptoms, TSH levels, T3 and T4 balance, and presence of thyroid antibodies, you may need treatment.
Women with antiphospholipid antibodies, including women with lupus, are more likely to have recurrent pregnancy loss, develop blood clots when they’re not pregnant, and experience pregnancy complications such as preeclampsia. If your pregnancy history includes multiple miscarriages, miscarriages after 12 weeks of pregnancy, or preeclampsia before 34 weeks, you may be evaluated for lupus anticoagulant, anticardiolipin antibodies, and beta 2 glycoprotein antibodies. You may be given blood thinners in any future pregnancies to lower your risk of developing a clot.
Blood clotting disorders
Women who have developed blood clots in their legs or lungs, and who have a history of preeclampsia, may be tested for hereditary blood clotting conditions like Factor V Leiden, PAI 4G/4G, or the MTHFR polymorphisms. Doctors vary in how they choose to treat women who test positive for any of these.
Your kidneys after preeclampsia will almost always take some time to heal, but they should go back to normal after delivery. Some women, especially those rare few who needed dialysis after delivery, may need several more tests to make sure their kidneys have healed. Kidney function is generally assessed by serum creatinine. Your creatinine levels might sometimes resolve, but not your proteinuria count. Your provider should check your kidney function until it returns to normal and your protein levels resolve. If your creatinine and proteinuria levels do not return to normal by six months, or if it gets worse, you should be seen by a kidney specialist (a nephrologist).
Women who have had preeclampsia in pregnancy may be at higher risk of heart disease, stroke, diabetes, renal failure, clot formation, and chronic high blood pressure later in life. Talk to your doctor every year at your well-woman visit about your preeclampsia risk factor. Annual monitoring of your weight, blood pressure, blood sugar, and cholesterol is an important way to stay healthy.
The American Heart Association includes preeclampsia on its list of risk factors for heart disease and stroke. Evaluation for risk of later-life cardiovascular disease requires consideration by the provider and patient. The American College of Obstetricians and Gynecologists advises that women with a history of preeclampsia (who gave birth before 37 weeks of gestation) or who have a history of recurrent preeclampsia get a yearly assessment of blood pressure, lipids, fasting blood glucose, and body mass index.
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