High-risk Pregnancy Care: When Is It Needed?

Posted by Brigham and Women's Hospital September 9, 2016

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Chelsea received specialized high-risk pregnancy care at BWH when she was diagnosed with a failing heart valve during her pregnancy with her daughter Aria.

Contributor: Louise Wilkins, Haug, MD, PhD, Division Director of Maternal-Fetal Medicine at Brigham and Women’s Hospital and a Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.

When 29-year-old Chelsea was in the second trimester of her pregnancy with her daughter Aria, she began experiencing dizziness and shortness-of-breath. An echocardiogram revealed that one of her heart valves had deteriorated.

Chelsea was referred to the Cardiovascular Disease and Pregnancy Program at Brigham and Women’s Hospital (BWH), where a team including high risk pregnancy (maternal-fetal medicine) specialists, cardiologists, and cardiac surgeons worked together to develop a specialized plan for her care. This included delivering her baby in a hybrid operating suite at BWH to enable the team to quickly respond with a range of treatments for Chelsea’s heart condition if needed during the delivery. Chelsea delivered a healthy baby girl and had successful valve replacement surgery at BWH the following week.

Who is at Risk for Pregnancy Complications?

Women with heart disease like Chelsea, are one of several groups that may benefit from high risk pregnancy care. Thesegroups include women with other pre-existing medical conditions, women who develop complications during pregnancy, women at risk for premature birth, and women of advanced maternal age (35 years of age or older). Maternal-fetal medicine specialists provide individualized care before, during, and after pregnancy for women who are considered high risk.

“Our goal is to ensure a healthy pregnancy and safe delivery for each mother and baby through careful planning, medical expertise, and team-based care,” said Dr. Wilkins-Haug.

Consultation and planning before pregnancy (pre-conception planning) is very important for women with pre-existing medical conditions, such as diabetes, heart disease, lupus, and psychiatric illnesses. High-risk pregnancy specialists often work closely with other specialists (such as cardiologists, rheumatologists, gastroenterologists, and psychiatrists) to make adjustments to a woman’s medications prior to and during pregnancy. They also recommend key nutritional supplementation and lifestyle changes to help reduce risks during pregnancy.

During high-risk pregnancy, there may be concerns about how the baby is developing. In addition to closely monitoring the mother’s condition, high-risk pregnancy specialists track the baby’s development and may provide treatment to support the baby’s developing systems. In some cases, they may be able to correct certain conditions before the baby is born.

How Pregnancy Complications Affect Long-term Health

Conditions that develop during pregnancy also can place the mother at long-term risk for health complications. Up to 60 percent of women who have gestational diabetes end up with Type 2 diabetes, and women who experience preeclampsia (a condition characterized by high blood pressure) have a higher risk of developing cardiovascular disease throughout their lifetime. High-risk pregnancy specialists help women after delivery and work with their primary care physicians with the goal of improving their health for many years after pregnancy.

Learn more about high-risk pregnancy care in this video with Dr. Wilkins-Haug.

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-Jessica F.

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Preventing Preterm Birth

Posted by Brigham and Women's Hospital August 18, 2016

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Medical and surgical treatment approaches can help prevent or delay preterm birth.

Contributor: Thomas McElrath, MD, PhD, Director of the Preterm Birth Clinic in the Division of Maternal-Fetal Medicine at Brigham and Women’s Hospital (BWH) and Associate Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.

There are a number of effective treatment approaches that can help prevent or delay preterm birth depending on a mother’s condition.

“Medications and, in some cases, surgery can be used to minimize risks associated with preterm delivery,” says Dr. McElrath.

One in nine babies in the United States is born prematurely (before 37 weeks of pregnancy). These babies have a higher risk of short- and long-term complications, and the risk increases the earlier the delivery.

To provide additional support to the cervix and help prevent preterm labor, specialists sometimes use a soft flexible ring (pessary) or a stitch (cerclage) at the cervical opening. Other approaches include the use of progesterone, a hormone, to prolong pregnancy.

In addition to a history of preterm delivery, other risk factors for preterm birth include prior cervical surgery, reproductive tract or uterine anomalies, multiple gestation pregnancy (twins, triplets, or more), low or high maternal age, and high blood pressure.

“Preconception planning and specialized care are key for women at high risk for preterm birth,” says Dr. McElrath. “A multidisciplinary team dedicated to evaluating, treating, and monitoring these patients will be able to ensure the best possible outcomes for babies and their families.”

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-Jessica F.

 

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Hybrid Operating Room – Not Your Typical Delivery Room

Posted by Brigham and Women's Hospital August 11, 2015

Chelsea Phaneuf and her family.

It’s not every day that a baby is born in the Brigham and Women’s Hospital (BWH) cardiovascular hybrid operating room (OR), but that’s where a multidisciplinary cardiovascular and obstetrics team was at the ready as 29-year-old Chelsea Phaneuf delivered her daughter, Aria, this spring. Chelsea had been admitted to the Shapiro Cardiovascular Center with a failing heart valve about a month before Aria’s arrival.

At the age of 23, an echocardiogram showed that Chelsea’s bicuspid valve had suddenly deteriorated and needed to be replaced. At such a young age, Chelsea was concerned about how the surgery would impact planning for a future family. The daily blood-thinning medication required for patients who undergo a valve replacement with a mechanical device is a risk to a developing fetus. Chelsea, therefore, opted for a biological valve, even though they don’t last as long as a mechanical valve.

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Preeclampsia: Pregnancy Complication Raises Heart Disease Risk

Posted by Brigham and Women's Hospital February 14, 2013

Preeclampsia in expectant mothers leads to high blood pressure.

Today’s post is written by Dr. Ellen Seely, Director of Clinical Research, Endocrinology, Diabetes and Hypertension Division at Brigham and Women’s Hospital (BWH).

Recently, the serious nature of preeclampsia, a complication of pregnancy, was highlighted on the popular TV series, Downton Abbey. During an episode that aired in January 2013, Lady Sybil Crawley suffered complications from the condition before delivery and after giving birth. In expectant mothers, preeclampsia results in high blood pressure and increased levels of protein in the urine. In some severe cases, preeclampsia can lead to eclampsia (seizures) and an increased risk of death.

Doctors have known about eclampsia for many centuries though its direct causes are unknown. The only cure for a mother-to-be remains delivery of her baby. In some serious cases, an early delivery, at times requiring Cesarean section, may be recommended, despite the health risks of a premature birth for the baby.

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