Regular feedings? Check. Diaper bag loaded? Check. On time for the pediatric appointment? Check. Your own postpartum obstetrics checkup? Not so much.
“About 50% of new moms skip their first postpartum visit,” said Farah Amro, MD, a maternal-fetal medicine fellow at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). “There are many barriers and factors behind this trend, including access to transportation and adjusting to dealing with a newborn baby. However, no matter the circumstances, most new mothers find a way to take their newborns to their pediatric checkups. I wanted to capitalize on that chance to check on mom’s health, too, and hopefully help decrease maternal mortality and morbidity in Texas.”
Amro worked with her mentors to come up with a quality improvement project at UT Physicians, the clinical practice of McGovern Medical School at UTHealth. Through the project, new mothers are screened for preeclampsia at their newborn’s pediatric appointments, since half of women are no-shows to their postpartum checkups.
New numbers from the Centers for Disease Control and Prevention show about 60% of pregnancy-related deaths in the U.S. are preventable, and 33% of those deaths happen between a week and a year after birth. While preeclampsia, a life-threatening hypertensive disorder, is known as a condition that happens during pregnancy, it can also develop after delivery.
“The no. 1 reason we see mothers being readmitted to the hospital after birth is preeclampsia, and normally they are readmitted within a week of giving birth,” said Clara Ward, MD, assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Services at McGovern Medical School. “This new process gives us a huge opportunity to leverage the resources we have here at our medical school to decrease pregnancy-related deaths that are related to hypertension.”
“Moms who deliver via cesarean section have their first postpartum appointment at two weeks after birth, and moms with vaginal deliveries are seen at six weeks. So, having various checkpoints at the pediatric visits helps us to evaluate women sooner and more frequently, which is lifesaving for women in some cases,” Amro said.
It is not uncommon for hypertensive disorders to be asymptomatic, but other times there may be subtle signs that women can mistakenly blame on loss of sleep or adjusting to caring for a newborn.
“Signs of high blood pressure can include headaches that aren’t relieved by over-the-counter medications, dark spots in vision, pain in the upper right quadrant of the abdomen, and/or shortness of breath. Women who have just given birth should look out for these symptoms, as they could be indicators of hypertensive diseases of pregnancy,” Amro said.
Baha Sibai, MD, professor in the Department of Obstetrics, Gynecology, and Reproductive Services and international expert in the field of preeclampsia, oversees the collaboration with the Department of Pediatrics. Kimberly Smith, MD, MPH, professor in the Department of Pediatrics, has been instrumental in facilitating the project.
“Everybody on my team is very excited about it and feels like it’s a great opportunity to improve care for mothers,” Smith said. “Mom’s health directly affects the baby’s health, so we’re thrilled to make sure our mothers are getting the care they need.”