Most maternal cardiovascular deaths are preventable, and over half of them occur after pregnancy. But postpartum care has tended to be underemphasized, and at least 40% of patients don’t attend any postpartum care appointments, said Kathryn Lindley, MD, Director of the Vanderbilt Health Women’s Heart Center.
That’s why the American College of Cardiology recently published its first guidance document specifically on postpartum care for women with cardiovascular disease, to offer specific recommendations for postpartum care and save lives, said Lindley, the chair of the authoring committee for the document.
“This is the first cardiovascular society guidance that has been published on postpartum care for women with cardiovascular disease and is a major step forward in evidence-based care to reduce cardiovascular morbidity and mortality in pregnant women,” said Lindley, who holds the Samuel S. Riven, MD, Directorship in Cardiology. “This is an immense opportunity for us to standardize and streamline care for high-risk cardiovascular patients.”
The document, published in the Journal of the American College of Cardiology, is also endorsed by the American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine and American College of Nurse Midwives.
Highlights of the new guidance include:
- Improving inpatient postpartum care. Reviews of maternal death cases reveal inadequate coordination of care during hospital stays after delivery and failure to recognize high-risk patients and transition them to outpatient follow-up appointments. The guidance makes clear recommendations, including screening and treating cardiovascular symptoms, Lindley said.
- Ensuring trauma-informed care. The new guidance places more emphasis on improving postpartum mental health, including screening for depression and anxiety before patients leave the hospital.
- Promoting lactation care. Emphasizing breastfeeding as a positive option and connecting women with lactation-safe cardiovascular medications is another recommendation.
- Focusing on contraception care. Linking high-risk patients to safe and effective contraceptive methods before hospital discharge can save lives.
Lindley noted that many postpartum patients don’t have a primary care provider or haven’t seen one in some time. The new document recommends transitioning postpartum patients to a primary care provider in the first year after delivery and providing the primary care provider with information about the pregnancy and postpartum course and cardiovascular risk.
To improve adherence to postpartum follow-up appointments, the document recommends better identifying the social barriers each individual patient has, such as lack of paid maternity leave. Does their work prevent them from going to appointments? Do they lack a vehicle or live a long distance from their care providers?
“I think step No. 1 for each patient is identifying those barriers and ensuring we are specifically addressing them,” Lindley said.
A secondary step, she said, is to bring care to the patient by setting them up with remote monitoring, such as remote blood pressure monitoring, and then meeting through telehealth, which has been shown to increase participation in postpartum care. Blood draws for labs could be done at a local facility and sent to providers, rather than requiring long drives to certain providers.
“We aim to ensure longitudinal health care optimization to both prevent complications in subsequent pregnancies as well as to prevent long-term premature cardiovascular disease,” Lindley said.
