Page 193 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

Recommendations for current practice
Discussion| 191
Gynecologist and midwife:
1. At the 6-weeks postpartum check-up after preeclampsia measure blood pressure and proteinuria. If still present, inform the primary health care physician by writing to take over follow-up. Advice to refer to a nephrologist if proteinuria is still present after 2 years or progresses. Advice for an extensive cardiometabolic screening if hypertension is still present after 2 years.
2. At the 6-weeks postpartum check-up after cardiometabolic complicated pregnancy, inform the woman about their increased future risk and the beneficial effect of a healthy lifestyle. Refer to primary health care physician (by writing) for lifestyle intervention.
3. Emphasis the need for a pre-conception consultation in case the woman wants to become pregnant again in the future. During pre-conception consultation focus on lifestyle and modifiable and treatable cardiometabolic risk factors. If applicable, counsel the woman that she will benefit from a healthier lifestyle.
Primary health care physician:
4. During follow-up after preeclampsia refer to a nephrologist if proteinuria is still present and perform an extensive cardiometabolic screening if hypertension is still present after 2 years.
5. Counsel a woman after cardiometabolic complicated pregnancy that she will benefit from a healthier lifestyle. If she wants to, refer her to a lifestyle coach/counsellor. The latter especially if she has risk factors for post-traumatic stress, like younger age, severe preeclampsia, cesarean section, fetal death, extreme prematurity and NICU- admission.
6. If a woman expresses the wish for a new pregnancy, refer her to a gynecologist for a pre-conception consultation.
Gynecologist, midwife and primary health care physician:
7. Write a local protocol describing (the organization of) follow-up, cardiometabolic screening and lifestyle intervention after complicated pregnancies.