By: Gina Edwards

Shermeise Caldwell works out regularly, drinks plenty of water, and takes care of herself. So, how did she end up in the ICU after giving birth?

Hypertension, or high blood pressure, affects one in 12 new mothers. Yet, it can go unrecognized during pregnancy and even months postpartum. High blood pressure that exceeds 140 mmHg over 90 mmHg may not have symptoms but leads to cardiovascular disease, which is the leading cause of death in women.

The UPMC Postpartum Hypertension Program at UPMC Magee-Womens Hospital has forged a unique collaboration aimed at helping new and soon-to-be parents like Shermeise stay heart-healthy.

Shermeise’s Birth Story

On December 15, 2022, Shermeise came to UPMC Magee for the scheduled inducement of her twin boys. After many hours passed without her water breaking, her doctors recommended expediting the process by performing a cesarean section (C-section). But then Shermeise began to lose blood, and fast.

Shermeise was connected to a device called the Jada System to control and treat the bleeding. But a few minutes later, when the clear container next to her filled up rapidly with blood, she knew that things had turned serious. She soon found herself rushed to an emergency hysterectomy.

Shermeise panicked, but the voices of her children on the phone, as she was wheeled to surgery, helped her gather the strength to confront what lay ahead.

“I just thought, ‘I have to push through this,’” she says.

Though the surgery controlled the bleeding, Shermeise’s high blood pressure kept her in the ICU for four days. She then stayed an additional five days because of a blood clot found in her lung. Even when she finally was discharged, Shermeise faced blinding headaches so severe that she could not breastfeed ... and ended up back at the hospital again.

Postpartum Hypertension Program at UPMC Magee

Following the birth of her twins, Shermeise joined the UPMC Postpartum Hypertension Program, part of the larger Magee-Womens Heart Program under the direction of Katie Berlacher, MD. The Magee-Womens Heart Program helps women manage hypertension throughout pregnancy and during delivery, while the Postpartum Hypertension Program focuses on managing hypertension after women give birth.

Their unique model, which combines specialties in cardiology and maternal fetal medicine to support patients in cardiovascular health, is creating a new standard of care for the cardio-obstetric population. The Postpartum Hypertension Program is aimed at helping patients recognize the possible warning signs of peripartum and postpartum hypertension, reduce the risk of chronic hypertension in the future, and discuss lifestyle changes to reduce the risk of heart disease. Patients can also use the space to discuss other topics like breastfeeding or C-section-related issues, placental pathology reports, and additional testing, if needed, for things like high cholesterol and diabetes.

The Postpartum Hypertension Program’s co-founders and co-directors are Alisse Hauspurg, MD, and Malamo Countouris, MD. Dr. Countouris is a general cardiologist and clinical researcher mentored by Magee-Womens Research Institute’s Janet Catov, PhD. She says that the Postpartum Hypertension Program’s care model is based on the understanding that there is a great deal of trauma related to hypertensive pregnancies and deliveries. Meeting with multiple providers gives patients the opportunity to have follow-up questions answered and receive support as they continue to monitor their blood pressure post-delivery.

“It’s a very busy time for new moms, but also a time when people are motivated to be healthier for their kids,” Dr. Countouris explains. “It’s a sweet spot for seeing people.”

Virtual visits and remote monitoring have also opened new avenues to see and counsel patients. In collaboration with physician-scientist Hyagriv Simhan, MD, patients can opt to participate in remote monitoring for up to a year postpartum. Participants record and report their blood pressure twice a week, which is automatically shared with the care team at UPMC Magee. The reports generated in a patient’s electronic medical record allow for better care coordination with other providers.

“We have a beautiful clinical collaboration with maternal fetal medicine, where we meet once a month and we talk about our highest-risk pregnant patients,” Dr. Countouris says. “We see the highest-risk patients from across the tri-state area, and we manage them very successfully throughout pregnancy. That’s a tribute to our very strong, multidisciplinary clinical collaboration.”

Closing Gaps in Cardio-Obstetric Care

While there is a general understanding that high blood pressure in pregnancy can lead to hypertension long term, the connection between high blood pressure in pregnancy and cardiovascular disease is less understood — in part, due to the recency of research.

“It wasn’t until 15 or 20 years ago that we started even recognizing pregnancy conditions as a risk factor for heart disease,” Dr. Countouris explains. “So, a lot of providers don’t know and aren’t talking about it.”

The Postpartum Hypertension Program focuses on a critical time in a new mother’s life: the fourth trimester — an opportunity to bridge care from the typical obstetric to longitudinal care providers, be it in cardiology or primary care. It is one of a handful of programs in the country aimed at supporting patients during this time.

“We often talk with our patients about prevention of cardiovascular disease and ways to reduce cardiovascular risk. I think one of the things that has been understudied is how adverse pregnancy outcomes, like preeclampsia and gestational hypertension, impact future cardiovascular health and how we should best manage patients after delivery and down the line when they might be at risk to develop clinical cardiovascular disease,” says Dr. Countouris.

Thanks to a grant from the American College of Cardiology, Dr. Countouris and her team are working on a toolkit for implementing a postpartum hypertension clinic and remote monitoring program so that others can scale the model in their care systems. The Postpartum Hypertension Program is also expanding its work by adding more clinic days each month. There are about 1,000 pre-eclamptic deliveries at UPMC Magee each year, with the Postpartum Hypertension Program currently seeing a percentage of higher-risk patients.

The team aims to do more preconception planning with patients who have risk factors but would like to get pregnant in the future. “It’s really during that preconception visit that we try and tell patients what their risk is of going into pregnancy, which has been increasingly informed by data,” explains Agnes Koczo, MD, cardiologist at the UPMC Magee-Womens Heart Program. “We can really help optimize patients, whether it’s blood pressure control or whether it’s optimizing their BMI to get them through their pregnancy.”

For patients like Shermeise, the Postpartum Hypertension Program has served as a support system and motivating force during a particularly stressful time. Driven by her desire to stay present for her children, including her twin boys who are healthy and thriving, Shermeise is continuing to do everything she can to manage her blood pressure — even through life’s challenges.

“The world can make you distracted from the things that really matter, like your health,” Shermeise says. “But in hindsight, money will be there, your home will be there, your car will be there... but you won’t be there if you don’t take care of yourself.”

Patients who are now experiencing or had high blood pressure in pregnancy, were diagnosed with gestational hypertension or preeclampsia, recently delivered a baby, or have chronic high blood pressure and want to become pregnant are eligible for the program.

For more information, visit the UPMC Postpartum Hypertension Program’s website.

Read the full Winter 2024 MAGEE Magazine issue here.