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CardioNerds (Amit Goyal), Dr. Natalie Stokes (Cardiology Fellow at UPMC and Co-Chair of the Cardionerds Cardio-Ob series), and episode lead Dr. Priya Freaney (Northwestern University cardiology fellow) discuss \u201cThe Fourth Trimester\u201d with Dr. Malamo Countouris and Dr. Alisse Hauspurg, from the University of Pittsburgh Departments of Cardiology and Obstetrics and Gynecology, respectively. We discuss the cardiovascular considerations after adverse pregnancy outcomes in the postpartum and long-term follow-up periods. The discussion is focused mainly on hypertensive disorders of pregnancy (HDP), guided by a series of clinical vignettes. We cover a wide range of topics from cardiovascular complications and management considerations in the immediate postpartum period after a HDP, postpartum outpatient follow-up, long term cardiovascular morbidity related to HDP and related preventive strategies, contraceptive considerations for the cardiologist, and interdisciplinary care management pearls for cardiologists working in a cardio-obstetrics team.\n\n\n\nNotes \u2022 References \u2022 Guest Profiles \u2022 Production Team\n\n\n\n\n\n\n\n\n\n\n\nCardioNerds Cardio-Obstetrics Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll\n\n\n\n\n\nCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!\n\n\n\n\n\n\n\n\n\nPearls - The Fourth Trimester\n\n\n\nBlood pressures >160/110 should be treated like a true emergency during pregnancy and the postpartum period, as the cerebrovascular circulation is more sensitive to hypertension, due to hormonal changes related to pregnancy.Women with pre-eclampsia are at higher risk for peripartum cardiomyopathy. Have a low threshold to do a clinical heart failure evaluation (i.e., natriuretic peptides, echocardiogram), and administer diuretics as appropriate to improve volume status and blood pressure.Women with HDP should have their blood pressures monitored closely after discharge, ideally with a home BP monitoring program, as they can have exacerbations of their HTN for up to 2 weeks postpartum.The American Rescue Plan Act of 2021 included a landmark policy to extend postpartum Medicaid coverage up to a year postpartum (from 60 days).Remember to take a reproductive history for every woman you see in cardiology clinic! This can be done in one minute. At a minimum, include obstetric history [number of pregnancies, outcome of each pregnancy, gestational age and weight at delivery, pregnancy complications (HDP, GDM, etc), and delivery method] and menopausal history (age at menarche, age at menopause).The Pooled Cohort Equations may underestimate ASCVD risk for a woman who has had pregnancy complications or premature menopause \u2013 consider obtaining a CAC score to aid in risk-stratification in middle-aged women who may have underestimated risk.Low dose aspirin during pregnancy in women who have risk factors for pre-eclampsia reduces the risk of development of HDP by 15-20%.\n\n\n\nQuotables - The Fourth Trimester\n\n\n\n\u201cSome of our traditional approaches to caring for women in the postpartum period just aren\u2019t realistic\u2026we need to think about how we can improve care from a policy standpoint to ensure women have access to care and think about how we deliver care.\u201d \u2013 Dr. Alisse Hauspurg\n\n\n\n\u201cSilos are never good. Cardio-obstetrics is a space where you really want to have open communications, be truly collaborative \u2013 taking into consideration the expertise of multiple disciplines\u2026because it\u2019s really hard to do it alone.\u201d \u2013 Dr. Malamo Countouris\n\n\n\nShow notes - The Fourth Trimester\n\n\n\nFor more on hypertensive disorders of pregnancy enjoy:\n\n\n\nEpisode #128: Cardio-Obstetrics: Hypertensive Disorders of Pregnancy with Dr. Jennifer LeweyEpisode #66: Case Report: Severe Pre-eclampsia & Cardio-Obstetrics \u2013 UPMC\n\n\n\nHypertensive Disorders of Pregnancy\n\n\n\n1.\xa0\xa0\xa0\xa0 What are some of the immediate postpartum cardiovascular risks and complications following a hypertensive disorder of pregnancy (H...