What is the difference between severe and mild pre-e?

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Expand view Topic review: What is the difference between severe and mild pre-e?

Re: What is the difference between severe and mild pre-e?

Post by caryn » Sat Jul 23, 2011 03:23 am

I think that Laura and Catherine both told me that 160/100 was what the Experts had told them to use. :lol:

Re: What is the difference between severe and mild pre-e?

Post by blythe » Thu Jul 21, 2011 10:54 am

The research and practice definitions are very specific and consistent -
http://mail.ny.acog.org/website/SMIPodc ... sisMgt.pdf - full text of the American College of Obstetricians and Gynecologists Practice Bulletin - Diagnosis and Management of Preeclampsia and Eclampsia
http://www.aafp.org/afp/2004/1215/p2317.html - full text of American Academy of Family Physicians Diagnosis and Management of Preeclampsia
http://emedicine.medscape.com/article/1476919-overview - emedicine summary article
http://www.acog.org/acog_districts/.../ ... gnancy.ppt - a very nice power point from ACOG (may have to google ACOG preeclampsia for the correct link, it shows up third in my search)

They all define "mild" as
"Blood pressure of 140 mm Hg systolic or higher or 90 mm Hg diastolic or higher that occurs after 20 weeks of gestation in a woman with previously normal blood pressure
Proteinuria, defined as urinary excretion of 0.3 g protein or higher in a 24-hour urine specimen


and "severe" as
Preeclampsia is considered severe if one or more of the following criteria is present:
• Blood pressure of 160 mm Hg systolic or higher or 110 mm Hg diastolic or higher on two occasions at least 6 hours apart on bed rest
• Proteinuria of 5 g or higher in a 24-hour urine specimen or 3+ or greater on two random urine samples collected at least 4 hours apart
• Oliguria of less than 500 mL in 24 hours • Cerebral or visual disturbances • Pulmonary edema or cyanosis • Epigastric or right upper-quadrant pain
• Impaired liver function • Thrombocytopenia • Fetal growth restriction


I do wonder if one of the criteria for "severe" is changing - some of the references don't include "on bed rest" for the bp criteria - just "two readings at least six hours apart" (and note that *either* 160 *or* 110 and you meet the "severe" criteria - you don't need both), and I've seen many research articles about preeclampsia reference this study:
http://www.ncbi.nlm.nih.gov/pubmed/15684147
Women with preeclampsia had strokes at bps lower than they expected - 155-160 systolic, and less than 105 diastolic.

and this article -the second author is one of the top Experts in preeclampsia research - references that same study and says
Our practice is to initiate treatment when BP is ≥150 systolic and 90 to 100 mm Hg diastolic.

I think Caryn has absorbed those numbers because she's been saying 160/100 (instead of 160/110) for "severe" for forever :-D.

So Libby, if it helps, you meet the criteria for "severe". I see what you mean by you having a higher baseline than other women, but the criteria don't take baseline into account. That might be a question for the experts as to why a higher baseline doesn't matter, feel free to submit that as a question and it might catch their eye.

I am a bit baffled by those of you who were told "before 32 weeks" automatically equals severe - maybe that's part of hospital management for your particular hospitals? I've never seen that distinction for severe vs mild in any of the research I've read, and we've had posters meet the bp and proteinuria criteria very early (20-24 weeks) yet *stay* mild and induced at 37 weeks. One poster even went against medical advice and insisted on waiting until 38 weeks because she was so stable. I have seen "before 32 weeks" as a cutoff for determining recurrence rates in subsequent pregnancies, maybe that's why they referenced 32 weeks?

Re: What is the difference between severe and mild pre-e?

Post by caryn » Thu Jul 21, 2011 10:30 am

It doesn't really matter - because all that matters with respect to these classifications is that someone with one reading over 160/100 will be classed into the "severe" group for the purposes of data management. People can have severe PE and really excellent outcomes, considering, or technically mild PE right up until everyone dies.

So really "severe" and "mild" don't map well at all to a lot of the measures we're really more interested in here. All of our posters want good outcomes regardless of how the data will be sliced and diced in the research papers!

Re: What is the difference between severe and mild pre-e?

Post by flori » Wed Jul 20, 2011 10:31 am

Christa, my peri told me that my IUGR (which included absent diastolic flow), protein, and earlier high bp readings classified me as severe. I questioned him about the whole diagnosis at my postpartum appt because I did not have swelling/weight gain, neurological problems, or high bp at delivery. It's funny what you choose to remember and conveniently forget.

Re: What is the difference between severe and mild pre-e?

Post by cmccaffrey » Wed Jul 20, 2011 04:52 am

My doctors considered me to be severe because it was developed prior 32 weeks(starting showing signs at 24 weeks), I had readings higher than 160/100 (went as high as 175/125), extreme swelling (11lbs in 5 days), but I dod not have excess protein in urine, neurological problems or organ failure. Doe's IUGR and placental blood flow play any part in the diagnosis or is that a whole different mess of problems?

Re: What is the difference between severe and mild pre-e?

Post by libby123 » Wed Jul 20, 2011 04:43 am

Hmmm...well my blood pressure pre pregnancy is in the 130s/80s, that is just what I run, so having an average BP of 150/90 isn't really THAT big a deal for me, and I only had 400 mg of protein in the urine, I also had no neurological symptoms or any other symptoms of organ failure, no upper gastic pain, no blood problems (they were constantly testing my blood).

So I guess I still see myself as mild, even though I had the severe blood pressure? Because someone who normally runs 90/60 is totally different from someone who runs 130/80 normally...if I had a blood pressure of 90/60 I would probably faint...

Re: What is the difference between severe and mild pre-e?

Post by caryn » Tue Jul 19, 2011 11:43 am

These are research definitions only. Since you don't have a record of a proteinuria count pre-seizure, no one would include your data in a preeclampsia data set! But you were definitely a severe case for your docs to manage. One of our Experts always says "We treat patients, not diseases."

Re: What is the difference between severe and mild pre-e?

Post by z1ggy23 » Tue Jul 19, 2011 08:54 am

aajatwins wrote:To make sure I understand that correctly - you only need ONE of those in the list of symptoms to be diagnosed with severe PE?

If yes, then would my BP of 150/105 at time of seizure make me severe PE AND eclampsia? or still just eclampsia?

why does it have to be so confusing?? :)


If you had full blown Eclampsia, I don't think the PE designation is all that significant *hugs*

Re: What is the difference between severe and mild pre-e?

Post by aajatwins » Tue Jul 19, 2011 08:52 am

To make sure I understand that correctly - you only need ONE of those in the list of symptoms to be diagnosed with severe PE?

If yes, then would my BP of 150/105 at time of seizure make me severe PE AND eclampsia? or still just eclampsia?

why does it have to be so confusing?? :)

Re: What is the difference between severe and mild pre-e?

Post by z1ggy23 » Tue Jul 19, 2011 07:48 am

interesting... I always thought of mine as "mild" but by both the previously given definitions I would have been severe...

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