Welcome! I'm glad you found us but sorry you needed to!
Keep in mind I'm not a doc, I've just read a lot. Please ask your doc if my answers fit in *your* case!
A few random thoughts from your narrative - diagnostic bp is just two readings taken at least 6 hours apart of 140 systolic or 90 diastolic or higher plus 300mg protein in a 24hour urine collection. The dipsticks are notoriously unreliable. It doesn't matter that some of your bps are lower than 140/90. It's good that they aren't *all* high, but I would still be cautious and concerned. [i]Does it matter as much since my diastolic is staying down or is a high systolic on its own concerning as well? I guess I'm trying to figure out why the OB doesn't seem worried about it.
My understanding is that systolic is more susceptible to activity, but those are *high* numbers. Our experts consider 160 systolic *or* 100 diastolic to be severe PIH. If you have just 300mg protein in a 24-hour urine collection as well you would be diagnostic for severe PE.
Does the blood pressure not matter as much since the bloodwork and protein were good? Does the PIH alone need closer monitoring and testing or just when it is paired with bad bloodwork/spilling protein?
Good bloodwork just means that you don't have HELLP, a fast-moving and severe form of PE - and it's always possible that you could still develop it. In your shoes I'd ask if and when they would medicate your bp. My doctor gave me bp meds when I was in the 150/100s. The caution with bp meds is they can decrease bloodflow to the baby, so they watch you and baby carefully if they give them. Women can still have strokes, seizures, abruptions - scary outcomes with "just" PIH, but they are more likely when you are also spilling diagnostic amounts of protein.
If my pressure comes back lower tomorrow (below 140/90) which it may since it has been down so far today, do I need to ask to see the Dr. anyway and push for additional testing?
I would remind the doctor of your readings in the hospital - usually docs seem to get extra worried when bps don't come down to normal when you're resting.
If so, what testing would you recommend? (I'm thinking 24 hr urine, growth ultrasound and BPP for baby?)
I would definitely ask if all three of those are appropriate in your case, and I would especially push for the 24-hour. I would also want an NST at the least, I think the BPP and growth ultrasound are reasonable to at least ask for. I would also ask for repeated bloodwork - and ask how often they would like to repeat it. How is baby moving?
I feel strongly enough about the 24-hour that in your shoes I would ask if it's appropriate, and if they decline, ask them to explain their reasoning, and to make a note in your chart that you asked for it and they declined, and ask for a copy of the note. The 24-hour is the way to make sure you are or are not spilling enough protein to make you diagnostic for PE. Complications can happen with PIH and PE, but if you are fully diagnostic for PE, we can parse out the research better on outcomes and treatment. If my blood pressure stays down all today and continues like that tomorrow, couldn't it shoot back up at any time? That is what worries me.
Your bp could bounce around a lot, highs and lows. I would want to know what your doctors' criteria for delivery would be. I would also ask your doctor how the HYPITAT study would fit with your case (google / search the forums for HYPITAT
[i]I want more than anything to make it to full term and let baby decide when he is ready to come out, especially since I am planning a natural birth and that is harder with induction. However, even more so, I want to do what is best for the health of baby and me even if that means delivering early!
I did inductions without drugs for all three of my deliveries. You have to be more flexible with the medical interventions you accept but it's very possible, feel free to search my earlier posts, I got kind of long winded about it
. Keep in mind that you might need magnesium sulfate as a precaution against eclamptic seizures, I had it with baby #1 and felt horrible on it and it can make inductions a lot harder, (though some women don't notice or even feel better on it) but discuss it with your doctor and if you need it it can be lifesaving. If you need more info on natural birth hopes with inductions let me know and I'll try to remember some other posts and tips.
Do you think we need to talk induction? What if my numbers stay down from now on, would it be okay to just monitor or do those few days of high readings still mean it's not worth pushing it?[/i] [/i] See HYPITAT
. Women with hypertension who were induced at 37 weeks had less c-sections and their babies did fine, women who waited had more sections and health complications and their babies did fine. PIH / PE can bounce around hour to hour, day to day, but eventually it will go up and stay up and you will get very sick. It's even possible for your baby to have more issues inside you due to the disease, sometimes faster than you get sick, and will do better "out" than "in". PIH / PE can also get bad fast - we've had women get very sick within hours, and there is no way to predict who will be the fast-moving cases.
As always, watch your signs and symptoms and especially look out for headache that doesn't go away with tylenol, URQ pain, visual disturbances, and decreased baby movement. Check with your doc for what bp #s, symptoms, etc. that they would want you to call L&D again, and when they would want you to go straight in.
And - bedrest won't stop the progression of the disease, but might keep your pressures a little lower for your protection. Those 180s are especially high. I would really ask your doc about those.What additional questions or concerns should I bring up with the Dr.?
[/i][/i] My brain is almost done for the night
. I hope I made sense, let me know if I need to clarify anything or said anything wrong! And hopefully other folks will jump in soon!
Good luck and let us know how your bp check / appointment goes!