Scheduled Induction for PIH?

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Re : Scheduled Induction for PIH?

Postby mom29 » Thu Mar 23, 2006 01:24 pm

My OB didn't want to "induce me right into a c/s" so he let me go as long as possible. The blood work indicated no pe during the pregnancy, just pih. Let us know how it goes for you.

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Re : Scheduled Induction for PIH?

Postby arj » Thu Mar 23, 2006 12:25 am

I'm really interested in what your doctor has to say. Please give us an update.

I'm thinking that your doc will want to weigh the benefits of the possibility of a failed induction (resulting in a C-Section) vs. the development of PE. Much of it depends on how favorable your cervix is, the maturtiy of the baby and your BPs.

Let us know!

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Re : Scheduled Induction for PIH?

Postby caryn » Thu Mar 23, 2006 12:17 am

Hi Tavilin,

Is this your first baby? (Edited to add: Never mind! I paid attention to your .sig *after* I posted...) I'm wondering because that can affect the progression of hypertension in pregnancy, and also because inductions are more likely to succeed if you've already had a vaginal birth...

In your shoes, I'd certainly ask what the plan will be for your care if you're still just PIH at 37 weeks. The Working Group guidelines say that 38 weeks is an indicator for delivery in PE patients, but I'm not sure about PIH patients!

FWIW, doctors can't diagnose transient gestational hypertension until about 6 weeks postpartum, because there's always a risk that you'll develop postpartum PE.

Let us know what they say.

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Re : Scheduled Induction for PIH?

Postby leahannj » Thu Mar 23, 2006 11:12 am

With my second child, I was induced at 37.2 because of PIH. I'd been on BP meds for about 8 or 9 weeks prior and had at least one big spike on the meds, then a few weeks of bedrest. I think part of my doc's reason for inducing, besides the risk of things going really wrong suddenly, was that I was so DONE. I was so sick and so exhausted and I think he took pity on me.

With this pg, I just got out of the hospital b/c of a spike of 160/110 at 35 weeks. My doc said if any of the blood work or 24 hour urine or BBP had come back with iffy results, she would have induced immediately. Luckily, all that stuff was fine and she sent me home on strict bedrest to try to make it a couple more weeks. But our plan is if I make it to 37 weeks, I'm induced. She won't risk another spike like that and she knows I'm really ready to be done. Four weeks of bedrest so far and counting! I know that's nothing compared to what some women have to go through, but still not fun.

I think if you really push your docon a 37 week induction, I bet he'll do it. I hope you're feeling ok! Or at least tolerable.

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Re : Scheduled Induction for PIH?

Postby missgamecock » Thu Mar 23, 2006 07:05 am

I had severe PIH with Sara. I was sick and miserable every single day that I was pregnant with her. My peri said that I looked like the most miserable pregnant woman alive when I went to the hospital to have her. It was just getting worse and worse. I knew that I wasn't going to get to 40 weeks because my bp was climbing even on a lot of meds. Heck, I was being told I would be lucky to get to 35 weeks! At 32 weeks +, the mw told me that I had to get through 13 days in order to deliver at my hospital. You have to be 35 weeks to go to my hospital otherwise they transfer you because they do not have a NICU. My ob had pretty much told me I wouldn't be allowed to go past 40 weeks as soon as I got pregnant. As time passed,it was clear that I would not go past 38 weeks. So I held out to 35 weeks, showed up for an ob appt with a bp of 160/118. Guess what, they DID NOT send me to the hospital. I thought for sure that that was the day I would be admitted. However, I had just hit 35 weeks and 0 days. I asked my ob look I am getting really really sick, how much longer? He said maybe another week or two. So he wasn't going to let me go past 37 weeks at that point. He also said lung maturity was iffy at that point. My hospital did not have the capabilities to handle a premature baby whose lungs were not ready yet. He said we may have to do an emergency delivery. Also I did not want to transfer as my ob only had privleges at my hospital. He sent me home on orders to go to bed, lay on my left side, and do not move till my peri appt on that Tuesday (this was Thursday). I was to call him if anything was wrong. Called him at home Friday night because I was getting worse. Called him all weekend. Called on Monday, he was in surgery and I was sent to L&D with him to check on me when he got out. L&D bp was 149/109, NST was good. Sent me home again, strict bedrest, do not move a muscle to my peri appt the next day. If anything changed my peri would call him. I really think he wanted the US to check growth and lungs. Next day went to my peri appt, I was so sick I couldn't even drive. She took one look at me and said, I don't like the way you look, you are sick; your bp is stroke level; and let's find a reason to have a baby today. She did the US, BPP, and NST. Sara had decels on the NST. Her NST the day before was fine. This one was not. She called my ob and said I was done. He told her to send me back to him and he was admitting and pitting. That is exactly what happened. I had an emergency induction. I went to the hospital, he admitted me, they didn't even check my cervix when I was admitted. It hadn't been checked since 9 weeks pregnant when I had a full exam. However I had been having regular NST and each one showed I was having contractions. They put the iv in and jacked the pit up every 15 minutes till I delivered. He went back to seeing patients when he admitted me. Then he came back after about an hour to check on me and that was when he checked my cervix. It was 50% effaced and a fingertip dialated. So those contractions on the NST had been doing something. I had thought that they would "ripen" the cervix too. I asked the nurse about it and she said oh no, we don't do that for an emergency. If you don't go into labor tonight and right away, you will be having an emergency csection. Your baby has to be born tonight. Fortunately, that was all I needed to go into labor was the pit. I had Sara 8 hours after I was admitted to the hospital and after the pit was started.

With Kirsten I had severe PE. I was told that I would not go past 40 weeks early on, but never imagined having her at 36. I thought I would have her two weeks early. She was an emergency induction too. They did check my cervix when I was admitted with her. Nothing was going on. I went through three rounds of ripening the cervix in less than 24 hours. First dose was 8pm on that Friday night. Second dose was at 3am on that Sat. morning. Then that didn't work. They told me I couldn't have a csection because my platelets were too low (It was actually impaired clotting ability) and that I would either have a stroke/seizure and or hemmorage and that they had to induce. They were going to try one more thing, if it didn't work, then an emergency csection. They did a balloon, foley catheter thing that hurt worse than having a baby and bam cervix was ripened. I then got an epidural and they started the pit. Kirsten was born 7 hours later.

I really think it is by situation and hospital policy. Probably if I had been at a hospital with a NICU, Sara would have been born between 32-35 weeks. It also depends on lung maturity. Boys lungs mature slower than girls. I think the dr looks at risks vs benefit. At what point is it better for baby to be on the outside? For my next pregnancy, my ob will not let me go past 40 weeks PERIOD. My peri has told me to expect to deliver between 35-36 weeks. I think my ob will be shooting for 37 weeks. I figure that I will have another induction. I am really interested in what your dr says about scheduling an induction in advance. My was like keep baby in as long as possible. For me that was 35 weeks 5 days. But for anyone ttc, when you talk with your dr, you should ask those questions. If everything is ok, how long will you let me be pregnant. How high are you going to let my bp go? I plan on asking that. I am thinking with my ob that if everything is ok, that I will be induced at 37 weeks. But I havn't ever gotten that far either yet to tell. I just know with Sara they were praying that I would get to 35 weeks.

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Re : Scheduled Induction for PIH?

Postby lucy » Thu Mar 23, 2006 00:30 am

I was hosplized on bedrest and induced at 37 wks when I had preeclampsia with Sebanna. Good luck.

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Re : Scheduled Induction for PIH?

Postby deerhart » Thu Mar 23, 2006 00:13 am

With my first child, my doctor continued to let me go because I did not have a ripe cervix. She did set my induction at 36 weeks for the next week as she wouldn't let me get out of my 37 week still pregannt.
With my second child she induced when my symptomns became persistant at 36 weeks regardless of how prepared my body was (though I was already having contractions)

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Re : Scheduled Induction for PIH?

Postby jen44 » Wed Mar 22, 2006 11:34 pm

Hi Tavilin,

I was hospitalized at 32 weeks with "just PIH" - no other symptoms except the high blood pressure. I asked my doctor this quite often during my hospital stay... "you won't really let me go to 40 weeks like this will you?" I was feeling awful and every day was like a century. His goal was to get me to 37 weeks but ended up inducing me at 36 weeks 0 days. I had gotten to the point of reaching the max. of antihypertensive meds and I was emotionally drained, I think my doctor could sense that I was at the breaking point of developing PE. Of course its only a guess because he induced me which didn't work so I ended up in an emergency c-section because my pressures were so bad. I didn't get any steroid shots, they didn't even ultrasound the baby. I guess I was too sick to continue so no matter what the condition of the baby was, I had to be delivered. Luka was born 6lbs6oz and perfectly healthy, he stayed with me in my room that very night.

Good luck, my advice is let the doctor know how you are feeling.

Keep us updated!

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Re : Scheduled Induction for PIH?

Postby blythe » Wed Mar 22, 2006 08:28 pm

I'm interested in what your doctor says!

I've been told 37 weeks at the absolute latest if you actually get pre-eclampsia, and your risk for developing PE is higher with gestational hypertension.

If you never develop any other PE indicators - proteinuria, fetal indicators, bloodwork elevations, visual disturbances - it may just be up to your doctor. Remind your doc how miserable you are, though, and maybe you can influence his/her decision [:)].

One of my friends was diagnosed with gestational hypertension remote from term like yours, and her doctor said induction 37-39 weeks, after an amnio to make sure the baby's lungs were ready.

You have my sympathy for such long bedrest!!! Good luck!

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Re : Scheduled Induction for PIH?

Postby scrapang » Wed Mar 22, 2006 08:06 pm

I don't really have an answer because my situations prior were slightly different where right at the end (38ish weeks I think) I had jumps and was induced. So I would think once you're in the safe range there's no reason to wait. I would think you're entirely correct to ask about it tomorrow. I know my SIL was induced at 36 weeks for bp jump at that point even though it wasn't major. I've kind of gotten the feeling once you're safe there's no reason to mess around because things can go south so quickly and most doctors don't wait.

I'll be interested in the answer others have, though. I've had a similar experience as you this time. Pre pgs were 100/60 and am on the same thing now. Difference is my OB keeps telling me it's no big deal and don't worry about it, no restrictions what so ever. He keeps telling me my pressures are great. I think my last one was 124/86 or something similar. That's not how I feel about it, though (being no big deal)! And I'm sick and tired of feeling tired and sick, too! The only thing he did say is I would not go over my date. I have 15 weeks left. Yuck!

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