BP almost diagnostic, then down again - WWYD???

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fiona
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Re : BP almost diagnostic, then down again - WWYD???

Postby fiona » Thu Aug 10, 2006 03:46 am

Blythe,

I completely understand not wanting to wait until you get sick again - but you seem to be some way from a diagnosis of pe right now.

My last pregnancy I was delivered at 36 weeks and 3 days, partly because, like you, I wasn't eager to hang around for pe. But when my OB and I came to the decision, my BP had risen to 160/110 on meds and a dipstick urine came up +2. As it turned out, I had to be delivered anyway because I went into labour and I'd had a previous classical section, so there was concern of rupture.

As you say, chances are, baby will be fine - mine weighed in at 7lbs 9oz and was considered full term; but as you are being monitored so closely, you might consider hanging on a few more days to see if your BP starts to rise, or you show signs of protein. Even if it means daily visits to your OB to get checked out, it might be worth the extra cooking time.

Good luck with your decision.

denise
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Re : BP almost diagnostic, then down again - WWYD???

Postby denise » Thu Aug 10, 2006 00:16 am

Like Kara has already said, this is your call.

I can share my experiences however. I had HELLP with my first pg and delivered just shy of 35 weeks--Baby spent 15 days in the NICU. Baby #2 was born this May and I had labile BP's which started at about 32 weeks. I was always having trace-+1's and the 24hrs would come back in the low 200s. I wanted to induce before something happened. I would cry the minute my OB would say "I'll see you Thurs." I just wasn't sick enough to warrant delivery and possibly have a problem with the baby. So, I made it to 37 weeks. We induced becuase things were starting to rise, and my platelets were continually going down (but not too low). He had originally said that anything after 36 weeks was fair game and we could induce. That last week I despised the man cuz he wouldn't do it yet.[;)] But I know overall, it truly helped to have that extra time. My peanut was 5lb6oz at 37 weeks. Thankfully he had no issues and was able to room in and come home with me. What helped me was the continual monitoring with NST's and BPP's and OB appts. I could see baby was doing well inside yet.

WHile I know the waiting for the other shoe to drop is an awful feeling, I believe that extra time really helped Phoenix continue to develop. That said, you really have to sit and have an open discussion between you, your partner, and your physician and weigh the options.

Best of luck to you. Please keep us posted.

kara
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Re : BP almost diagnostic, then down again - WWYD???

Postby kara » Wed Aug 09, 2006 11:55 pm

Unfortunatley this is your decision to make....:-) Your diagnostic criteria for PRE-e isn't there yet. I would be more worried about the 10 day delay if you were already over the protein or the BP limits. We have some ladies who have reached both and docs are making them wait it out to get those extra days for the baby. If it were my decision (and it isn't), I'd want the extra time for baby's lung development. Some women don't even get pre-e with second pregnancies, maybe PIH, in which case you may not have to have mag. I wouldn't want to be in an emergency situation of course, but I'd take the mag over the nicu anyday. I delivered on mag with no epidural.

Again, this is your decision and we are here to support you! Please let us know what you decide so we can wait for the baby announcement!

Signs & Symptoms page http://www.preeclampsia.org/symptoms.asp

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heather j
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Re : BP almost diagnostic, then down again - WWYD???

Postby heather j » Wed Aug 09, 2006 09:52 pm

I couldn't possibly tell you what to do in this situation, but if it were me I would certainly be tempted by the early induction - especially if my dr. was supportive of it. Second, I would never try to guess what PEs plans are in terms of it holding out 10 more days...you may not develop it all, but then again it's an uncertainty. I know every baby and every pregnancy is different, but my son was born at 36 weeks to the day and spent no time in nicu. I hope you can make a decision that you are comfortable with. Best wishes!

blythe
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BP almost diagnostic, then down again - WWYD???

Postby blythe » Wed Aug 09, 2006 08:41 pm

Hi everyone! I need some opinions! I need to say up front that I know I am very lucky. I am constantly amazed and saddened by the stories of so many women here who have had early and severe disease! I am almost embarrased to ask my question!

I am 36 1/2 weeks into my second pregnancy. My BP started to rise over the weekend - after holding nice and low in the mid 100s/70s all third trimester, even lower than it was in my second trimester. This Saturday was high 110s/80s, and Monday my highest readings were 119/93 on the automatic grocery store machine, and 138/88 in the office (I insisted on being seen! [:)]). I was sure I was heading for another induction.

Tuesday morning in the office was 118/64, just a trace of protein in my urine, NST fine, and bloodwork fine.

Wednesday morning at the automatic BP I got 114/83 and 105/71.

Swelling in my ankles has been bad in the past week or so, not much in my hands or face at all.

I see my doctor again Thursday (tomorrow) morning to check everything again and revisit the idea of semi-elective induction.

My doctor this pregnancy is amazing. She flat out said that at this point it is my call if I want to be induced or not.

Like I said, I know I have been lucky, but I want to be luckier - I want a natural childbirth without mag this time, one where I get to hold my baby right after he's born and don't have to go anywhere near a NICU.

My doctor is on vacation starting Friday afternoon, for 10 days, and after my last birth I really only trust **her** to be flexible about my natural birth hopes while still keeping me and baby safe.

So my choices are to be induced tomorrow or wait. If I induce tomorrow, baby is 36 1/2 weeks and has a small chance of ending up in the NICU, induced labors are less likely for me to be able to tolerate without an epidural, and slightly more likely to end up with a c-section. BUT mag is very unlikely, my doctor is on call, and I won't be confined to bed on my left side, immobile, throughout labor. And not a small concern - the earlier I deliver (if I actually am starting down the PE road again) I am unlikely to develop complications in labor like more severe PE, eclampsia, or HELLP.

If I wait until next week, until I'm actually diagnostic with PE, my doctor is gone. Depending on which of her partners I get, I may end up on mag and unable to tolerate labor without an epidural - but the baby will be a few days older and less likely to end up in the NICU.

So What Would You Do? Why could my BP be almost diagnostic, then drop again? Do you think I can hold off the disease until my doctor gets back [:)]?


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