PIH at 19 weeks..what is the likely outcome

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PIH at 19 weeks..what is the likely outcome

Postby meg » Sat Jan 17, 2004 04:03 pm

I am writing for my sister. Her computer is messing up and she asked me if I could find a message board to ask some questions for her..so here goes.
With her first pregnancy she started having HBP at 29 weeks on a Monday. She was on hospital bedrest by Wed and her son was induced on Fri! He was 2 lb 15 ounces. Stayed in NICU for about 2 months. He is now 2 1/2 and medically/physically great but has speech langauge delays and some Autism type symptoms. They are now pregnant again. The first 19 weeks of her pregnancy were fine. Last week she noticed she was having headaches and went to a drug store BP machine. It was 144/94. SHe called the doc and they asked to see her the next morning. It was 140/90. They had her rest and rechecked and it was the same. They sent her over to the hospital for bloodwork and a 24 hour urine. Her blood work came back fine and her 24 hour was fine. They sent her home with Aldomet and moderate bedrest. ( hard to do with a 2 1/2 year old). When she has been able to rest completely it will go down to like 126-74 but when she gets up sometimes it goes back up. The doc saw her Fri ( she is 20 weeks now). her urine dip was fine and more bloodwork was fine. Her BP was 156/83. He told her to continue the same amount of meds and moderate bedrest and he would see her again in one week. that was yesterday. I talked to her today and her husband was gone all day on a job making some extra money so she was taking care of the 2 1/2 year old herself. She said as long as she reasted it was fine but one time after some activity is was 145-99.
So here are her questions ( and I know there are no absolutes and every case is different; she is just looking for the common outcomes and also maybe some positive/optomistic outcomes)
1) Given the history of PE, how likely is it that this PIH will turn in to PE?
2) Is it possible to just have PIH that never turns into PE and to make it full-term ( or close).
3) is there anyway at all to predict how much "time" she might have?
3) What are the effects of HBP and/or BP meds on the baby if he is living in these conditions for months?
Again, I know that there are exceptions to everything and every person is different, but with her history and this starting so early, honestly; is she most likely headed for another very early preemie? Of course we want to be optomistic but dont want "false hope", KWIM?
Thanks so much for any advise!
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Re : PIH at 19 weeks..what is the likely outcome

Postby laura » Sat Jan 17, 2004 04:38 pm

Hi Meg! Boy, I'm sure a whole bunch of us (incluiding myself!) can identify with your sister's worry!

There IS hope! I don't know if your sister's doctor mentioned it, but often when women develop hypertension before or near 20 weeks, it's not necessarily considered PIH, it's considered as being caused by underlying chronic hypertension. What's so good about that? Well, women with chronic hypertension are considered to have a 25% chance of developing superimposed preeclampsia. Women who have chronic hypertension that's easily controlled are considered to have chances of a good outcome close to 'normal' women. [:)]

I know she's on meds, but remember, these meds aren't the most effective meds out there- or else they'd be used frequently in a context outside of pregancy. They are, however, the meds considered the safest for her baby. Your sister may need an increased dose to bring her pressures down, or to try a different med. In any event, don't panic yet!

Hypertension is rough on babies, there's no doubt about it- it can cause smaller babies, placental abruptions, low amniotic fluid, etc. but just having hypertension doesn't make it automatically happen, and it's encouraging that her docs are treating it so readily.

But, just to answer your questions- the recurrence statistics range from 20-60% with the most common number thrown out there being 33%. Anne has mentioned often that 50% of gestational hypertension (or PIH) turns into full blown PE. And, really, there's no way of knowing if PE does turn up, if and when it will get severe.

Some people may disagree with me- but the most current research indicates that strict bedrest probably has little effect on outcomes. Doctors prescribe it because it can't hurt (they think) and could potentially help. They don't realize, however, how much guilt many of us feel when we are unable to keep strict bedrest.

My doc and the peri I saw prescribed modified bedrest for hypertension (that began around 22 weeks, and ended with a PE free birth at 36 weeks) which included two uninterrupted four-hour blocks of time lying on the left side per day, to help encourage blood flow to the placenta.

I hope this helps some, and send your sister our best wishes for a healthy pregnancy and do let us know how she's doing!



Laura-28
DH Jack-31
Allicia 5-13-98 (35 weeks-pre-e)
Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/
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Re : PIH at 19 weeks..what is the likely outcome

Postby cathyinwa » Sat Jan 17, 2004 07:12 pm

Hi,

I had PIH. It started at about 14 weeks. My highest blood pressure was about 160/100. I was put on atenolol which kept my pressure under ok control. Later in my pregnancy, I did have some highs(140/90) when I went to the OB (but not at home). I was not on bedrest.

I had a full term healthy little girl. I went into labor on my own. She was 6 lbs 3 ozs and 21 inches long. She didn't have a lot of fat on her. But at about 12 weeks now she is over 13 lbs.

The most important thing is to have good doctors. I had a peri and an ob. And I did what they said to do.

I also have diabetes, which made it even more interesting. And I was having my first baby at 42. The high blood pressure has not gone away after her birth. So I'm having to stay on the medication. But she turned out perfectly.

Cathy
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Re : PIH at 19 weeks..what is the likely outcome

Postby meg » Sun Jan 18, 2004 04:59 am

thanks for your quick replies and words of hope! After seeing what they went through with their last son I just hate to see them heading down that road again :( I know you all know what I mean. I am glad to know there is hope!
Her doc did mention that it could be chronic hypertention but since it has been around 126/70 the whole time between pregnancies and the first 19 weeks of this pregnancy I think he is going with the PIH label. But he did mention it could have been chronic and "unmasked" my pregnancy. He did consider increasing the Aldomet but he wanted to wait one more week and see how things go. Her doc is not even trying to give them any kind of predictions b/c he is scard to be wrong I guess. He told them they are just week by week from now on. Thanks again. I will probably be popping in here the rest of her pregnancy. Thanks ;)
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Re : PIH at 19 weeks..what is the likely outcome

Postby sarab » Sun Jan 18, 2004 07:46 am

Hi Meg,

I just wanted to say "hello and welcome!" [:)]

I'm sorry to hear about the rough time your sister is having. Please let us know if there's anything we can do, this can be scary stuff. Keep us posted!



Sara, 23
DH, Scott, 25
Maggie Lylas, 6/9/03, 29 weeks, severe pre-e
http://www.babiesonline.com/babies/m/maggielylas/
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Re : PIH at 19 weeks..what is the likely outcome

Postby annk » Sun Jan 18, 2004 08:06 am

Hi,
Your sisters story has some similarities to mine. In my first pregnancy I started having high bp readings at 19 weeks, was put on modified bed rest and watched closely. I was able to make it to 35 weeks. At 35 weeks I started having protein in my urine and my bp shot up to 180-90/115. I was induced and DD was 6lbs.3oz. and spent 5 days in the NICU for breathing difficulties. I also suffered a partial placental abruption during labor. It was scary(and very painful)but I was still able to deliver vaginally. My bp's returned to normal 3 weeks after delivery.

I am now 22 weeks into my second pregnancy. Again at 19 weeks I began having high BP's. This time they have diagnosed me (for now) as having chronic hypertension instead of PIH and have me on labetalol. I asked my peri why they think I have chronic hypertension when my BP is only high after 19 weeks in pregnancy and he said he thinks pregnancy brings out an underlying tendancy to develop hypertension. I dont completely understand but I guess they are the experts. I too am concerned of what this means for me this time around. Fortunately I was able to make it pretty far into my first pregnancy and DD did very well but this time my bp's are a little higher than they were at this point last time. My peri has not put me on bed rest for now and I wonder if they will. I understand how hard it is for your sister to adhere to bed rest with a toddler. I cant imagine being on bed rest while taking care of my 18 month old DD! I guess I will cross that bridge if I get to it. Good luck to your sister and keep us updated.


DD 6/29/02 35wks due to PIH
baby#2 EDD 5/24/04
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Re : PIH at 19 weeks..what is the likely outcome

Postby laura » Sun Jan 18, 2004 02:18 pm

I absolutely had the same reaction when I was told chronic hypertension with mine! How can you have chronic hypertension when your blood pressure is low? I ran a steady 120/70 prior to pregnancy.

My doc explained it this way- right now, you're too young to have hypertension, but as you age, it will emerge. It's likely essential, genetic hypertension. And when I thought about it, hypertension does run really strongly through my family, and yup, it's probably going to be a problem for me, I'd be surprised if it weren't.

I guess you could think if it this way- there are structural problems with the cardiovascular system, that over time, will turn into hypertension. The stress of pregnancy unmasks that problem, the same way that age does. So, it's not out of the blue disease of preeclampsia causing the high blood pressure, it's chronic hypertension (especially when it starts so early!), which could eventually develop the disease of preeclampsia on top of it, but for right now, it's 'just' hypertension. I hope that made some sense [:I]



Laura-28
DH Jack-31
Allicia 5-13-98 (35 weeks-pre-e)
Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/
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Re : PIH at 19 weeks..what is the likely outcome

Postby meg » Sun Jan 18, 2004 02:31 pm

Thanks :) yes, it makes total sence for it to be genetic. I got PE with my first but not until 35 weeks and luckily not at all with my second. But both of our parents are medicated for HBP!!
So is the chance of HBP turning into PE more or less likely if its chronic as opposed to PIH?
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Re : PIH at 19 weeks..what is the likely outcome

Postby laura » Sun Jan 18, 2004 03:01 pm

PIH can sort of be seen as how PE begins... the only difference between PE and PIH is the protein. Anne has quoted the statistic that 50% of gestational hypertension-- PIH-- will turn into full blown preeclampsia. And you have to factor into that, many women will develop PIH very close to term (ie 38 weeks, etc.), and then deliver before it develops into PE.

Whereas- if you have chronic hypertension, you have a 25% chance of developing PE, and I have read docs say that if it is easily controlled, or remains mild, that your chances are even better than that.

Hang in there- it's not always a smooth road, but you guys can do it!



Laura-28
DH Jack-31
Allicia 5-13-98 (35 weeks-pre-e)
Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/
laura
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Re : PIH at 19 weeks..what is the likely outcome

Postby annk » Mon Jan 19, 2004 10:11 am

Thanks Laura for the clarification on chronic hypertension. It does make sense looking at my family history that I would be prone to hypertension. My Mom and both of her parents are on meds for hypertension and my Grandmother (& her mother as well) struggled with hypertension during all 4 of her pregnancies and developed chronic hypertension later in life. I guess it is something I will need to address down the road as well. It is comforting to know that a chronic hyper. dx may be less serious than one of PIH. Although in my last pregnancy things did turn more serious. I think I am most concerned about the chance of placental abrubtion since I had a partial abruption last time. Is the abruption most likely due to damage from high bp in general or is it more of a function of PIH/pree? Does that make any sense? Anyone know?

DD 6/29/02 35wks due to PIH
baby#2 EDD 5/24/04
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