New With Questions *Labetatol Questions

[trying4two]

Hi everyone, I'm new here. I am so glad to have found these forums though, you all seem like an incredibly supportive, strong group!

I apologize in advance if this is lengthy! Perhaps I'm just looking for some support or reassurance, I'm not really sure.

I am currently 36w2d. I have had several complications this pregnancy (and went through fertility treatments to get here), but my most recent ones have obviously brought me to all of you!

I have been dealing with pregnancy-induced Tachycardia (120 bpm + at rest). I was initially put on a very low dose of Atenolol (12.5 mg 1x/day) by my Cardiologist after a normal Echo/EKG/Holter Monitoring. It did nothing and my OB switched me to 100 mg 2x/day of Labetatol. I'm really not sure that the Labetatol has done anything, either. My pulse is still typically between 100-120 bpm at rest. But I digress.

Apparently my BP has been going up over the course of the past several appointments. I was admitted 3 weeks ago when I felt really terrible (and ended up contracting the entire time), and had a clean HELLP Panel then. But since my BP has still been rising, my OB ordered a 24-hour urine collection and another HELLP Panel, even though I had no trace of urine in office. I'm still waiting on those results, but hopefully I'll get them tomorrow.

My biggest concern right now is what the potential complications or what the typical course would be if my urine and HELLP Panel came back normal, but my BP is still high. I am especially concerned since I am *on* a blood pressure medication already! My OB typically seems concerned about things, but then leaves me with little resolution when tests come back normal. Which of course drives me crazy!

For reference, my office-visit BP's have been as follows:

11w - 108/58
12w2d - 124/70
15w - 126/52
18w4d - 130/60
22w4d - 138/56
26w4d - 140/78
28w5d - 130/74
30w3d - 134/76
32w1d - 134/70
33w6d - 140/78
35w6d - 142/76 (repeated: 142/68)

However, I have also been taking them at home (via a digital wrist monitor) since my most recent appointment. At 36w1d, the result was 140/87. Today, at 36w2d, my results have been 147/83 and 150/90 (I took it again because my hands have felt swollen and tight). Not that I'm a rocket scientist, but these numbers just seem so high for someone who is on Labetatol already (for a different intended purpose, but nonetheless). Especially considering that my activity level has been very low.

So obviously, I'm concerned! I would appreciate any insight that anyone has to offer!

[fiona]

Hello and welcome.

Your BPs are not at a dignostic level for preeclampsia, but - as you say - the meds may be masking the progression of the disease. Certainly they are high from your baseline, especially when you are on labetalol.

Honestly, if your pressures continue to rise and/or your proteinuria is high or your labs show signs of things going south, I would expect your OB to start talking about an induction/delivery. Escalating BPs with no proteinuria is called gestational hypertension, or pregnancy induced hypertension (PIH) and is every bit as concerning as preeclampsia.

The good news is, you are almost at term. You don't say if this is your first pregnancy, but I know that 36 weeks can sound worryingly early. Around here, we think it's a great place to be (my third son was 36wks 3 days at birth and had no issues whatsoever).

The best thing to do is to continue logging your BPs and watch out for any new symptoms: a headache that won't go away with Tylenol, visual disturbances, URQ pain, swelling of the face. Any of these require a trip to L&D.

Apart from that, I would try and spend as much resting time lying on your left side, and chase up those results tomorrow. At that point, you can ask your OB for their management plans and what they will consider the tipping point for delivery.

Good luck and do keep us posted.

[trying4two]

Thank you so much for taking the time to respond!

This is my second pregnancy, and I currently have a repeat C-Section scheduled for 39 weeks.

I know that the odds that she'll be perfectly okay if she were born now are very good (we've also dealt with an irritable uterus, pre-term labor, etc., so getting to this point was a big deal!), my blood pressure is just making me so nervous.

The problem with using headaches as a signal is that I get terrible migraines that are even worse during pregnancy. I have not felt swollen until the past few days, and now my body is just so achey and tight. I took my BP after waking up this morning and it was 140/86. I'm just worried that I did the HELLP Panel and 24-hour urine before my BP really starting going up. But I guess we'll see what the results are today.

[trying4two]

My OB's nurse just called (not a fan of hers at all).

She said that my HELLP Panel was okay and my protein came back at 178, which is "normal" - the cut off being 220.

I told her about my blood pressure being so high (it was 145/92 this morning) and having swelling now, and she basically wrote me off... which is what she typically does. She told me that it's because it's a home machine (except that it always said 120's/70's before!) and that a manual is better. I told her about the swelling and she said it was normal (um... okay) and to elevate my feet and blah blah.

So anyway, now I'm just upset! I can't stand this nurse... three weeks ago I called when I felt the worst that I ever have in my life (migraine for four days, extreme nausea, exhausted, etc.) and she told me that I had the flu. On the phone. I was admitted the next day because I still felt awful, and everything came back fine in my labs (though I ended up contracting the whole time), but I definitely did not have the flu.

But I'm not sure that there's anything else that I can do now except play doctor myself and wait for my next appt. on Thursday.

[trying4two]

I really appreciate you taking the time to respond.

I'm left feeling so unsettled with the whole situation. I really can't stand my OB's nurse. I'm convinced that unless I call and tell her that I'm covered in pink and black polka dots, everything will be labeled "normal" - even when I know that it may not be normal.

My second BP of the day was 149/93. I don't know, it just seems like it's gone up a lot over the matter of just a few days. I don't like it! As far as my 'home monitoring' goes, it always gave really normal results before... so I highly doubt that's the problem here!

I did weigh myself, and the scale says that I'm up 5 pounds from my appointment on Thursday... which definitely seems a little crazy. I have only gained 15 pounds at this point, so 5 pounds would be a huge gain in a short amount of time! So it has to be swelling.

Ugh, I hate having to second guess everything. I am thinking of moving my appt. from Thursday to Wednesday (it will be with another OB since mine is on vacation, probably a good thing!) so that if I have to do another 24-hour urine, I can get the results before the weekend. I'm still undecided as to whether I should call and demand to be seen today for a BP reading and another 24-hour urine. I hate having to practically prove my case... as if I enjoy spending time there or something!

[anrmacon]

I am sorry you're having to be such an advocate for your care. I've actually had OB's who said I should not monitor my BP at home b/c it would cause stress thus causing an increase in BP. (Yeah, right.) Watching your BP increase and the scale climb while feeling like no one is paying attention to you is hard. Keep a close eye on the numbers and if ANYTHING feels *wrong*, go to L&D immediately. I would consider seeing another doctor, too. It never hurts to have another opinion. I completely agree that your pressures are too high. Please review the PE warning signs and continue to take good care of yourself. Keep us posted.

[caryn]

I definitely agree with you that it's worrisome to watch it climb like that in late pregnancy, coupled to unusual weight gain, particularly when you're on meds. And since the symptoms are so unexciting I always encourage everyone with climbing pressures to have a serious chat with their care providers about how their proteinuria's going to be monitored and where the threshold at which to call is. I think trying to move your appointment up is a great idea, and another 24-hour is also a great idea.

Since you're taking your pressures at home, I'd log the time and the reading so that you can take them in to the office or into L&D to show to the docs. That way everyone can see why you're concerned.

Here's a link to our Experts (top clinicians and researchers into hypertensive pregnancy) talking about how to take blood pressure:
http://www.preeclampsia.org/forum/viewtopic.php?t=321

Here's a link to our Signs and Symptoms page:
http://www.preeclampsia.org/symptoms.asp

Please keep us posted.

[willow&sam]

Hi and welcome. You might want to try showing up at your Drs appointment with your 24-hour collection already done if you don't think they will order one. It's something I have done in the past and the response is usually, since you've done it already, I guess we'll run the tests. It couldn't hurt. If your urine is ok but your BP is still up, there are other meds they can add to the labetalol to help. I'm on 200 mg labetalol and 1500 mg of methyldopa 3 times a day.

Regarding the monitor, I've found that when your pressure is "normal", the digital monitors are pretty accurate but, once your BP starts to rise, they tend to run on the high side. I've gone through 4 or 5 different types over the years and they all have given me similar results - I finally broke down and bought a manual one.

Good luck with everything.

[trying4two]

Thanks again everyone.

I've had the worst headache since yesterday that just won't go away. It's hard for me to know the difference between a terrible headache and a migraine, though... since I get migraines frequently. But it's not going away with Tylenol #3. So that combined with the fact that my face and hands are very swollen, my BP is still up, and the scale shows a 5 pound + weight gain in the past 4 days... I called. I was under the assumption that my OB was out this week (since she told me she was), but apparently that's not the case. No idea what that's all about. And I was looking forward to talking to a different nurse! Ugh. So I had no choice but to leave a message on her nurse's VM. I basically said that I'm more swollen, my headache won't go away, and I'd like to come in and have my BP taken THERE. I didn't really give her much room to argue with me, but we'll see what she says. She doesn't usually call back until 5pm, anyway. How frustrating!

[panguitch02]

To be on the safe side, go to the Labor and Delivery. Have an OB check you out.

It is worrisome that your OB's nurse is making these decisions for you, maybe without your OBs knowledge. You currently have some several symptoms: headache not helped with Tylenol, rapid weight gain, and rising BP. If you have a gut feeling that you are not being taken seriously, then you are most likely correct. I wouldn't wait for her to call back.

PE can progress very quickly. I also had trace protein (don't know my 24hr count, but it was diagnosable) and BPs around 150/85-90.....I had no physical symptoms, and I was put on hospital bed rest. My OB explained that things can go back so quickly that he felt better having me in the hospital until they decided it was too dangerous to continue the pregnancy.

You are at 36 weeks, which is soooo awesome. The most important thing is to have a healthy mommy and baby when all is finished. Don't let some anyone brush off your symptoms and feelings.