new member saying hi!

This section is for discussions with other women who have probably been through the same signs/symptoms that you may be experiencing. Please note, we cannot offer medical advice and encourage members to discuss their concerns with their doctors. New members, come on in and introduce yourself!

new member saying hi!

Postby smb » Fri Jan 23, 2009 04:19 am

firstly - wowee you girls know your stuff. I have been reading your site for a week and feel a little overwhelmed with the codes and info.

I think this summarises my situation best.



2004 I had a baby girl born on my due date.High blood pressure from 23ish weeks (not above 100 no protein or swelling) and slightly smaller than normal girl - 6lb 7 oz. I would classify this as mild pre-eclampsia. Would you all agree??

2006 my son was delivered at 28 weeks. Severe IUGR (he weighed 715 gms) due to high BP from week 20. Platets low so the baby was delivered. I would classify this as HELLP or severe pre eclampsia (no swelling or protein). I was on LAD and calcium and BP meds from week 20. No supplements or meds seem to make a scrap of difference to my situation.

So, am I correct in thinking I have a 60% chance of getting severe pe again and 20% chance of it being before 28 weeks??

I have a pre pregnancy appt soon and I am trying to get all my data together. What are the underlying conditions they test for? I have had my kidneys scanned already . My Mum had pe so I think I am in hereditary camp.......... so is there any point checking the other factors?

Please let me know if I have got my info right - I left the hospital not being fully aware of what went on other than I had high blood pressure in pregnancy.
thanks
sacha


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Re : new member saying hi!

Postby aundapenner » Fri Jan 23, 2009 05:21 am

Hello Sacha and welcome to the PE boards! As you've discovered, there is a wealth of experience and research to be found here.

No one here will tell you reoccurance rates. In fact, I'm not sure where you got your numbers ... we're not doctors, just a group of experienced individuals who've taken an interest in learning more about these diseases (PE and HELLP) and finding a support network.

Preeclampsia is defined as 2 BP readings of 140/90 in a 6 hour time period (someone correct me if I've misspoken) AND protein in your urine - <300 in a 24-hour urine collection. As you've stated that you did not have protein, you probably (again, not a doc, just a mom with experience) had Pregnancy Induced Hypertension (PIH).

In my first pregnancy, I started out with PIH and that dragged on for about 5 weeks before going into moderate PE.

Before making the decision to TTC #2, we met with a perinatologist (high-risk OB) both in Ohio before we moved and here in Germany after we moved.

It's always good to meet with a peri AND to have them check for any possible underlying conditions. I'm pretty sure there is a posting here with questions to ask ... hopefully someone else can find them for you.

In the meantime, I'd write down any and all questions you have - regardless of how silly they might seem. Like you, I also have genetic factors against me - both my mom and sis had PE. I do not have any underlying conditions and while I had PE in my first pregnancy not too early, it's reared its ugly head earlier for me this time around.

Hang out here - there's loads of support and info to be gleaned here.

Also - do you have a copy of both your doctor's records and the hospital records? Those always prove interesting ...
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Re : new member saying hi!

Postby caryn » Fri Jan 23, 2009 07:59 am

Hello Sacha, and welcome to the forums; I'm glad you've found us. Did your son have a long NICU stay?

Technically a preeclampsia diagnosis requires just two bp readings of either of 140/90 and a 24-hour proteinuria of 300 mg or more. If you had no protein either time, you're what they'd call a "gestational hypertension" case -- which is in the spectrum of preeclampsia -- and you're right that low platelets are one element of HELLP. (It's Hemolysis, Elevated Liver enzymes, Low Platelets.)

IUGR is definitely related to this syndrome, because it also has something to do with shallowly implanted placentas that don't send a lot of blood to the baby, which compromises the growth of the baby. We know that something goes wrong with the growth and development of the placenta right at the beginning of pregnancy that causes these problems later in pregnancy.

Supplements and meds don't seem to make a scrap of difference to most hypertensive pregnancies. :-)

IIRC, aspirin is thought to lower incidence by about 10%, which means if you took everyone with a history of gestational hypertension and a 60% recurrence risk and put them on LDA, and had them get pregnant, instead of 60% of them getting it again, 54% would and 6% would not. So yeah, it's not a big shift.

Calcium only seems to help people who were eating very low-quality diets, i.e. people in starvation in third world countries, but there's no data showing an effect of calcium supplementation on those eating standard Western diets.

And blood pressure meds are known just to reduce the maternal risk of stroke by holding her bp down, but not to affect risk of gestational hypertension.

You're right that one of our Experts has said that [url="http://www.preeclampsia.org/forum/viewtopic.php?t=331"]recurrence rate[/url] for a woman with a history before 28 weeks would be 60%, one third of which were at the same gestational age.

I don't think there's a standard workup for underlying conditions, but they usually check thyroid, autoimmune conditions, thrombophilias, and family history. And probably some other stuff. Is your mom a chronic hypertensive now?

This syndrome is overwhelming and there are lots of bits of shorthand. Holler if you need translation. :-)
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Re : new member saying hi!

Postby blythe » Fri Jan 23, 2009 08:53 am

Sacha, I just wanted to add my welcome! I'm glad you found us.

You've gotten great answers already, and I'll just add my not-a-doctor 2 cents input. For your first pregnancy, if your bp went up that early yet you still delivered at term, I would guess you had gestational hypertension. Our Experts say that gestational hypertension develops into PE about 25% of the time, though my understanding is that they're usually referring to bp that starts to increase late in the third trimester.
http://www.obgyn.net/femalepatient/femalepatient.asp?page=sibai_tfp
quote:

To make the diagnosis of gestational hypertension, I would add that elevated BP should be persistent on at least two separate occasions at least 6 hours apart but not more than 1 week apart. Gestational hypertension is fairly common among nulliparas, occurring in 7% to 18% of them. Time of onset is usually 36 weeks’ gestation or later; in 20% to 30% of cases, it progresses to pre-eclampsia.12
quote:


Since your bp went up so early, I would keep in mind that you might be destined for chronic hypertension when you get older, and that the strain of pregnancy just "unmasked" the hypertension.

In your second pregnancy, your condition was obviously serious for your baby to be delivered at 28 weeks. It's hard to say HELLP or severe PE exactly because you don't mention your red blood cell status (hemolysis?) or liver values and you weren't spilling protein... but you were still very very sick! Complications from hypertensive pregnancies don't always follow the "usual" course of bp up first, then spilling protein, then liver/other end organ damage or central nervous system involvement (eclamptic seizures). I like this table:
quote:

http://www.emedicine.com/EMERG/topic480.htm

Diagnostic criteria for severe preeclampsia include at least one of the following:

* Systolic BP greater than 160 mm Hg or diastolic BP greater than 110 mm Hg on 2 occasions 6 hours apart with the patient at bed rest
* Proteinuria greater than 5000 mg in a 24-hour collection or more than 3+ on 2 random urine samples collected at least 4 hours apart
* Oliguria with less than 500 mL per 24 hours
* Persistent maternal headache or visual disturbance
* Pulmonary edema or cyanosis
* Concerning abdominal pain
* Impaired liver function test findings
* Thrombocytopenia *dangerously low platelets
* Oligohydramnios, decreased fetal growth *your baby's severe IUGR, or placental abruption
quote:



And a similar table from the Working Group Report
Working Group Report on High Blood Pressure in Pregnancy http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_preg.htm (archived just because it's old, our experts tell us it is still accurate)
quote:

TABLE 3. INDICATIONS FOR DELIVERY IN PREECLAMPSIA*
* Delivery should be based on maternal and fetal conditions as well as gestational age.
Maternal:
Gestational age >38 weeks
Platelet count <100,000 cells/mm
Progressive deterioration in hepatic function
Progressive deterioration in renal function
Suspected abruptio placentae
Persistent severe headaches or visual changes
Persistent severe epigastric pain, nausea, or vomiting
Fetal:
Severe fetal growth restriction
Nonreassuring fetal testing results
Oligohydramnios
quote:



You are right that women with mothers and sisters with PE have a higher risk of PE themselves - it may be genetic, or it may be that moms and sisters just have similar risk factors.

These pre-pregnancy consults where we try to get a % risk for "next time" are really hard. No matter what # you get... well, a "retired" moderator here used to say it's really just 50-50, either you get it again or you don't. The best you can do is try to treat an underlying conditions, monitor yourself closely, and have an excellent medical team in place so you and your baby are taken care of if you get sick again.

Let us know what you learn from your consult!

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Re : new member saying hi!

Postby ambersjourney » Fri Jan 23, 2009 11:25 am

Caryn, you mentioned the rate at which aspirin is thought to lower incidence, do you have/know rates for heparin/lovenox or would it be the same as aspirin?
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Re : new member saying hi!

Postby caryn » Fri Jan 23, 2009 01:23 pm

I don't, but they usually only give those to women with a dxed clotting disorder, and the aspirin data is for the whole population of preeclamptics, so they're not really comparable groups anyway.

Sacha, in case I wasn't clear before, you *totally* belong here, because all of these are grouped under the umbrella "gestational hypertension", which is sort of misleading. Really the problem appears to stem from some sort of shallow initial placentation, probably caused by the maternal immune response to the invading blastocyst in the first weeks of pregnancy.

And it manifests very differently in different people, so whether or not you met the research definitions for preeclampsia or HELLP isn't necessarily relevant to your management. If you're clearly hypertensive, and the baby is better out than in, and your platelets are low, no one's going to quibble over whether or not you met the research definition except researchers. :-)

Is your preconception appointment with an MFM?
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Re : new member saying hi!

Postby annes » Fri Jan 23, 2009 01:24 pm

Welcome to the Forums! You have gotten such great answers from the other ladies but I just wanted to say hi! I hope your pre-conception appointment goes well, keep us updated!
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Re : new member saying hi!

Postby smb » Sat Jan 24, 2009 04:21 am

Thanks for all that - all very interesting - especially the placenta stuff. My placenta was very small 3-5% (115g) and I had chronic villitis according to my placenta report.

What is a MFM - medical fetal something? I am a New Zealander so our hospital systems are a bit different.

My son was in hospital for 80 days - I have kinda resigned myself to the fact that if I have another baby - mostly likely I will be doing the whole NICU thing again. My fear is that with my sons stats of 1lb 9oz and born at 28 wks and me being 3 years older (34)..... there isn't a whole lot of viable movement there. In NZ paedtricians are called if the baby is 500gm and/or 26 weeks.

My mum isn't a chronic hypertensive now.... I was unaware of my BP before either pregnancy so I couldn't say if my BP was normal before I entered both pregnancies - I have had some randomn bp readings and been diagnosed with "white coat syndrome" prior to being pregnant. This theory seemed to fit with the first pregnancy (term and healthy weight baby and just high BP readings) however clearly I couldn't use this excuse with the second pregnancy (HELLP IUGR and 28wk old baby. I have bought a bp monitor now so plan to get a better idea of what is going on.

thanks for your comments - I appreciate your time.

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Re : new member saying hi!

Postby caryn » Sun Jan 25, 2009 07:00 pm

A [url="http://www.smfm.org"]MFM[/url] is a maternal-fetal medicine specialist, an OB with extra years of training particularly in medically complicated pregnancies. Like when the mother develops cancer, or the baby needs in-utero surgery, or preeclampsia or PTL.

Planning for these pregnancies is fraught. We've got a lot of Aussies around who might be able to email you with doc recommendations.

Keep us posted.
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