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.
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 weeksÃ¢â‚¬â„¢ gestation or later; in 20% to 30% of cases, it progresses to pre-eclampsia.12
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:
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
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)
TABLE 3. INDICATIONS FOR DELIVERY
should be based on maternal and fetal conditions as well as gestational age.
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
Severe fetal growth restriction
Nonreassuring fetal testing results
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!