Superimposed PE

[kellikbock]

Another question:
I'm considered chronic now, and I was doing research. I have come across the term "superimposed preeclampsia" many times. I'm trying to understand if it is worse than PE on a "normal" person. The medical community makes it seem so.
I don't really understand it. Is it just harder to see PE coming because of already high BP? OR, is it actually worse with a higher mortality rate or exagerated complications?

[blythe]

This Working Group Report is old, but the information is still fairly accurate. http://www.nhlbi.nih.gov/guidelines/archives/hbp_preg/index.htm

If I remember right there's a good section on superimposed PE - let us know what you find, or someone else should be along soon with a better answer!

[kellikbock]

Thanks for the link. I was reading it & it really didn't explain superimposed preclampsia. It mentioned it, but again made it seem like "this is bad" without explaining why.
I searched old forums & saw someone (I believe Caryn) say that it means that you get sicker faster than with "regular" PE. Also, I've gathered from all of this reading that it is harder for doctors to diagnose PE in CHT patients because of the already preexisting condition of CHT. Basically, test these women more to make sure that they don't miss PE.
Does this sound right?
I'm still wondering about why superimposed preeclampsia seems so horrible. Why it has a higher mortality rate (or does it?)...and is this just setting CHT up for failure?

[blythe]

I'm not sure about getting sick "faster" - though if Caryn said it she usually has her references to back her up! It definitely seems like superimposed PE is harder to diagnose so closer monitoring is important.

I did a pubmed search on superimposed preeclampsia and outcomes and found these articles for you:
http://www.ncbi.nlm.nih.gov/pubmed/18259010 -
"Adverse maternal and perinatal outcomes occur in women with chronic hypertension; the prevalence of infants born small for gestational age and preterm is considerably higher than background rates, and is increased further in women with superimposed preeclampsia.

http://www.ncbi.nlm.nih.gov/pubmed/16137819 -
"Superimposed preeclampsia occurred in 28.4% of hypertensive women, with an increased rate of small-for-gestational age babies (30.7% versus 8.9%), a lower birth weight (2587.75+/-832.97 versus 3167.35+/-536.3; p < 0.001) and a higher rate of caesarean sections (69.2% versus 35.5%) than controls."

http://www.ncbi.nlm.nih.gov/pubmed/12151166 -
*I really like this abstract, it might be worth it to purchase the full text. The author is on our medical board and he writes very clearly, and very balanced.

http://hyper.ahajournals.org/cgi/content/full/51/4/960 - is also another very good article

I'm curious about your "setting CHT up for failure" phrasing - that sounds like natural childbirth wording? I am definitely a natural-crunchy gal - did natural childbirth despite PE for all three of my births - but I tend to be wary of some of the assumptions of natural childbirth advocates. When you say "failure" what are you worried about?

[kellikbock]

Great, I will be looking into all of those links.
What I meant by "failure", I guess, was this: I'm nervous (more so, terrified) about getting PE or PP PE in any subsequent pregnancy & it seems that the medical professionals give CHT patients no hope for going through a pregnancy complication free. It also seems that if you do get PE then it is termed superimposed & that carrys some stigma about it being so much worse. That is what I meant by failure.
I'm all for having as little medical intervention as possible, but I say go for it if you need it! No birthing center or midwife (outside of a hospital staffer) would consider me last time I was pregnant, but that worked out because I got very sick with PP PE. I'm not sure if that is because I live in FL where the malpractice laws and medical provider's insurance are crazy. We have many practicing OBGYNs and MFMs that are leaving the state because of it.

[kellikbock]

OK, after reading these, I enjoy the second one the best, lol. It states how women with mild CHT can have good perinatal outcomes! I believe that I am a mild chronic. I'm not really sure, though. I am on the low dose of Norvasc & get nice readings at home...although, I can get crazy readings at the doctor's office (wonder why?).
Thanks for your help. Educating yourself is the best way to arm yourself in these situations, I think.

[alexa5]

quote:

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Originally posted by KelliKBock

OK, after reading these, I enjoy the second one the best, lol. It states how women with mild CHT can have good perinatal outcomes! I believe that I am a mild chronic. I'm not really sure, though. I am on the low dose of Norvasc & get nice readings at home...although, I can get crazy readings at the doctor's office (wonder why?).
Thanks for your help. Educating yourself is the best way to arm yourself in these situations, I think.

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As for the readings at the doc's office, for some of us that is just the way it is. I get terrible readings at the doc's office (pregnant or not--though my readings were a little better while pregnant). I try to just accept it, know that I have good bp in most other situations, but it is frustrating because there is always that initial reaction by the nurse--oh, your bp is high! Then I say, it is always high here. Then my doc makes them recheck it later, and sometimes it goes down, other times not, but he doesn't medicate me for it as he has gotten used to asking me what my readings are at home.

At the moment, it doesn't have any significance for me, but I do know that my white coat syndrome along with having had pre-e, does indicate a possible higher risk for cardiac issues later on.

[blythe]

I wonder if what you're hearing is docs / others warning you not to *get* pregnant because of the risks. You'll notice in the first abstract that women with CHT had small for gestational age babies and preterm delivery more often that "normal" pregnancies, even if they didn't develop superimposed PE - so being fully informed of the risks before getting pregnant is important. But I read the same things, that "mild' chronics generally have good outcomes. Have you talked to an MFM about your specific risk factors and chances for PE?

When it comes to *being* pregnant with CHT, it may be just our posters, but it seems like most MFMs are confident they can handle the complications and chronics are allowed to run much higher pressures and spill more protein before they are considered in danger or diagnosed with PE. The "superimposed" label is one we use a lot around here to explain the care and monitoring and difficulty of making a PE diagnosis on top of CHT. If / when the MFMs use the term, it seems very appropriate and very useful in moving mom and baby to a quick and safe delivery.

I'm a bit out of the loop on meds - is Norvasec a pregnancy-safe med? You might ask your doc and see if you can get switched and have your bp stabilized on a pregnancy-safe med before you TTC again.

[kellikbock]

No, Norvasc is not a pregnancy safe drug, but there is a pregnancy approved version of it. I haven't been put on it yet because we aren't officially TTC. I have one more appointment to go to the 18th to see what he has to say.
I have had an MFM appointment already where he didn't think much of my condition & I can't decided if that is a good or bad thing. Good, if he thinks that my body can handle it with no big deal. Bad, if he's being too easy going about it.
It is incouraging to see many CHT women having good experiences and outcomes.

[glimmer]

Hi - I never got the impression that "superimposed" is really worse than "normal" PE. Just that it is harder to diagnose. Another issue is that if you have an underlying condition it is more "likely" to get PE again, but doesn't mean it is necessarily more severe. Given that you had it twice, I guess your chances of getting it again are high, but since you had 3 full term babies your chances for carrying to term are excellent - in my non-doctor opinion.