"Lying down" blood pressure

[RogueFemale]

OK so this may be a REALLY stupid question. Feel free to laugh at me if you must.

I know the correct reading of blood pressure is taken while sitting up. Mine has been consistenly high in that position (but not alarmingly, mostly only 140s/90s sometimes higher--I've been lucky so far). So my question is, as long as I stay lying down and my blood pressure returns to a much lower reading in that position, am I 'safe' for now? (I understand that if true PE sets in, nothing will keep the BP in check, and thus it becomes a whole new ballgame--hopefully that won't happen this time.)

I'm at 33 weeks and really hoping to make it to 36 for a c-section--we don't want labor or even dilation to start because I also have placenta previa. We also don't want another abruption like last time, which happened at 36 weeks. I guess I'm just wondering if BP-wise I'm in a good position if I stick to lying down all the time, regardless of my sitting up pressures?

(And my I just add I cannot WAIT to be off procardia 4x a day--every single time I take it I get woozy, my heart races for an hour, and my cheeks feel like they are burning with fever.)

[celina]

I will preface this by saying I am in no way an expert. I am sure there are more well educated people here who can weigh in on this more accurately.

Having said that, I would not put much stock in a BP taken while laying down completely. Reclining slightly while in a seated position might be acceptable but I believe that the blood pressure cuff needs to be at the same level as your heart when BP is taken.

Best of luck to you:)

Celina

[riehlism]

Yes, the textbook method of taking BP is sitting upright, with both feet on the ground and arms resting at the level of the heart. When you have full blown PE there's really no stopping the rising BPs. The purpose of lying down is not to keep your BP from rising...because it will inevitably do so. The purpose of lying down to keep your BP as low as possible is for you baby. The more time you spend with extremely elevated BPs, your baby is not getting enough nutrients. So while (just as an example) your BP may continue to rise, it is advisable to stay in a position where your BP can be the lowest to keep feeding your baby.

[caryn]

There are no silly questions here.

The thing about PE is that the other symptoms of PE do not march in step with blood pressure. We have had posters seize with pressures lower than 140/90. We have had posters abrupt with pressures that had only crested higher than the threshold once or twice. Scary high proteinuria numbers don't mean automatic delivery. So it's very difficult to say a lot about how sick anyone is simply from her numbers, and then of course we're not docs which is why we always say things about how the *real* experts in L&D are much better placed to decide things based on your symptoms there. (In particular, a BPP and bloodwork can give a whole lot of useful info.)

Bedrest to the left side keeps the weight of your uterus off of the main artery supplying it, which is the theoretical argument in support of it. Turns out that it doesn't seem to actually *do* anything, when tested in a broad population, to affect week of onset or severity of PE, and I'm not sure it does much to affect fetal growth either (but am not as familiar with those studies.) Our Experts have said somewhat discouraging things about bedrest in the past and I'm quite sure no one would be willing to tell you that you were "safe" or even "safer" because of it; it's justused because it's one of the only things that's available to the pregnant population.

[ktsl123]

When I had severe preeclampsia my blood pressure was at least 160/90 sitting up, but laying down was down to 120's over 80's. The Dr's thought I could go home on bed rest and monitor me every 2 days until they checked my urine which was 2160 of protein and my blood work was slightly elevated. My Dr said I was heading in the direction of hellp

[RogueFemale]

This is such helpful information from all of you--and it's rather sobering, as well. That's the nasty and frankly scary thing about this spectrum of disorders, isn't it--that it can look so different, on a case-by-case basis. I so wish there were some sort of easy diagnostic "test" for everyone. Every day that I feel lousy and nauseated, for instance, my mind starts to wander . . . do I feel this way because I am 33 weeks pregnant and have joint pain (sadly, I think my rheumatoid arthritis is starting up early rather than waiting until AFTER the pregnancy is over to flare, the way it's "supposed" to). Do I feel lousy because I've been stuck on bed rest for so long and just desperately need fresh air and sunshine? Or is something else going on that is causing me to not feel just right?

I certainly don't want to be paranoid, ad believe me, I'm SO grateful to have gotten to this point of the pregnancy with a healthy, growing baby. But as we get closer and closer to our hoped-for delivery point during the final week of the year, all these fears keep coming in. The thing I am MOST afraid of is another placental abruption--the previa I can handle, and I have no problem with another c-section, and I laugh at the idea that being 41 will make any sort of real difference. It terrifies me because my son and I barely made it last time I had an abruption, in 2007. And even though I know there's only a 10% chance of another abruption occurring, and even though I realize there's no direct proven correlation between high blood pressure and abruption, I'm scared because I know that pressure can be an important factor. And my numbers are currently running as high as they were 3 years ago (and that's WITH Procardia--last time I wasn't on any medication at all).

So I see my OB this Wednesday, and she told me a few days ago that she wants to decide whether or not to put me under observation in the hospital until it's time to deliver, in order to monitor more closely my labs, my BP, and my previa. And of course that would be Christmas week. Of course. I just don't know what to do or say about that. And believe me, I do feel guilty about coming here to whine, when so many other parents here have suffered devastating losses and have been SO much more ill than I've ever been. My concerns feel so petty in that context. But, well, I guess I'm just scared now that I can see the finishing line.

I'm sorry. I'm truly rambling here.

[heather j]

I completely identify with you fear of another abruption. This is my second pregnancy since having an abruption with my first and it's what I've most feared both last pregnancy and this one. I knew something was definitely, unmistakably wrong when I had mine, but there are so many times that they are silent. I'll be 33 weeks this week. Are you getting BPPs? We do them weekly, and that's one (of many) form of monitoring I did not have with my first. It does help to ease my concerns ... somewhat. If there's one thing I remember from last time that is holding true again, it's that the homestretch is HARD even in the best of subsequent pregnancies. Hang in there.

[RogueFemale]

Thanks so much for your perspective, Heather--and it looks like we're in the exact same spot in our pregnancies (I'm at 33w 5d today).

I am doing BPPs about every other week, both to check on the previa and to monitor for any beginning abruptions (because I know there is an increased risk of that happening with a previa, once the cervix starts to dilate). But I'm still scared because an abruption can happen SO suddenly and SO unexpectedly. Besides PIH (I wasn't even spilling any urine at that point), I had absolutely no warning signs, not even the proverbial intense pain. The only thing that let me something was going terribly wrong (two days before my scheduled induction because of HBP) was when I woke up to a massive hemmorhage. It's so hard to get that out of my mind.

Are you getting a c-section, if I may be so bold to ask (there is no other option for me)? My due date's not until Jan 26th, but my doctor and I want to deliver my little guy in week 36 (not even sure if we'll do an amnio first to check for lung maturity)--there's some research that if an abruption occurs again, it's more likely to happen at a date earlier than the first time, which for me was 36w 6d (and I'm sorry--I don't have a citation for that--it may have been published in the American Journal of Obstetrics and Gynecology).

[heather j]

I, fortunately, did have seering pain and didn't start bleeding until I was in l&d. I also had been on left-sided bedrest for 6 weeks and was spilling protein with erratic bps. What you've described your experience as is the abruption scenario that scares me. Yes, I am most definitely having another section. We're planning on an amnio at 37 weeks to the day and delivery that morning if the amnio is a go. This was the plan for my last one, too. That puts me one week later than my abruption with my first (and it was a hard week last time); I was 36 weeks by barely an hour. Here's hoping 36 and 37 weeks get here quickly for us both.

And I know you said you aren't concerned about another section, but I found the second one to be an easier recovery and smoother delivery.

[RogueFemale]

Here's hoping 36 and 37 weeks get here quickly for us both.

Bravo to that! We're almost there! (And that actually kind of scares me--I'm not superstitious, but I always feel like I'm about to jinx myself when I say that!)

And I hope you're right about the second c-section. I have heard that it's somewhat easier, and I'm hoping that's true (though I'm already so weakened from so many weeks of bedrest). Since the first one was such an emergency situation and I had in no way prepared for it mentally and I lost so much blood in the process, I am thinking that at least mentally I know what to expect!

You hang in there, too!