Is this still pre-e? 24 hour results went down

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twolittlebirds
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Re: Is this still pre-e? 24 hour results went down

Postby twolittlebirds » Wed Feb 23, 2011 10:42 pm

Wow, thank you for the explanation, Caryn! That's really interesting. The big babies part is especially interesting to me. My twins were born at 35w6d and were pretty large for their gestational age at 5lbs13oz and 6lbs10oz. I was so surprised that they would be that big when I was having so many issues.

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caryn
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Re: Is this still pre-e? 24 hour results went down

Postby caryn » Wed Feb 23, 2011 10:47 am

In all pregnancies the chemicals that are associated with preeclampsia are produced by the placenta. They're just produced early, and in excessive amounts, in the pregnancies that are preeclamptic. Those chemicals damage the bloodstream by preventing quick repair of the lining of the blood vessels - and the vessels in the kidneys spill protein as a result.

A lot of women who are chronic hypertensives (or who will be as they age) are a bit more sensitive to the beginning of this. As I understand it, our repair process is a bit slower and so it's easier to disrupt. So we can limp along at the edge of danger for a while, and then have everything worsen quickly when the placenta finally begins to give out.

Here's the more technical explanation: soluble Fms-Like Tyrosine kinase (sFLT) is one pregnancy chemical, and is dramatically elevated in PE. It binds to Vascular Endothelial Growth Factor (VEGF) and pulls it from circulation. VEGF helps repair the vasculature, and each individual has different baseline levels of it in her bloodstream. Women with less baseline VEGF (or maybe less active VEGF or something like that) are more likely to be chronics. Pregnancy depletes those VEGF levels because pregnancy produces sFLT, which binds to VEGF and makes it inactive. So some of us are just running lower levels and even in a regular pregnancy it's hard for us to keep up.

When the placenta develops real hypoxia (this happens as fetal growth outstrips the ability of the placenta to ferry blood) the hypoxia increases production of sFLT. That's likely because damaging the blood vessels at the interface between the placenta and the uterus makes it detach postpartum. But since we're not in labor and the placenta isn't *supposed* to shear off yet, what it does to us is a) damage all of our vasculature, and b) make us more likely to develop placental abruption. Much more likely.

Chronic hypertensives are more likely to develop what is called "superimposed" preeclampsia, where the placenta might not even be shallowly implanted as it is in the case of a classic preeclampsia patient - instead, it's just much harder for our bodies to tolerate pregnancy in the first place and we develop it in a quarter of our pregnancies. Or, our immune systems might respond to the arrival of the foreign placenta by making it implant shallowly, but that particular placenta is able to compensate for the shallow implantation by manipulating other maternal metabolic factors, at least for a while.

One interesting thing about chronics is that a lot of us on the boards seem to have seriously big babies. (My firstborn was on track to hit 10 pounds plus at term, had I gotten that far. If the placenta was shallowly implanted, how did it manage to ferry that much blood and nutrition? Well, possibly by mucking about with my metabolic rate, which it definitely did. Or maybe it was implanted normally, and I just couldn't tolerate being pregnant any longer because the VEGF wasn't free to repair my blood vessels because I just don't make a lot of VEGF in the first place. There's no way to take a good look at the depth of implantation of the vessels in a pregnant woman, so the researchers are trying to work out a good way to determine which of these might be the case.)
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

twolittlebirds
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Re: Is this still pre-e? 24 hour results went down

Postby twolittlebirds » Tue Feb 22, 2011 04:41 pm

As an update, my latest results this week were right at 300, so it looks like I get to stay pregnant a little longer, at least. My labs are all coming back fine and my BP is high, but not crazy high yet. Weekly NSTs and kick counts are all showing baby girl is doing ok, too.
This sucker moves fast when it moves.
This what I keep waiting for. :( It's so nervewracking not knowing when!

I did have a baseline done near the beginning of pregnancy, and I can't remember the exact amount, but it was under 150. What would cause you to spill protein around 300 throughout pregnancy?

crowderkb
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Re: Is this still pre-e? 24 hour results went down

Postby crowderkb » Mon Feb 21, 2011 08:11 pm

Did you have a baseline done early in the pregnancy? I started my pregnancy with 300 in my urine and they weren't concerned until it went higher than that a few weeks ago. Now it is back down to 200, so who know what is going on, but the MFM seems much more concerend with bloodwork, BP and baby factors than with the protein.

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caryn
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Re: Is this still pre-e? 24 hour results went down

Postby caryn » Wed Feb 16, 2011 07:40 pm

Along with Angie's anecdote about rapid changes, here's mine: I went from a trace dip to +17,000mg proteinuria in under a week.

This sucker moves fast when it moves.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

angieb
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Re: Is this still pre-e? 24 hour results went down

Postby angieb » Tue Feb 15, 2011 02:47 pm

319 still really isn't great. Higher than it should be for non pre-e. And it doesn't always have to be consistent. You might have had 319 today but tomorrow you could be at 600+. I have a blogger friend who doesn't post here who went from a normal (100ish) 24 hour urine to spilling 1000 in less than a week.

And, spilling protein doesn't always mean much in the scheme of severity. I didn't even spill a trace of protein and yet I had full blown HELLP. It just affected my liver and platelets instead of my kidneys or blood pressure. (My liver enzymes were literally doubling every 6 hours to the point they were concerned my liver was on the verge of rupturing, and my platelets dropped by 100,000 in 6 hours and kept steadily declining from there...all the while..my blood pressure was fine and I wasn't spilling protein.) I did have URQ pain and some swelling, but there isn't really a "normal" case where they know exactly how sick you will get and how soon, it can be and often is different for everyone. You might have a milder case and make it full term just fine, or you could have a severe case and suddenly end up in the hospital tonight or tomorrow, or some variation in between. It's very hard (I'd say impossible) to predict, how or if it will progress.
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/

alexa5
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Re: Is this still pre-e? 24 hour results went down

Postby alexa5 » Tue Feb 15, 2011 12:04 am

But the thing is that everything can change on a dime. It might seem slow, but it can go from bad to worse very quickly. It doesn't mean it will, but many of us got to the point of delivery quickly because of the pre-e suddenly getting worse.

twolittlebirds
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Re: Is this still pre-e? 24 hour results went down

Postby twolittlebirds » Tue Feb 15, 2011 10:10 am

So what do you guys make of this? :? I got my latest 24 hour urine test back and it is over 300 again, but barely.

2 weeks ago - 325
1 week ago - 250
yesterday - 319

If this is pre-e, it sure is slow going!

twolittlebirds
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Re: Is this still pre-e? 24 hour results went down

Postby twolittlebirds » Tue Feb 08, 2011 06:32 pm

Thank you for the replies. I'm still going to be closely monitored with weekly NSTs, appointments, and 24 hour tests, but this result threw me for a loop. I didn't realize the numbers could go down with pre-e. I've been really hoping they were right and that it might not be pre-e since I'm just 28 weeks. :(

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caryn
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Re: Is this still pre-e? 24 hour results went down

Postby caryn » Tue Feb 08, 2011 05:54 pm

Once you've scored a number over 300mg, it's preeclampsia even if the number fluctuates from that point. Proteinuria can sometimes change in response to bedrest, or diet, temporarily. It's just a marker of the disease, so treating the proteinuria by lowering the number via positional or dietary changes that let less protein fall through the holes doesn't make the holes, or the disease, go away (the same is true for therapies that lower blood pressure.)

Shortly we should have a bloodwork diagnostic test that will actually be able to measure the levels of the two known proteins in the bloodstream, sFlt-1 and sEng, that are the biochemical cause of the downstream symptoms like proteinuria and hypertension. Unfortunately, at the moment it's only available in Europe.

The docs are more likely to suspect chronic hypertension than other underlying disorders simply because most preeclamptics turn out to be chronic hypertensives. :)
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy


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