Blood pressure going up at 24 weeks

[bnicolef]

Hello. I'm new here. 24 weeks, 5 days pregnant with my second child. I didn't even know I was expecting until 16 weeks along, it has been a dream pregnancy until the past week. On Sunday I woke up with a swollen face, hands, and feet. Had a mild headache, but not too bad. I happened to check my blood pressure that evening at the store, and it was 140/80' s, and my blood pressure is normally 105-100/55-50. I was a bit concerned, but had an appointment the next morning, so I didnt worry too much about it. Then I took my blood pressure a few hours later, different store, nearly the same numbers. That night I had severe pain for the second time ( it had happened two nights before) that just felt like the worst indigestion ever. Right beneath my ribs, felt like I was being crushed. I was about to call the midwife when it went away. I assumed it must have been indigestion. The next morning I went in, swelling had went down, explained what had happened the day before. My blood pressure was 118/62 and I had gained just under 15 pounds in four weeks. She decided to do lab work, but only scheduled me back in in another four weeks, and didn't seem too concerned since my blood pressure wasnt very high, and I wasnt very swollen. Fast forward through the week, my average blood pressure is now 135/76, with spikes in the 150/90's, visual disturbances with the headaches ( they feel like very dull/ mild migraines) and lots of face swelling. The nurse seemed extremely concerned when I told her what was happening, so I rushed into the office. My blood pressure had been 155/82 when I left the house. When I got to the office, it was down to 135/76. I was told to go home, sit in a dark room, take tylenol, drink coffee, and see if the headache went away. It didnt, and when I called them, a new midwife was on call. She told me to go to the ER, that everything was normal for pregnancy, except for the headaches, those could not possibly be pregnancy related. The ER doctor couldn't say anything about anything, except that he couldn't figure out what was causing the headaches, and I really needed to see my midwife about my blood pressure. He did say that on Monday I had no protien in my urine. So, now it's Friday evening. I'm unsure of whether or not I am just overreacting. Ive never had high blood pressure. I also don't know what to do, or what I should be asking the midwives to do. I hope it's nothing, I hope I'm overreacting, but I have a terrible feeling. I've had it since I woke up last Sunday with my face swollen. Any advice? What would you do in my situation? Thank you in advance, my husband and I are just so confused. I never had any blood pressure problems with my daughter, same father as this one.

[bnicolef]

Oh I think I posted this is the wrong place and can't figure out how to move it. So sorry if I did!

[kerisue]

As valuable as ER docs and midwives are, they are not the experts on preeclampsia. If it was me with your symptoms I would want a consult with a Maternal Fetal Medicine specialist (Perinatalogist) as soon as possible. Good luck and I hope it's nothing.

[caryn]

Seconding Kerisue - I would go to the L&D of a hospital with a Level III NICU, because when preeclampsia *does* show up early, that's where we are treated, so they are used to seeing us and know how to rule out these problems. Midwives do not usually see us and don't care for medically complicated patients, so they do not always realize (they probably see a lot of late PE, but not early cases.)

[bnicolef]

Thank you for the replys! I ended up going in to the l&d triage on Saturday to get a second opinion. My blood pressure was in the 130/75 range, which is what is had been all day. I was told that was nirmal. The midwife refused to tell me what symptoms to look out for, what blood pressure I should call about. She actually told me to go home, ignore all of my symptoms, and to not take my blood pressure at home.
I called the office today to see if I could come in, since my blood pressure has only periodically dipped below 140/80's today. She said no, because my blood pressures were all fine in the office lasr week, and to take tylenol if I had a headache. I could make an appointment for later in the week if I wanted to.
The way the office works, I have to be reffered to see a doctor by a midwife. I can switch hospitals and see a doctor possibly, but I would be going to a lesser hospital, and I would just get transffered right back to where I am. All of that would leave me waiting for weeks before I could even speak to a doctor.
I keep trying to convince myself that I am over reacting, and then I do something like stand up and my vision messes up and after 10 minutes of sitting my blood pressure is 150/85.
I don't know what to do. I am supposed to fly across the country for the easter holiday, and I
don't feel comfortable without being properly assesed and monitored.

I know no one is a doctor, but since the midwife won't give me a number, what would be a number for me to just go in to l&d or the er? Obviously if I have any new or worsening symptoms I will go in regardless, but is slightly high blood pressure immediately dangerous or should I just wait until the morning?

[blythe]

Can I ask your general location? Are you in the US or possibly England or Australia? I'm surprised that your midwives are gatekeepers to seeing a doc and i'm wondering what experiences we might have with different care systems to help you navigate your health care as best as you can.

As for bp, our experts have said that anyone with an increase of 30/15 over baseline during pregnancy should be watched closely but that 30/15 increase isn't diagnostic. Two readings taken at least six hours apart of at least 140/90 is diagnostic for pregnancy induced hypertension, and those bps plus 300mg protein in a 24 hour urine collection is diagnostic for preeclampsia. In your shoes, since the midwife wouldn't give you a call-in number, I would call l&d and ask them when they would like you to call.

I hope we can help you find a way to talk to your health care providers and get a clearer treatment plan, especially considering your upcoming travel. Hang in there!

[bnicolef]

I am in the US. When I call after hours or go to labor and delivery, I speak to or see a midwife. I have medicaid, and while they don't specify that I have to see a midwife, the only two places that accept it use midwives, and require you to be refered by a midwife to see one of their doctors.

[amjon]

If you haven't already INSIST you see a MFM! I had borderline readings and was sent to be evaluated (at 26+1). I was told everything was fine and to go home and continue care with the MW. She died on 26+5. If they won't give you a referral tell them you have notified them that you think there is an issue that requires OB care and if they will not give you the referral then you want them to sign that they are refusing to transfer you for a referral and will be responsible if anything happens. I bet they'll change their mind then.

[blythe]

I wish I knew more about the medicaid system - anyone with experience, please speak up! In your shoes I would just keep watching your bp and signs and symptoms and keep calling and going in when you have concerns! We've had women with bps that spike then come back to normal for their entire pregnancies and go full term, and we have women like the previous poster who have gotten sick very quickly with tragic results. There's no way to predict the course of the disease, that's why we get watched so closely, and sometimes spend weeks in and out of the hospital. How are you doing today?

[alexis]

Hmm... Well my experience is limited. (I have never been on Medicaid for pregnancy though I know women who have.) I do know how hard it is to find providers that take Medicaid, and practices that do often rely heavily on midlevels. I know the FQHC I went to was primarily CNMs for OB/GYN.

There may not be an MFM taking Medicaid. (I remember once looking at the specialist lists when my daughter had Medicaid and seeing how few would take it.) if there is it would ordinarily require a referral from OB--even if MFM sees self referrals, Medicaid normally requires them.

How many midwives are there? Any chance of rotating? I would try to bring in a detailed log with times and explain exactly what makes your BP rise. Pregnancy gave me orthostatic hypotension. My BP would be fine sitting but would drop badly on standing. Not the same problem as you, but because I was able to describe it, the doctor took my BP sitting and then immediately on standing and was able to see the drop for himself.