Alternative diagnosis

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Re: Alternative diagnosis

Postby caryn » Wed May 23, 2012 10:34 pm

Labor itself causes spectacular changes in pressures, because hypoxic placentas produce more soluble flt, which pokes little holes in your vasculature, which freaks out your kidneys, which send out vasoconstrictors because obviously something is wrong because all of the fluid is leaking out into your interstitial spaces between your cells instead of coming to visit them, so your blood has the wrong ratios of stuff, which triggers release of said vasoconstrictors. And placentas get hypoxic - short of oxygen - because you're contracting. So there's really no way to not be contracting and still have a baby except Caesarean, which... yeah.

Preeclampsia is just a runaway train. There really aren't a heck of a lot of "good" options, except the ones where everyone lives!
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)
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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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Re: Alternative diagnosis

Postby blythe » Thu May 24, 2012 09:51 pm

I assume pitocin can raise your bp just like labor can raise your bp (and the preeclampsia biology Caryn describes is both fascinating and a scary reminder of why labor and the first 24 hours after birth are especially dangerous) - but I'm concerned about your statement "And that can actually lead to many of the same things preeclampsia causes."
That doesn't seem accurate to not-a-doc me. Here's a study that lists complications of preeclampsia, I'm not aware that hypertension from effort (I'm thinking hard exercise or weight lifting as a comparison?) has any similar bad outcomes:
CONCLUSIONS: (1) The morbidity of severe complications from high to low are: placental abruption, DIC, induced cardiopathy, renal failure, cerebro vascular accident and HELLP syndrome. (2) The main causes of mortality for gravida and puerperant are: cerebro vascular accident, HELLP syndrome, DIC and induced cardiopathy. (3) The major complications harmful to perinatal newborns are in the order of: placental abruption, HELLP syndrome, DIC, renal failure, cerebro vascular accident and induced cardiopathy.

My understanding is that the blood pressure increases and the other complications of preeclampsia are symptoms of the underlying pregnancy dysfunction.

I can "hear" you still trying to wrap your mind around all this, you're doing good, keep reading! If you can find more specifics about why pitocin would be similar to preeclampsia I'm more than happy to learn more! Oh - and I can't find it right now, but I'm sure there's some other Expert responses about the 30/15 increase, and I'm pretty sure there's one about pre-hypertensives and hitting the 140/90... have fun in the Ask the Experts archives and let us know what you find! Also, keep in mind that the 140/90 is a *research definition* - women can and do get sick at lower pressures, with and without protein, with and without bad labs. The research definitions are very important for research, but in practice, doctors have to be more flexible! Our Experts say over and over that "doctors treat people, not diseases".
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

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