advice please?

[JJ]

Hi,

I'm 33 weeks pregnant. I have had pregnancy induced hypertension since about 30 weeks with bp around 165 over 110 at its worst. Was in hospital for a week trying to get the bp down with medication. So I'm now on 500 mg of methyldopa 3 times per day and 10 mg of nifedapine twice per day. I've had to take my maternity leave early because I can't possibly work when taking the methyldopa as they make me so drowsy. So far I have only had a trace of protein in my water when having weekly check ups and my bp has remained controlled so no one seems concerned. However, I can't help but feel that something is not quite right because of the extreme water retention in my hands, feet and face. I know some swelling is normal but I can't get any shoes on my feet. I've had to buy flip flops especially, a size too big as that's the only thing that will fit and they still leave a dent! I tell the midwife about my swelling but she doesn't seem concerned as it's not accompanied by protein in my water. So far I have had no other signs of pe but I don't want to wait for it to get to a severe stage but I have a strong feeling its more than just pih. I did have a head ache that lasted all dc a few days ago but nothing since. I tested my urine this morning and there was a plus of protein but not later on. Baby is moving fine, am I right to be concerned or just paranoid please help

[caryn]

Welcome to the forums. I'm glad you've found us.

No, you are not paranoid. Not even a little. Numbers like that appearing for the first time after 20 weeks of gestation are likely to mean that you're experiencing the early stages of the umbrella condition we call preeclampsia. It's great that they're controlled with meds right now, but the disease is could still be progressing in the background and you'll want to stay vigilant for any progression of symptoms. 50% of women with new hypertension before 32 weeks develop preeclampsia (I say "probably" because sometimes it's unmasked chronic hypertension that never progresses to clinical disease, not even postpartum) and those are *high* spikes.

In your shoes I would want to be tracking and logging your pressures at home, running frequent 24-hour urinalyses, and following up on any new symptoms.

Technically, swelling has been removed from the diagnostic criteria for preeclampsia, because pregnancy swelling is weird stuff and women with normal pregnancy can have crazy swelling. But in someone who's already a severe gestational hypertensive, swelling like you're reporting is worrisome.

You're in the UK, right? Here's a link to PRECOG, the care guidelines that should be in play for you now that your pressures are so high: http://www.bmj.com/content/330/7491/576.full

[angieb]

I second what Caryn said about not being paranoid at all.

When you say you only have trace protein, are you doing a urine test where you just give a sample in the office, or are they doing a 24 hour urine test? (Where they give you a container to pour your urine in for a 24 hour period...) In office tests are not considered as reliable because someone can have pretty diluted urine if they drink a lot of water but still be spilling a lot of protein when all of their urine from a 24 hour period is tested. The diagnostic criteria (at least in the US), for preeclampsia of 300 mg of protein or more, is based on a 24 hour urine test. If you haven't done a 24 hour urine test yet, I would call and ask for one first thing in the morning. (Disregard this if they are already doing 24 hour urine testing.)

[JJ]

Ah thanks so much ladies, its nice to hear people so well informed. I did have a 24 hour test when in hospital, I'm not sure of the numbers but they said that it was ok (as were my blood results) but I feel like my wfaterworks seemed to have changed somewhat since then. I drink alot and am usually back and forth to toilet every 5 minutes, but am urinating far less frequently now even though I feel that I am drinking the same. I just seem to be retaining it. So I have just been using the dipsticks at home and this morning was showing a + 1. I also have a blood pressure monitor at home which is not completely accurate but reliable enough that if I get a very high reading I need to go in and get it checked. I do have a manual one but can't seem to do that very accurately because I can't hear the artery under all the swelling! But when ever the midwife checks it, it's usually aroud 135 over 85, which is not great considering I was 100 over 60 at the first readings of pregnancy but they consider it stable. Also forgot to mention that I've had a growth scan and baby has grown just fine so far, bigger than average when plotted on a graph, which is a good sign. I'm due to see the midwife Thursday, I think I can wait until then for an accurate bp reading as I can't see it spiking too high on all these tablets but I think I'll ring the on call midwife today and ask them to do a 24 hour urine sample. I don't want to be a pain but I think you just can't be too careful with things like this. Thanks so much for all the info ladies, its so nice to have some support, I think these pregnancy and health forums are a god send, probably saved lives.its so important to keep people well informed. Hopefully, if all this turns out well, I can be of some use to someone else one day! thankyou so much again girls, really appreciate it! : )

[angieb]

If your last 24 hour urine was around 3 weeks ago, definitely you want to do another soon. As Caryn said, with all of your symptoms and everything, doing them weekly in your case would be very appropriate. They are a much bigger pain for YOU to actually do (ugh) than for your midwife to order. As far as testing goes, they are cheap and easy to be ordered.

[JJ]

Well my bp shot back up to 160 over 110 this morning, guess I was right to be concerned! In hospital now, they are monitoring my protein and bloods, which are elevated but not at a dangerous level. Best place for me I suppose, still a Bit scared though!

[JJ]

Hi ladies, could do with some more advice if anyone can help. I am still in the hospital, 33 weeks today. Was in antenatal ward but moved to labour and delivery as bp was spiking really high between doses. My protein is a +3 so I've been diagnosed with pre eclampsia now and looks like I'll be staying in til baby is born. I have had steroid injections for his lungs, the last of which was this evening, so they want at least 24 hours until tomorrow evening to take full effect and then take things from there depending on how my symptoms are progressing. At the moment my blood work is ok, showing increases in lives enzymes etc but nothing that they are concerned with as yet. MY worry is really, how do the judge the balancing act of keeping baby in as long as possible for maximum benefit without putting him at risk of being defeated. I'm concerned about my swelling, it's getting worse, they are measuring urine output which is far less than consumption so my kidneys are clearly not working as they should. My worry is that if my body is storing water at this rate, it could well lead to swelling on the brain and convulsions. IS it possible to get to that point before other blood results get out of control. So far there's no visual disturbances or epigastric pain. But will they wait for it to get to that point before they consider benefit ouweighs risk of delivering baby? They said the c section would be in the next few days but I'm worried at potentially how fast the disease can progress and how far it will go to buy time. MY bp is stable at the moment as my dose of methyldopa and nifedapine is at maximum but it's anyone's guess how long it will stay that way. Any advice would be much appreciated, thanks : )

[angieb]

If your liver enzymes are increasing then there is a possibility that you are heading towards HELLP syndrome which usually means delivery ASAP. When they realized my bloodwork was going bad with DD, they redid it every 6 hours. It sucked, but I am glad they were really vigilant. (I ended up having labs drawn every 6 hours for 3+ days until they finally started getting better, even after delivering on day 1.)

I would ask them to keep checking your bloodwork because labs CAN go bad quickly. My liver enzymes went from "slightly elevated" upon admission to doubling in 6 hours, meanwhile my platelets dropped by 100,000 but I honestly did not feel any worse and my blood pressure was normal. My labs continued getting worse from there. Not saying that yours will, or that the elevated liver enzymes are a sign of HELLP for sure, but it's certainly something they should be watching VERY VERY closely.

My guess is that if your labs get much worse, they will be delivering the baby pretty quickly regardless of how far along you are. They may be telling you "in a few days" while they are really thinking that you might be delivering tomorrow. I know in my case my OB had me transferred hospitals and was going to keep me there on bedrest for a few weeks, until an MFM was consulted (and she consulted a few more on her own), and they insisted I had to deliver immediately...even at 23 weeks. (She didn't misinform me on purpose or try to mislead me, she underestimated how bad it was and hadn't talked to an MFM yet.) At 33 weeks with everything you have going on, I am guessing they are not going to push their luck very much farther. 33 weekers do need NICU time but generally do extremely well, the survival odds are the same or very close to the same as a fullterm baby. If you aren't being followed by high risk doctors/maternal fetal medicine specialists/perinatalogists (all interchangable terms for the most part), then I would definitely want someone experienced in high risk pregnancies making the important decisions.

I don't think they will deliver you for swelling alone but it's possible that they may just be waiting for the second round of steroids to have time considering everything else. Definitely be sure to mention your concerns.

Thinking of you, please keep us updated as you are able.

[caryn]

I'm glad followup got you properly admitted.

With swelling where output is lessened they will mostly be watching for pulmonary edema, because the seizures in preeclampsia are usually foreshadowed by headache and/or visual disturbances and/or hyperreflexia. They will also likely be monitoring labs closely, as Angie mentioned, doing fetal monitoring, etc. If you do develop some pulmonary edema they will probably get you oxygen and start an induction, but be ready to deliver if anything goes pear-shaped. I had oxygen at the start of my induction but then we moved to section for fetal indicators, delivered at just 34 weeks and little only spent a week in NICU so you are in a comparatively good space even though this really sucks and is not ideal.

Please keep us posted as you're able.

[JJ]

Well thanks for all the advice! Just thought I'd update you all. I'm now a proud mother to jaiden, delivered by emergency c section 5 days ago at 33 weeks plus 2 days gestation. At 4lb 13oz we are both still In hospital but he's doing amazingly well. It was an awful experience and he has been in an incubator on oxygen which was just heartbreaking but is now in a cot in special care unit breathing on his own, doing absolutely amazingly, the only thing he has to work on is his feeding before he can come home. So I'm feeling like one very lucky mummy at the moment! So the pre eclampsia developed, even though my blood results weren't too concerning and my kidneys were showing some signs of dysfunction as far as the docs were concerned but 'not as bad as some' according to the midwives but my bp was out of control. They tried some extreme measures to try and keep it down, It stayed down for a day, at which point the panic seemed to just disappear and the midwives seemed convinced I could hold on for a few weeks and I never really got a straight answer from the docs. But as I predicte it got way out of control very fast and I ended up in high dependency hooked up to an iv with catheter and fluid restriction to monitor my kidneys. I knew my body was just shutting down and was relieved that I was finally being taken seriously because it seemed that as long as the symptom of high blood pressure was being masked no one batted an eyelid because my blood results weren't the worst they'd seen. But this condition is a mixture of symptoms and everyone is different. Anyway after a night of absolute * I was finally given a c section and even though I was only 33 weeks I honestly felt that the baby would be safer outside of my body because it was just shutting down. I was petrified but I knew it was the right thing. Now we are both on the mend. MY bp is still high but all other symptoms have subsided. My boy is just thriving and I'm sure he will be home in no time