Possible onset of pre-e found at 24 weeks

[acm990]

Hi ladies, I am so glad to have found this site!! Hoping for some insight into what I could be facing..

Last week on my 24 wk appointment I went in for the second half of my a/s (since LO had been difficult and curled up the first time) and for a regular prenatal visit with my Dr. I had a few concerns that I was planning to discuss with the Dr. but I didn't get the chance to share them before he gave me the news that my bp was 140/85. I mentioned to him the concerns I was having:

*Severe swelling in hands and feet as well as puffiness in my face
*Headaches
*seeing spots and flashes of light from time to time, before having a sharp pain in my stomach and vomiting

Up until my 20 week mark I had only gained 1 lb and as of 24weeks I had added on 8 lbs in the past 4 weeks. He said my weight gain is excellent, but said the swelling was a cause for concern and mentioned the possibility of removing me from my job (in a factory which obv didnt help the swelling) and to consider my options as far as STD was concerned, to start planning because I could have the onset of Pre-e. He said that it was rare to see it this early in a pregnancy however, and so he almost didn't believe it and would like to see me back in two weeks.

This week however, the swelling was getting worse and I had been monitoring my bp and decided to make a call and get myself into the office to get checked out..I figured feeling so bad like I have been wasn't a good sign and I needed to be seen sooner. So I went in Tuesday to see a different Dr in the practice, whom I have had previous appointments with. She made the decision to take me off of work and put me on bedrest. NO protein was found in my urine, just the high bp and swelling. She set up a fetal growth u/s for tomorrow and I have an appointment with her afterwards.

I haven't had any issues before with my bp so it seems to be pure gestational hypertension.

My question for you ladies is more or less, Have any of you had signs or symptoms this early into a pregnancy that DID indicate pre-e was forming?

I am overwhelmed. Not only is being off work a stress added, I can't help but panic over the thought of my LO coming so early and the problems we will both face. He has been before now, in the 95th percentile and healthy..I am just worried seeing as pre-e can come on so quickly and things can change in the blink of an eye. Any insight into experiences like mine would be very helpful. Thanks Ladies!!

[cgoodi1]

I had symptoms at 18-19 weeks pregnant. My doctor dismissed them and at 21 weeks I went to the hospital for a second opinion and everything went downhill. My baby died inutero literally ten minutes after we were in the hospital (not to scare you) and I had to give birth to my stillborn baby. I was admitted for 1 week. My pressures were really high and the protein in my urine was ridiculous. I went to see an MFM and she was so surprised at how severe it was. So far I don't have any underlying problems that could have caused this so yes... at 24 weeks preeclampsia can happen and it can be bad. I would keep monitoring your blood pressure at home and every time it's high go in to the hospital. I wouldn't want you to have what happened to me occur.

[ktsl123]

I had swelling that started at 4 months preg and in my face as well. I developed PE in the 34th week.

[acm990]

cgoodi1- I am so sorry for what you had to go through and the loss of your LO. I think you are absolutely right about being an advocate for yourself during pregnancy and all other times. Thank you for the advice

[angieb]

No protein in your urine in an in office dip test means NOTHING. One of my friends had an appointment just last week and had no trace of protein in the office sample, but when she did a 24 hour urine test (which her doctor ordered because she had other signs of pre-e), it came back at 250 mg (pre-e is diagnosed at 300 mg and two readings of 140/90 or higher.) We tell people this all of the time here, but even I was surprised at how high her 24 hour urine came back without even showing a trace in the office test. Request a 24 hour urine tomorrow (or demand it if you have to. Tell them you would like it noted in your medical records that you requested a 24 hour urine and that they have declined.) It drives me crazy that doctors don't order this when there are other symptoms of preeclampsia present. It is a cheap test, a pain in the butt for you to do, but a very basic standard of care. (Disregard this if you have done a 24 hour urine test and it came back clear, that's another matter altogether, but from your post it sounds like you just did an in-office sample. A 24 hour urine is where you collect all of your urine for 24 hours and then turn it into a lab so they can measure how much protein your kidneys are spilling, if any.)

If you are heading towards pre-e at 24ish weeks, which it sounds very possible you are (I had severe preeclampsia and HELLP at 23 weeks, our daughter passed away shortly after she was born, it is *very* possible to get it this early.) You should be seen by a Maternal Fetal medicine specialist or perinatalogist, someone accustomed to working with high risk pregnancies, not just a regular OB. I would also request steroid shots sooner than later. There are some women who end up delivering within days or even hours of being diagnosed. And then there are women who are diagnosed but manage to stay pregnant for several weeks and even months before they have to deliver. Since you don't know how rapidly it might progress and right now you are near diagnosis-levels in the micropreemie gestational age range, you absolutely positively want to get steroid shots to help develop the baby's lungs before you deliver, if there is time. Timing them is tricky because they are two doses 24 hours apart and need 48 hours to work, but ideally you want to get them as close to delivery as possible. I would err on the side of getting them too early vs. possibly not being able to get them at all. (In cases like mine, I was admitted to the hospital at 3am, our daughter was born at 8:48 pm that same day, no time for even 1 dose of steroids because it was so emergent.) Steroids are no guarantee, but they make a huge difference in the survival rates of micropreemies. Definitely keep an eye on your blood pressure at home.

[lemons]

I only have a couple of minutes to post, so this is going to be short and to the point-
Sorry that you had to find us here, but glad that you did.

In your shoes, I would want three things done as soon as possible-
1. an ultrasound to check baby's growth, blood flow to the placenta and to baby, and amniotic fluid levels (sounds like this will be done tomorrow).
2. a 24 hour urine collection (since spot urine tests aren't always accurate).
3. blood work to check your liver and kidney function (what we call "labs" here on the forums).

In my opinion (and I am not a physician), I don't think that you can be diagnosed with "only" pregnancy-indued hypertension (PIH, aka gestational hypertension) and not preeclampsia without doing the 24 hour urine and blood work. Especially, since you have swelling, gastric pain, and visual disturbances- all are serious symptoms of PE/HELLP. If the 24 hour urine and blood work turn out normal, then your OB will probably start talking to you more about PIH and taking BP medication to help control your symptoms.

Good luck tomorrow. Please keep us updated as you can. And keep posting if you have any other questions or need some encouragement!

[acm990]

Thank you both so much for your stories and suggestions. I am in fact having a fetal growth check tomorrow, with a maternal fetal specialist, on a different floor of the hospital. I will bring the 24 urine up to my doctor and also inquire about the blood work. I haven't had any blood work since before my 20 week appointment...its possible that they could already be planning for this tomorrow. Good news through all of this is that the hospital in which I have my appointments and will deliver at is the only one in my city with an NICU, and its level III. That does give me comfort atleast

[angieb]

Thank you both so much for your stories and suggestions. I am in fact having a fetal growth check tomorrow, with a maternal fetal specialist, on a different floor of the hospital. I will bring the 24 urine up to my doctor and also inquire about the blood work. I haven't had any blood work since before my 20 week appointment...its possible that they could already be planning for this tomorrow. Good news through all of this is that the hospital in which I have my appointments and will deliver at is the only one in my city with an NICU, and its level III. That does give me comfort atleast

I am glad that you are seeing an MFM tomorrow. While they are doing the ultrasound, ask if they are/will/can do a blood flow study (also referred to as a "doppler blood flow study"), they might already automatically do it along with the growth check but it wouldn't hurt to ask. (It is an ultrasound so they can do both at the same time.) Hopefully your baby is still nice and big, but even if his growth has slowed down (and if he's measuring significantly smaller than he was 4 weeks ago, be sure to point that out. They may look at a baby measuring 30%ile and think that's still within the range of normal, and babies definitely don't grow at a steady rate so it can change some, but if growth goes from 95%ile to 30%ile (just as an example), you definitely want to point that out. (Not that they wouldn't notice on their own, they might or might not, I like to be a pain and remind them so I know that they know, since I know they don't have the time to review every piece of my medical information before they see me and they see a lot of different people.) I am glad you are being seen at the hospital with a level III NICU, hopefully it won't be necessary, but glad it's available if it is.

[MomTimesThree]

I'm also very thankful you'll see an MFM tomorrow. Just to second another poster, my dips in the office are always negative, yet we do 24hrs every two weeks and it's always above 400, so those stinkin' things are sooo unreliable. Leaving the appointment for sure with PIH labwork and 24 hour will give you a good idea of where things are. Do keep posted when you can!

[acm990]

Update time!!

I went in to the MFM this morning for a bpp. LO looks wonderful. 85%ile for head and 87%ile for abdomen..His weight right now as of 25w3d is 2lbs 4oz. This makes me VERY happy, seeing as we know for a fact I am not going to make it to my edd Oct.2.2012. Blood flow from the cord looks perfect, as well as the placenta.

Bp was 141/85 and +1 protein was found in my urine. I did ask for the 24hr urine catch and received that lovely little bucket, so I will turn that in Monday morning and will have the results from that and blood work Wednesday. I also inquired about the steroid injections for his lungs and they said this is absolutely something we will do; However it will hopefully be a few weeks/months before we do this as they said ideally we want to have these injections as close to delivery as possible.

My OB will be seeing me twice a week now, instead of a weekly visit with the MFM. I suppose they were just for a second opinion, and now have info on me in case I need to switch to them in the future. I still haven't been officially diagnosed with pre-e, but they made it clear that they believe they have caught the early development of it. I am not sure weather this is good or bad...Good to make myself aware and educated and have the chance to manage it better but then again I worry that being so early on in my pregnancy, I might have to deliver before 34 weeks, which I was told today is our goal.

Thank you ladies so much!! I am so glad I have found out about this site and board. Didn't know pre-e existed a week ago and now I feel much more prepared for everything.