What is normal treatment plan for PIH only?

[growlie]

Well, labs are all normal but BP readings are very labile. Dr has ordered no visitors except my husband, and plans to induce at 37 weeks. She suspects that I will develop pre-e, but is most concerned with BP's right now. If BP's stop being labile and go up a little nudge more and stay up, baby will be out sooner. 37 weeks is just ten days from now, so we are almost there.

[blythe]

Good to hear you're staying in the hospital and being watched closely! Fingers crossed that you get those 10 more days!

[growlie]

Well, just had BP of 156 over 110. Never had bottom number nearly that high. Haven't seen dr, but we will see what the plan is from here.

[blythe]

Have your 24-hour or lab results come back?

[growlie]

Yes - 24 hr test was 194. I had posted 154 but I misunderstood the nurse (or she got it wrong, not sure).

Today's BP readings have both been bad. 155 or so over 110 and 4 hrs later 164 or so over 103. I dont know why it's easier for me to remember bottom #s.

The dr on call today said he wasnt worried about a high # here or there so long as they weren't consistent. They are only checking every 4 hrs, which maybe is normal, I don't know.

I am 35 w 5 days at this point. We definitely won't go past 37 weeks (10 days) but I'm wondering if we might meet our son sooner if the BPs don't get a bit better.

I couldn't get the on call dr to tell me for sure how many worrisome (per dr. 160 something over 100-110 something) in a row (or over what time period) before the care plan changes.

I know "my" OB is out of the office monday but will come see me Tuesday, assuming I stay pregnant that long.

Right now I technically have PIH and not pre-e because labs/protein don't meet diagnostic criteria. I just pray they don't let this linger on for long if it seems to be getting worse. Of course I want a full term, healthy baby, but I REALLY want a healthy momma and baby needs that too. Nurse said she will call dr each time bp was high like that, and that dr ordered another 24 hr urine to start tmw morning. Not sure why not now.

[blythe]

Ah - sorry, I had it in my head that you were repeating the 24-hour already. Sometimes they don't repeat them, once they know you're sick they just rely on the dips, so I wonder if in your case they're expecting you to be diagnostic now and they just need to confirm the diagnosis?

How often are they drawing labs?

When I was in the hospital I'm pretty sure they were taking my bp every four hours, it seems like they only took it every 15 minutes when I was in labor.

I've never understood completely why the docs don't get quite so worried until bp stays high, but my guess is that they're not so worried about organ damage unless you're consistently high, and because they're trying to keep baby in as long as possible, they're walking that tightrope between your health and baby's gestational age. My guess is that if you were 37 weeks they'd be considering induction a lot more imminently. Right now they're trying to eek out a few more days.

In your shoes I'd take comfort in being *in* the hospital already and that they're watching you close. They don't want you to get really sick either! But they also don't want to see baby in the NICU unless it's really necessary. It's so hard to be where you're at, because there's just no good choice.

Hang in there...

[growlie]

The on call dr. consulted with one of the MFM's yesterday after I continued to have 160x/1x0 type readings. I got on some BP meds last night. I don't know the dose but he said he was starting it at a low dose. After an hour, my BP dropped from 165/100 to 132 over 72. I was not feeling good. Everything was shaking/jittery, even my lips! They made me drink juice and milk and eat peanut butter and crackers and that sort of helped. Are you supposed to eat with this stuff when you take it? I asked the nurses but they said no. But, I slept until 6 am when they checked me again and it was up again to 160 something over 105. I am due for another dose of BP medicine at 8 am. I know I just started it...does it eventually work for the full 12 hrs?
Dr said it would take a day or two to really start working...is that what he means?

They were apparently considering induction yesterday and are really not happy with the BPs. I am glad they are finally taking it seriously because I've thought it was serious for the last month!

They are starting the 24 hr collection at 8 am and will draw blood work tmw at 6 am to get them back at the same time. I don't know why they didn't start it yesterday. On this floor, they don't dip if they are doing the 24 hr, which makes a bit more sense, but I've been here since Wednesday and they haven't dipped a single time, which doesn't make sense to me. So Monday lunch or so they will have the 24 hr and the labs back, and Tuesday I will see my OB. I know that even if whoever is on call won't decide anything other than just trying to keep me ok long enough for my OB to see me again, at least she will have the best possible information.

There's no doubt that I will be induced at 37 weeks as the very latest date. The only question is how long they want to let this other stuff simmer and brew. I think the thought is if they get my BP more stable on meds for at least a few days, induction would be safer for me.

[blythe]

I'm glad they've got a schedule for your labs, and I'm very confused that they haven't been dipping - I think they dipped every time I went to the bathroom when I was in the hospital. On the other hand, our experts have been clear that proteinuria isn't a deciding factor in delivery,
http://www.preeclampsia.org/forum/viewt ... ry#p139173
and they're watching you closely in every other way.

I've heard docs tell women that another day pregnant can save three days in the NICU, so that's another reason for the balancing act, even while your bp is going higher. In your shoes I'd ask what they'd consider reasons for delivery in your specific case. Here's an old post where I lit-searched a little too much about general PE delivery criteria
http://www.preeclampsia.org/forum/viewt ... ia#p138938

I remember being miserable in the hospital in my first pregnancy, are you finding anything enjoyable to pass the time?

[growlie]

The labetalol is working! 100 mg ever 12 hrs. Getting mostly 130s over low 80s or high 70s, overnight was 120/70. This morning was 144 over 88 but I am due for another dose in an hour and a half and dr. said itd take a few days to really work well. I cannot believe how much better it feels when your BP is not through the roof.

I am finishing the 24 hr urine this morning. Had labs drawn but tech didnt stick me very well and didn't get much blood. Same person stuck me a few days ago and they had to send someone different a few hours later to redraw. Hopefully she got enough blood.

According to MFM they wanted to try to get my BP under control bc my labs were still very good. I feel comfortable that they will probably re-consult with one of the MFM's if there is any signficant change in the labwork.

The only new development otherwise was my leg reflexes were plus 1 on one leg and plus 2 on the other in the morning, and both plus 2 in the afternoon.

There should be a different on call dr today, so fingers crossed that she is a better communicator til I can talk to my OB tmw.

[growlie]

The labetalol is working! 100 mg ever 12 hrs. Getting mostly 130s over low 80s or high 70s, overnight was 120/70. This morning was 144 over 88 but I am due for another dose in an hour and a half and dr. said itd take a few days to really work well. I cannot believe how much better it feels when your BP is not through the roof. (Just had them retaken and they are still 140 something over 80 something, but thats better than 160 something over 100 something)

Got labs back. Platelets were a bit lower at 160K and dr. has ordered that to be redrawn tmw morning. 24 hr catch actually got better - last one was (thursday) and this one was 134. So no pre-e diagnosis at this point.

Dr. said I'd probably have an ultrasound tmw to check on baby, and baby has been looking good on NSTs. Should talk to "my" OB tmw and have a better idea of the treatment plan.