What is normal treatment plan for PIH only?

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Re: What is normal treatment plan for PIH only?

Postby growlie » Wed Jul 11, 2012 07:57 pm

Well, I am replying from the hospital. My BP was high although no higher than it has been and saw MFM who sent me back to L and D for monitoring. FINALLY saw my OB who wanted labs and a new 24 hr urine. Although I am not crazy about spending another night in the hospital, they will get the results of the 24 hr much much faster. p'

Assuming protein is less than 300 and bp's arent crazy, I should be able to go back home.

Dr's offi cial plan is if I get mild pre=e, induce at 37 wks. If not, induce at 38 wks for PIH. If I get severe pre-e, get the baby out immediately.

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Re: What is normal treatment plan for PIH only?

Postby alviarin » Wed Jul 11, 2012 11:44 am

Unfortunately I don't think there is a "normal" plan yet, recommendations vary a bit from doc to doc as you have seen. However it seems like more doctors are reccomending delivery at 37 weeks in part due results of the HYPITAT study. Also it will be interesting to see what new guidelines might come out of ACOG's Hypertension in Pregnancy Task Force: http://www.preeclampsia.org/forum/viewt ... 19&t=44954.

My personal experience with labile BPs and OB recommendations:
1) My first OB scheduled an induction at 38 weeks since my pressures wouldn't get better and might get worse. He was right, since day of induction I developed rapidly worsening pre-eclampsia and narrowly avoided an emergency-c section.
2) During my second pregnancy, when my pressures started acting up again, my MFM said it meant I was heading for pre-e again, chronic hypertension later in life, or both. Unfortunately it was both! We induced for mild pre-e at 37 weeks and my pressures spiked after delivery and I was eventually diagnosed with chronic hypertension.
3) During this pregnancy, on BP meds now for chronic hypertension, my MFM is recommending delivery at 37-38 weeks. My OB is hoping we can get to 38 weeks, but of course if pre-e rears it's ugly head again we'll deliver sooner. We ran a baseline 24 hour urine in early pregnancy, and if anything changes symptom or pressure-wise we'll run another one.

Bloodwork will tend to pick up criteria for severe pre-e or HELLP syndrome, but it won't pick up milder cases of pre-e. And protein dipsticks can be slightly off sometimes. So a 24 hour urine test is still considered the "gold" standard for diagnosis of pre-e.

What does the MFM reccomend in terms of monitoring and setting a delivery date? They tend to see more patients with hypertension and preeclampsia.

I hope this helps, keep the questions coming.
Hypothyroid mom to
Connor (severe pre-e at 38 weeks)
Claire ("mild" pre-e at 37 weeks)
Annabelle (chronic HTN & GD, superimposed pre-e @34 weeks, induction @37 weeks)

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What is normal treatment plan for PIH only?

Postby growlie » Wed Jul 11, 2012 11:19 am

Hi friends,

I am on my third week of bed rest for gestational hypertension. So far my lab work has all been normal and no or only trace protein. I am feeling some anxiety becauseI have not been able to see "my" OB, although I have seen 4 of the doctors in the practice. It is my understanding that "my" OB will make the actual treatment plan, but I don't see her again until next Friday, so I am looking for any insight until then.

I am 35 w 2 days at this point. Around 32 weeks I started having swelling and some pitting edema in ankles/feet but normal BP. I was scheduled for the next week for a BP check. I ended up calling the on call dr. a few days before the checkup because my swelling seemed worse and my home BP cuff indicated readings in the 140s/90s. I usually am 120/70-80. She had me go to L&D where I was monitored, given a jug for 24 hr collection, and sent home. On my scheduled check up, BP was 140s/90s and I was sent back to LD and admitted because the 24 hr urine was not back yet. I had labile blood pressure readings. The blood work was good. Apparently labcorp messed up the 24 hr catch and didnt record total volume, so I had another one done. I don't know what the number was but was told it was good and I could go home. Dipstick was negative.

2 days later I was seen for BPP. Baby scored 10/10. I lost 7 lbs of fluid from a weekend of bedrest. BP was down a bit to 138/85 or so. Bloodwork drawn and urine dipped. I was told to come back 3 or 4 days later for another NST and BP check. Urine dipped, no blood work. BP was better - 128/82

Is it strange that they have not done another 24 hr urine? I thought the dipsticks were not very accurate. What does the bloodwork tell them, and does it replace the 24 hr urine? I can see my blood work from the dr's office but not the hospital. It was a CBC that was ordered.

Today I am scheduled for another NST with a midwife and then to go to the ultrasound after that. I am not sure whether I will see an OB today or not. There is a MFM doctor who read the first BPP and she is to read this one. I don't know if I will get the BPP results before leaving or what.

Then I don't have another appointment until next Friday (7/20) but thankfully it is with MY doctor and I plan to ask for a specific treatment plan. I am fully aware that things could change but I'd really like to know what to expect if things continue the way they are now .

Of the 4 OB's I've seen since this all started, I've been told
are n
1) induce at 37 or 38 weeks but not stop labor if it started on its own
2) induce around 38 weeks
3) induce 38-39 weeks
4) induce at end of 39 weeks

I am sure some of the variance has to do with the big push by March of Dimes and ACOG, but I am also familiar with the study about better maternal outcomes with induction for PIH.

No one has told me they'd just let me go as long as mom and baby were healthy. Is induction (assuming natural labor doesn't start) a forgone conclusion with PIH?

Thank you in advance for any advice or insight. I am a first time mom and just trying to be the best advocate I can be for my health and my baby's.

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