HELP! pre-e w/good blood and urine @ 36 weeks?

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HELP! pre-e w/good blood and urine @ 36 weeks?

Postby jakluk4 » Fri Jul 20, 2012 10:09 pm

Hi Everyone!
New here, and just told by my OB he believes I am pre-eclamptic.
I have had chronic hypertension since I was 17 weeks, and have been taking 250mg of Aldomet 3 times a day (every 8 hours) ever since.
This is my 5th pregnancy, I have 4 other sons ages 16,15,12 and 9. My 5th son is due August 13th. I am also 39 years old.
I have been seeing my OB every week since week 32, so he could keep a close eye on my blood pressure. Every week, its been slowly creeping up....from being 120/68 range on meds, to now yesterday reading 140/92 2 hours into my Aldomet medication. He has not wanted to increase my dosage, afraid of "masking" any preeclampsia that might be going on in the background he said. The past 2 weeks, I have begun swelling, especially in my face. I now look like a pufferfish! My eyes are so swollen! My hands and feet are also swollen, but not as bad as my face. Last week, he took blood and a 24 hour urine, after a routine urine collection in the office showed a significant amount of protein in it. BOTH blood and 24 hour urine came back GOOD. But, my swelling continues, and so does the constant headache. My vision is now beginning to look "pixelated" at times, and the headache is like a dull constant migraine. I have also been experiencing nausea and some vomiting this past week. I went into my OB's office yesterday for my weekly check, and he said by looking at my test results, Im fine...no pre-e. But, by looking at me physically, I am definitely suffering from pre-e! My quick urine collection yesterday was protein free, but he took more blood and I am currently doing another 24 hour urine collection that I need to turn into the hospital tomorrow morning. His office called me today to tell me my blood work once again came back good, no signs of pre-e. Tomorrow, at the hospital after I turn in my 24 hour urine, I am to take a non-stress test, and depending on what the urine shows, I might be induced. I also want to mention I had an ultrasound done on Monday to check baby and placenta, and the baby looks great! so does my placenta.

So, here is my question I'm hoping someone can answer for me, because Im so confused. Can I be pre-e and have no protein in my urine, and have my blood tests come back good? Is that possible? I have scoured the internet trying to find this out, and have come up empty in regards to this. I have so many other signs/side effects, the facial swelling, headaches, vision issues, nausea, the rising blood pressure even under medication....but yet my urine is ok and so is my blood. Does this mean I could be pre-e, its just not effecting my organs yet? or does protein in the urine HAVE to be present to be pre-e? HELP! thank so much you guys!
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Re: HELP! pre-e w/good blood and urine @ 36 weeks?

Postby sam10 » Sat Jul 21, 2012 08:36 am

Hello and welcome, but so sorry you had to find us.

Some of your symptoms you are describing (BP, vision problems, swelling) sound quite worrisome to me (not a doc though) and it seems that something is up. PE can move quickly and labs can be just below threshold, but can turn diagnostic in matters of hours.

I am glad your doctor ordered another 24 hour urine collection (dipsticks can be somewhat unreliable) and has ordered an NST. Since birth (removal of the placenta) is the only cure to treat PE, I am not surprised that your doctor mentioned induction, especially at your gestational age. They usually wait as long as they can, but sometimes baby is safer outside than inside.

Let us know how it goes and what your further lab results are. Will be thinking of you.
~Julija (40)
MC 3/2009 and 3/2011
Henry (1/1/2010-1/7/2010) - forever loved and missed; severe PE with Hellp; partial placental abruption, classical c-section at 25.6 weeks
Matilda (Nov. 2012, born at 35.4 weeks) - severe PE


Our pain has been put into words, placed into empty cradles, to remember that all our babies lived, that they mattered and always will. - Field of Cradles http://www.fieldofcradles.org/
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Re: HELP! pre-e w/good blood and urine @ 36 weeks?

Postby alexis » Sat Jul 21, 2012 09:26 am

It's a little confusing here, because the official definition of PE involves protein, you're right. But chronic hypertension throws a wrench into it--and IME they watch very carefully for any upward trend or symptoms as this may be a strong sign that you're developing superimposed preeclampsia. As a complete guess (not a doctor) that's what your OB thinks is happening--you're developing the disease, but it hasn't yet hit the point where it's reflected in your labs. Superimposed PE can progress quite quickly, but there can also be a gradual trend upward before the decline, which happened to me.

The HYPITAT study says that delivery results in improved outcomes for patients with mild preeclampsia or gestational hypertension over 37 weeks. (Just to be clear, delivery would be preferred with severe preeclampsia--just that doctors already knew that, so the study concentrated on the "mild" patients.) So even if your urine is normal again, you may be discussing induction at a fairly soonish point.
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!
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Re: HELP! pre-e w/good blood and urine @ 36 weeks?

Postby blythe » Mon Jul 23, 2012 11:45 pm

Our experts have said that third trimester nausea is an "underappreciated" symptom. Have you gotten the results from your latest bloodwork and 24-hour collection? Your headache and visual disturbances are also concerning to not-a-doc me. How did your weekend go??

To answer your question, my understanding is that yes, you can be sick without having protein in your urine. You aren't technically diagnostic for PE without protein, but the diagnostic criteria are strict only in research - if you're sick, you're sick, and one of my favorite experts noted "we treat people, not diseases".

To get more technical, protein usually shows up later in the disease progression, and studies have shown that the underlying factors that cause the damage we see in PE are elevated up to 5-6 weeks before woman are diagnostic.

To get less technical, we've had women here seize while having "just" high blood pressure. I think Caryn was the one who coined the term "kidneys of steel". Search Caryn's posts, she reads even more than I do and she says a lot about the "umbrella" of hypertensive issues of pregnancy, and how the symptoms manifest differently in different women and due to the mucking around of the underlying factors. Some women can have super high bps but no protein, others have low bp and protein but still have liver failure and HELLP. Other women can have CNS involvement and eclampsia while the rest of their symptoms are relatively mild.

And to get back to the actual diagnostic criteria, I've read waay to much and even I'm confused. Take a look at this old post where I compiled some reading.
http://www.preeclampsia.org/forum/viewt ... 10#p341346
Where I'm confused is that, yes, bp and protein are required for PE, but severe PE *seems* to say that you just need *one* of the things on the list, like super high bp. What I'm not clear on is - do you have to be diagnostic for PE and *then* you can diagnose severe PE with another thing on the list? Or is just any one of those "severe" symptoms enough to diagnose severe PE, even without protein?

Okay, I've read the criteria yet again and I think it's the first - "Preeclampsia is considered severe if one or more of the following criteria is present:" - so you have to at least have a diagnostic amount of protein... but, I'll go back to the "umbrella" of hypertensive disorders of pregnancy and give my not-a-doc guess that you could still be sick.

Remember I'm no doc, but I wonder if you're one of those "kidneys of steel" gals, who actually are very sick but your kidneys just don't show it. You can also have CNS involvement (implied by "the" PE headache, visual disturbances, hyperreflexia) and be a risk of eclampsia without having protein. I'm glad to hear your bloodwork is good! - but you can be sick with PE without bad bloodwork, bad bloodwork is how you know if you have HELLP, a severe and fast-moving form of the disease.

I hope some of that helps - ask again if it doesn't and I'll see if I can grab Caryn!
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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