PE - 34WK + 2 - Checking BP at home

[JBNYC]

Hello All:

I plan to come back and share all of the details regarding our experience with PE. Tonight, however, I just need a little help understanding how to know when a visit to L&D is required due to BP results (at home monitoring) and how to measure the at home results.

My wife was experiencing a perfectly healthy pregnancy. At her 33wk evaluation her BP was raised 135/89 (120/80 is her norm). Our OB sent us directly to L&D to be monitored. Her BP, over a few hours, lowered and lowered again. Her blood work came back normal and the dip strip showed no signs of protein. We were sent home with instructions for the 24hr catch. It was a Friday so the catch started Sunday and we returned it Monday. Again, on the return, her BP was elevated and once again we spent a few hours in L&D and watched her BP lower and lower again. This time, however, they wanted to keep her in the hospital. She stayed for 2 days and her BP's were 140's/80's and 130's/70's. After 2 days they sent us home. The 24hr test showed protein levels at 600. She was ordered to stop work and complete bed rest. Growth scans and NST show the baby doing well. At 33wks +4 the baby was 4lb-14oz. During the NST test 3 days ago she again showed high BP 150/90. Again we were sent to L&D and her BP again lowered and lowered again. Her blood work came back normal and her dip stick test showed no protein. Thankfully, the staff at *****, her OB and the Head of High Risk are not messing around, they are keeping a close eye on her. So she is home now, full bed rest and the responsibility of monitoring her BP rests on my shoulders. I just want to make sure I am not making any mistakes.

She always gets nervous about BP tests, especially now. So here are her results from today:

10:15AM - 155/83 5 minutes later 140/84 5 minutes later 133/70
1:30PM - 143/82 5 minutes later 134/78
3:30PM - 159/85 5 minutes later 134/75 5 minutes later 127/66
6:30PM - 149/82 5 minutes later 137/71 5 minutes later 128/66 5 minutes later 125/84
8:30PM - 138/89 5 minutes later 136/73
10:30PM - 105/59 (she was sleeping)

I know the threshold is 140/90 and obviously we have some #'s that exceed the top number and a few getting close to the threshold for the bottom number. My question is this: As you look at these numbers there is a clear trending down from the first result and the results taken in 5 minute segments thereafter. Is it the first result that counts? the average of the results (for each time period) or do you look at the best result for each time period?

I took us about a week to wrap our heads around the fact that this is a full blown disease and to be treated as such. This forum has been a great help and we thank all of you for sharing your stories. I am doing everything in my power to make my wife's bed rest as pleasant as possible. It is 3 days until our next visit to the OB and Hospital (twice weekly) and I just don't want to screw this part up.

Thank You
Jon in New York City.

[Lateralus88]

All the number counts, basically you want to be normotensive
Meaning always below the 140. About going to the labor and delivery I would assume that if they let you go home that they know what's going on with her- so i would go back to l&b if these spikes in systolic bp (the top number) are symptomatic or persistently over 160. This is something you need to discuss with the Ob. Ask them directly- when should i come back to labor and delivery?

Good luck, recently had a beautiful baby girl but currently my wife is suffering from postpartum preeclampsia- it's a terrible to say the least

[MomTimesThree]

Knowing what your call in or go in numbers are takes a lot of pressure off you. You'll want to ask your team what they would want to hear about.

Ours started as call in if I got stuck at 140 systolic or 90 diastolic. I was to go directly to L&D if I got stuck at 160 systolic or 105 diastolic. Though, after we knew what my norm was, they no longer wanted me to call at the 140 level because that's just where I was normally. They also made some adjustments to my diastolic because it was normally so low to begin with.

At your next appointment (and it sounds like you'll have plenty which is great) I would definitely ask what the specific situation will be for your family.

You might also want to ask how frequently they'd like you to monitor BP. Ours was 2x a day, and then 4x a day. Instead of relying solely on taking my BP I was also mindful of other symptoms (headaches, blurred vision etc) and in the absence of those or feeling off I tried not to take it more frequently than asked.

Good luck! It sounds like you are in really good hands, and I wish you many more weeks of pregnancy for you and your wife.

[JBNYC]

Thank you for taking the time to reply.

Momx3 - can I ask what you define as "Stuck"? If you are taking it four times a day, are you stuck if the FIRST score for each of the four readings per day is over the threshold? Did you take multiple readings during each of the four times per day? If the majority of the readings per session were under your threshold but one was above did you consider that to be the one that counts or did you consider yourself under the threshold. I take 3/4 readings per session as I know my wife is very nervous when we start.

Once again, thank you for taking the time to respond. We are obviously nervous. As my wife says, why cant she have the romantic comedy version of pregnancy. To finally find a place where we can talk to people who have gone through this experience is both calming and appreciated.

[amberstrika]

Just wanted to chime in and say that I know preeclampsia is no joke, and should be taken VERY seriously (I've had it twice already myself). That being said, for the entirety of this pregnancy, my BP was typically through the roof from the sheer anxiety of being worried about it being high. At home, it generally always starts off too high, then creeps down as I try to curb my anxiety. And with every lower reading I have, the subsequent reading tends to be even lower! My appointments are a different matter. Every time, without exception, When I went in for my OB check ups, my BP would run around 150's/high 90's. My OB has had me put in hospital on two separate occasions, and both times my BP started out high, and gradually crept down to low levels. I have officially been diagnosed with white coat hypertension. You wife's patterns look alarmingly similar to mine. They start out higher, then she gets calmer with each reading and they start to creep down. When she has been laying down sleeping, not worrying about it at all, it's normal. Just something to think about. With a protein reading of 600, she should be ready and expecting to have an official diagnoses of PE, and should take it easy. But be aware that with her numbers coming in at a very healthy, lower reading at night many of her higher day time numbers might very well be simply anxiety and stress related. When her BP rises to the point that the pressure never lowers, even at night, it's game time and you need to seek immediate medical attention. What I have been doing this pregnancy is taking serial readings every 15 min for an hour four times a day. With the serial readings, I take the lowest number as my overall BP status. My doctor told me that the lower numbers are the best indicator as to how I am doing throughout the day, because they are more accurate as to what the base line truly is. For example:
you take a reading for her and she is most likely nervous, worried it may be high. It comes back around 140's/90's. 15 min later it's 130's/90's. yet another 15 min later and you're looking at 120's/80's. The 120/80's is more likely the accurate reading, because the anxiety starts to lessen. When you get to a point that it is in the 140's/90's and no amount of serial readings, or laying down makes it move even a bit, you have yourself a seriously problem.

Hope this helps.

Also, have you looked into buying the dipstick reagent tests for use at home? They can be a great way for you to check your own protein readings from home every day. That's how I found out about my last bout of preeclampsia. Woke up one morning with a reading of +2 in my sample. That's 100 mg in the little cup. I can only imagine how much protein would have been in a 24 hour catch! My OB delivered me the same day. You can buy them from Amazon for super cheap, Here's a link.

http://www.amazon.com/Response-Paramete ... is+reagent

[trish]

Welcome! Sorry you aren't haven't the "romantic comedy" pregnancy we all would like but at least here you'll find a lot of people in that same boat! Glad to hear baby is growing nicely!

The BP's you are getting look pretty good to me although I'm not a Dr! That it drops so much after 5 min. of rest/relaxing is very positive. When I was on bedrest my Dr. wanted me to come in/call in for any BP 160/100 that did NOT go down after an hour. They also knew how much taking my BP was stressing me out so they said not to take it more than 3 times a day: morning, mid-day and bedtime. Taking it several times, 5 times a day is likely more stressful than helpful at this point.

For your own peace of mind I would talk to your Dr. and find out what his BP parameters are for calling in or going to L&D. Everyone is different so it's best to find out from your own Dr. what they want you to do. Keeping a log of BP's is good so you can see a trend - are they usually higher in the am or higher toward the end of the day, are they slowing trending upwards etc.

Keep us posted on how your wife is doing. Hang in there!

[MomTimesThree]

Just wanted to check in... hope you guys are doing well and hanging in there!