New here with a question...

[jpayne75]

Hello! As the title says, I am squeaky new here. I am 36, and am currently exactly 35 weeks pregnant with baby number six. My last pregnancy seven years ago did end with me being induced a couple of days early because I developed pre-eclampsia, so my (first) midwife and now OB have been watching carefully for signs this time around. At about 24 weeks, I came in for my monthly appointment with my midwife, and saw that my BP had crept up again, this time to almost 140/100, up from 120/80 at previous visit and high 90something/70ish initially pre-pregnancy. Dipstick showed +2 for protein in my urine, and I seemed to be having at least some mild hyperreflexia. So I did a 24 hour catch, and everything came back...normal. Totally normal. BP went back down, etc. I was told to take it easy and that the heat and the stress from my then upcoming move had probably contributed, though my midwife said she was pretty confused by this outcome. Moved to my new town and started seeing my new OB. First visit went great. BP totally normal at 100/80, etc. Next visit resulted in another high dipstick test but still normal BP. OB asked me to do another 24 hour collection.

Meanwhile, I am swelling quite a lot, to the point that even compression socks can't contain things, but I live in the Midwest, where we've been having a horrible drought and high temperatures, which no doubt did not help matters on that front. But my 24 hour catch came back with very high (says my OB) protein of about 1900. He refers me to a perinatologist and suggests that I may have to be admitted and begin steriod shots. He also says he's really confused and says that, quote, "You're breaking all the rules," meaning I guess not presenting typically for pre-e? Needless to say, I completely freaked out! Went to the peri, my BP is still normal, my swelling has gone down, etc.They don't admit me, but I do yet another protein catch, and it's elevated *more* to 2300. That was yesterday. Baby girl looks great and is only a little small, but as I am petite and she's 36%, they're not too worried about her growth. But I still have to come in twice a week, once with the peri and once with my OB. All my other labs come back within normal ranges. My kidney function and liver function is fine. As of right now, my swelling is completely gone, and other than some fatigue and other late pregnancy aches and pains, am feeling okay. No headaches, sparklies in the vision, nausea or abdominal pain. I am not dehydrated and am now on a high-protein diet. BP still extremely normal. They thought there might be something wrong with my kidneys, but no. And I guess maybe I could still develop pre-eclampsia, but since my labs seem to be all over the place, I'm wondering if it's something they're going to catch in time without a corresponding rise in my BP, which has remained steady at about 105/80ish aside from that initial increase in the second trimester. They're watching me and baby closely, so I probably shouldn't worry, but I find the whole thing very confusing. Apparently, they don't understand what's going on, either. It's like being in some kind of medical no-man's land where I have this weirdly high protein, but no other symptoms, or at least none that stick around or get worse. Anyone else experience something like this and have it develop into pre-e, or have it turn out that pre-e never developed? Thanks in advance, and sorry for the length/rambly nature of this post!

[MomTimesThree]

Hi There-

Glad you are in good hands... your kidney's aren't functioning all that well because you're spilling a lot of protein. A friend of mine was recently induced when her protein topped 5000 even though her BP was managed, and actually pretty low. I'm sure a momma with more experience will chime in, but I do believe inducing for protein is when it goes over 5000, because it can result in permanent kidney damage- and given that you're already 35 weeks.

I'm really glad you're being so closely monitored.
Lauren

[angieb]

I developed HELLP without high blood pressure, not sure what protein would have been- it got too severe too quickly to do a 24 hour urine- but no trace on dip tests. They only caught it b/c I was in severe enough pain to go to the hospital, they did bloodwork, it was mostly normal, but then they redid it 6 hours later and it was clearly getting ugly fast, platelets dropped by 100,000, liver enzymes went from slightly elevated to more than doubling. I did not feel worse, and my blood pressure was still normal. So watch out for any upper right quadrant pain as well.

Pre-e can do funky things and can present differently from person to person and even pregnancy to pregnancy.

My non-doctor guess is it's hitting your kidneys first. (With my hellp, their explanation was it hit my liver first.) That's a very high amount of protein, diagnostic for pre-e is 300 mg. I think it's good they are watching you closely. Are you monitoring you blood pressure on your own at home? With that much protein and a history of pre-e, I think it would be a good idea if you aren't already.

[jpayne75]

Thanks, ladies! Lauren, I'm glad they're watching closely, too! DH is irritated with my OB and thinks he's an alarmist since I didn't end up getting admitted and induced early. I told him that it's better for the OB to OVERreact than UNDERreact, but I don't think he agrees. Mostly because things seem to be okay. I imagine he wouldn't be saying so if I were having the baby now or stuck in the hospital...or God forbid something worse. Grr.

As far as monitoring my BP at home, no, I haven't been doing that. I have checked it randomly when out and about, like at Walgreen's or Wal-mart, and it's never been over 120/80 then. Peri hasn't suggested doing so, but I have an appointment with my OB on Friday, so I may ask about it then.

I suppose that you're correct that my kidney function isn't really that good, considering how much protein I'm spilling, but I guess what I meant was that they didn't think it was due to any underlying condition and that the bloodwork wasn't showing anything that warrants immediate action. I did not know that if my protein got that high that it's something that you could be induced for, though of course it makes sense. Hopefully, my levels won't keep rising and I can dodge that outcome.

Thanks again!

[ellemoon]

With a 24 hour protein that high... I would worry. I'm not sure of the check list for diagnosing pre-e but with your kidneys spilling THAT much protein, that means they are stressed and your kidneys could begin to fail (in my not-doctor opinion). Even though your BP isn't high (that's great). The swelling is something to be concerned with. I would definitely want to be hospitalized and have them keep a close eye on things, as well as baby- they need to be doing BPPs to make sure baby is doing ok. I wouldn't want to walk around with protein that high... things can go bad SO fast. My 24 hour was 1900 and I had pitting edema (as well as high BP but I am chronic hypertensive so they diagnosed me based on the protein). So, I was hospitalized and delivered DD 6 days later. Good luck!

[jpayne75]

Hi, Leslie, and thanks!

They are having me in weekly and doing ultrasounds at each one of those visits. Checking fluid levels and blood flow, etc., and so far all seems well on that front. And it probably got buried in my monster initial post (sorry about that!) but my swelling has gone down significantly...my feet almost look normal and my hands do, too. No facial swelling at all *crosses fingers*. So it's really just the high protein that seems worrisome at this point, so I understand why they've not admitted me. I don't think there's really anything for them to manage at the moment. Just time to watch and wait, I guess, and with two appointments per week, they seem to be taking it pretty seriously. I don't have to do a 24 hour catch this week, but I will next, unless something changes.

Thank you all so much for sharing your experiences with me. I really, really appreciate it!

[tree]

Hi, welcome to the forum.
It sounds like your OB and peri are watching you really closely. That is about all they can do when you are sick, but not quite sick enough or far enough along to deliver. You are consistently spilling a lot of protein. Have you ever done a 24 hour outside of pregnancy to get a baseline? Sometimes it helps the doctors to know if you spill protein outside of pregnancy. The third post in this link describes the different diagnostic thresholds for protein levels. Yours are really high, but not yet severe.
http://www.preeclampsia.org/forum/viewtopic.php?t=1716

Many of us have labile or transient symptoms for a while. I also had horrible swelling that came and went. Many women have blood pressure that varies throughout the day/week/month before it stays high. The watching and waiting has to be stressful, but at least you know that they are really looking out for you. PE and HELLP can move really quickly (hours for some of us), so they have to monitor you frequently. I hope you are one of the lucky women who just have to watch and wait without getting sicker. PE can move slowly in some women.

Two other things came to mind after I read your post. The first is that there is unfortunately nothing we can do to slow, stop, or reverse preeclampsia other than delivery. That fact completely stinks. This disease stinks. You mentioned that you are on a high protein diet. The PE foundation experts agree that there is no benefit to following a high protein diet, and that it may actually do some harm. There is some information here on that:
http://www.preeclampsia.org/forum/viewtopic.php?t=3919

The second thing is that recent scientific studies had changed how many doctors think about inducing women with mild or stable PE. Have your doctors discussed what would cause them to deliver you? They would probably deliver you immediately if your BPs or liver/kidney function gets worse, but what will they do if things stay stable? The recent HYPITAT study demonstrated that women and babies have the best outcomes when delivered at 37 weeks if there are any hypertensive issues. There is a bit of information on that study and the changing guidelines in the US that have resulted from the study here. I will try to find the link to the actual study if you would like that as well.
http://www.preeclampsia.org/forum/viewt ... 19&t=44954
It might be worth discussing with your doctors so that you don't have any surprises if they recommend delivering the baby before you go into labor. It might also be good to make sure they are aware of that study if you are concerned about them delaying delivery.

I hope you and baby continue to hang in there for a while! Sorry for the long post...

[jpayne75]

Thanks for the links, Teresa! A link to the study would be greatly appreciated, too, so thank you for offering.

I think one time I did have a baseline 24 hour -- I was sick with some kind of gastro thing last year. Everything came back pretty well normal -- gastro diagnosed it as a spastic colon. *shrug* It cleared up with probiotics and time, probably triggered by an earlier illness, they say. But no trace proteins, liver enzyme issues or kidney funkiness then, AFAIK. My blood pressure got quite high, but at the time, I was in so much pain that they thought it was gall bladder attacks, so my elevated BP then was a pretty understandable reaction to the pain.

I haven't spoken to either of my doc's about a plan going forward. To be honest, I was just so relieved I wasn't going to have to deliver last week that I just accepted it as it was. While I don't feel really terrible aside from the fatigue (I actually slept six whole hours straight last night, woo hoo! and just woke up from an hour nap), I know I do *look* pretty terrible. Brown circles under the eyes and such and I can't really exert myself without getting some pretty intense BH contractions, pain/pressure. But if I lie down, drink more water, etc., it usually subsides. The only thing that I can't quite pinpoint and I realize now I haven't mentioned to either doc is the fact that I'm very itchy, mostly on my wrists, tops of my feet and my belly. From what I understand, it's worrisome if it's itchy on the bottoms of your feet and palms, but I don't itch there. I plan to mention it tomorrow (must remember to write it down, lol). I will ask them about what the plan is if things remain largely the same, rather than getting worse or better. Since I feel mostly okay, and baby is doing good, and I'm not in the hospital and not on any restrictions, I guess I just haven't thought about the idea that I may actually be sick and not just pregnant. Which sounds stupid, but it's true, ha.

I did do some reading somewhere that a high protein diet can be harmful if you have some kind of kidney disease, and that did initially concern me, but since doc hasn't mentioned anything further about my kidneys and instructed me to continue eating the protein, I assumed that it was to ensure that I'm replacing enough of what I'm spilling to try to control any growth restriction the baby might suffer as a result. I will ask him about that when I see him next Tuesday. I think I may be just taking too much at face value, here, because they're not telling me what I don't want to hear -- that I have to deliver now, you know? Thanks again!

[tree]

Here is a link to the summary of HYPITAT study:
http://www.thelancet.com/journals/lance ... 40-6736(09)60736-4/abstract

It is probably helpful for your OB and peri to know that you had a baseline 24 hour collection done outside of pregnancy, and that it was normal. They might not have that result at their fingertips, but they can probably get it quickly if they decide that they need it. Some women do spill protein outside of pregnancy. In that case, spilling large amounts of protein may be less concerning.

I agree with you about writing EVERYTHING down. You have a lot more experience with pregnancy than I do, but I was so unbelievably stupid and forgetful towards that end that I would forget to mention all kinds of things when I saw the doctor. I could have taken much better care of us if I could have accurately reported my symptoms. I would be up all night in pain and completely forget about it the next morning. The itching is unusual, and can sometimes be related to liver issues, and I would report that. Itching is pretty unusual with HELLP, but I think we have had posters report it before. The only thing that is universally true about PE and HELLP symptoms is that they are usually weird and different in all of us.

You are in a pretty good place if you have to deliver soon. I agree that not delivering last week was great! My 35 weeker was fine, but life would have been easier without the little NICU adventure. It seems that all you can do is continue to report your symptoms to your doctors and hope for the best. You sound like you have a good attitude about taking the whole thing day by day. Many of us struggle with that, but it is all you can do. Feeling ok is probably a good sign. Many of us felt incredibly bad when we got sick enough to deliver, but there are a few posters who report feeling pretty much fine despite being really sick. I hope you can hang in there for a while longer. Congrats on the six hours of sleep and the nap. That sounds wonderful right now!

[tree]

Check out Caryn's post (maybe 3rd one down) in this thread for some more information on proteinuria. Hers was REALLY high, and even that wasn't a delivery indicator until other things cropped up.

http://www.preeclampsia.org/forum/viewt ... 12&t=45227