Labile pressures at 34+2...now what?

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MomTimesThree
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Re: Labile pressures at 34+2...now what?

Postby MomTimesThree » Thu Jul 30, 2015 05:09 pm

Hope you're doing well! Update when you're able.

:)
2008-Our Baby Girl, PTL born too early at 30w6d, Fought so hard... Forever Loved & Missed
2010- Lil' Bro, Pre-E at 29 weeks... Induced at 36w6d, Born 37w
2012- Lil' Sis, Super-imposed pre-e at 25 weeks, PTL & GD at 35 weeks, Evicted 36w

MomTimesThree
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Joined: Sat Feb 11, 2012 3:54 pm

Re: Labile pressures at 34+2...now what?

Postby MomTimesThree » Sun Jul 26, 2015 10:01 am

First- congrats!! Sorry you've hit a bit of a bump during this pregnancy. Thankful to hear how well baby is looking! It sounds like you're in good hands and being watched closely. If not already, I would start monitoring at home twice a day and keeping a record. I'm sure will yield good information for everyone.

In my second pregnancy I had labile pressures and I wasn't medicated. In my third I had labile pressures much earlier (I think 17 weeks) that wound up high round the clock by 25 and I was medicated during that pregnancy. I couldn't for sure say that was the reason I was medicated in one and not the other though. And when it stopped keeping my pressures as low as when I started, we didn't up my dose and I remember our doctor sharing that she didn't want me so medicated that it masked issues creeping up.

Each case being so unique, and sounding like you have such a great team- seems a fair question to have them explain in your case why meds would or wouldn't be an option to get you to 37 weeks. As well as specific indicators that would cause them to push for an earlier delivery than that. 37 weeks is right around the corner- I will be rooting for you!! I hope you will keep posted!!

Lauren
2008-Our Baby Girl, PTL born too early at 30w6d, Fought so hard... Forever Loved & Missed
2010- Lil' Bro, Pre-E at 29 weeks... Induced at 36w6d, Born 37w
2012- Lil' Sis, Super-imposed pre-e at 25 weeks, PTL & GD at 35 weeks, Evicted 36w

alviarin
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Re: Labile pressures at 34+2...now what?

Postby alviarin » Sun Jul 26, 2015 04:32 am

Sorry to hear you may be headed for pre-e again. It sounds like you are being watched closely though.

Maybe they aren't worried about a 24 hour urine since they are planning to deliver at 37 weeks already (as reccomended for mild pre-e)? Dips are less accurate at lower / borderline levels of proteinura (and dehydration can cause false postives) but if your protein levels become severe they should be reflected in a positive urine dip.

I'm not sure on exactly what criteria they use when considering BP meds. I know when my pressures were labile in my second pregnancy, I was not put on meds even though I was getting some readings in 140s/90s. (In additon so some readings in 120s/70s). They did tell me to go to L&D and get checked out if I hit 160/100 (either number) though. Maybe next appointment you can ask your doc for more detail on the decision making process for when to start meds?

I was on meds for chronic hypertension during my most recent pregnancy, and they tried to keep my pressures below 140s/90s. I had to go in for some extra ultrasound appointments, since overmedication can potentally restrict fetal growth.
Hypothyroid mom to
Connor (severe pre-e at 38 weeks)
Claire (dx'd with pre-e and induction at 37 weeks)
Annabelle (chronic HTN & GD, superimposed pre-e @34 weeks, induction @37 weeks)

angieb
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Labile pressures at 34+2...now what?

Postby angieb » Sat Jul 25, 2015 04:33 am

It's been awhile since I've posted here so to quickly recap, I developed HELLP at 23 weeks with DD in my first pregnancy. (I may or may not have had pre-e, they never did a 24 hr urine before my labs went bad, I had had swelling and urq pain for weeks prior, but my bp stayed good except for maybe 2 readings the whole time I was in the hospital). With DS1 my pregnancy was mostly smooth sailing with maybe a couple borderline bp's towards the end a few weeks apart though---and by borderline it was probably like 142/70 and then normal again, (I was a tad bit crazy with him and he kept the NST's overly dramatic.) With DS2, my blood pressure stayed normal throughout, but I got so swollen my MFM had me get steroids at 32 weeks and pushed my OB to deliver at 36 weeks- we made it to 37 though and all was fine.

So now here we are at 34+3 with DS3. I've gained 10 lbs in 2 weeks and can tell there is quite a bit of swelling in my feet, hands, and face. But my labs were okay on Tuesday and not spilling protein at least for dip tests. (I know that a 24 hr urine would be more accurate but neither of my doctors seem to want to do one.) On Tuesday I went for monitoring and my bp was initially 155/75 (normal for me is around 110-120ish/60's-70's, consistently through this pregnancy and my others.) After he easily passed the NST , 30 min later, she took it again and it was still 151/71. Thursday at my ob appointment in the morning my bp was normal. In the afternoon I saw my mfm and it was something like 130's/90 initially, after sitting awhile and having it taken again it was down to 130s/89 or something like that. MFM is on guard and seriously considered starting me on bp meds except that I had been taking my bp (very casually b/c I wasn't expecting this at all) at home and was running like 120s/85'ish.

So today at monitoring my bp was 134/89 (which the nurse called "good", uh, ok.Better than 155/xx certainly but still not what I would call good.) My bp's at home today have all run similar, high 130's /88/89/87, just below my 140/90 call in and pretty consistent with retakes.

This is all really new to me, my bp wasn't even like this with HELLP. My ob sounds like she doesn't want to risk much and will just deliver me if my bp starts acting up. I've been spoiled with no-NICU take home babies and would really like to make it 36 weeks at least. (C-section already scheduled for 37w exactly, would love to make it that far, but not trying to get my hopes up.) My MFM soundslike she is more willing to try meds/bedrest/etc. to squeak it out to 36/37 weeks.

Do they normally do meds for labile but not chronically high pressures? Would meds make more sense in my case considering my baseline is normally like 120's tops/70's tops and are now typically running at least +15 higher or would it be risky that it would bottom me out too much since I'm not typically 140/90 yet? (If I had been for it, my mfm would have prescribed them Thursday.) I have been having daily headaches- very mild and lasting under an hour- but I think it's from the facial swelling and not bp because my bp has never been high with them so far. I'm also wondering how likely it even is that we can squeak this out to 37 weeks? I know everyone is different, but I am really hoping to avoid the NICU and it seems like we are sooo close. (Growth has been good- estimated at 5 lbs last week- and NSTs and fluid levels have been good too.) Anyway, I'd really appreciate any thoughts!
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/


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