Should I push for 37/38 week induction?

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laney_p
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Re: Should I push for 37/38 week induction?

Postby laney_p » Wed Nov 11, 2015 04:19 pm

Keep us informed on how you are doing this week! We'll be hoping for the best outcome for you both.
Director of Community Relations for the Preeclampsia Foundation
*does not provide any medical advice*
for more information, please visit www.preeclampsia.org

La Directora de las Relaciones con la Comunidad
*no ofrece consejo médico*
Se habla español
Para mas información, por favor visite: www.preeclampsia.org/es

warren1980
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Re: Should I push for 37/38 week induction?

Postby warren1980 » Sat Nov 07, 2015 07:08 pm

Thanks. My dr actually pointed me towards that report and I read the whole thing. But she doesn't seem to be following it with regards to pushing an induction date, which honestly I"m ok with. I don't want to be induced at 37 weeks if I can avoid it. I think because other than the PIH, I don't technically have a pre-e diagnosis yet since blood work and proteinuria aren't there yet, so we're basing everything on my high bp, headaches, vision, and prior history. She is monitoring me excellently though, 2x weekly NSTs, weekly appointments with her, just did a growth scan, monitoring bp 2-3x/day at home (morning and night + anytime I feel off/have symptoms). I've done 2 24 hour urines. I didn't do an original baseline, but I was always negative on the dip stick. I've between a 1+ and 2+ since 33 weeks except this past week when I was negative and my bp in office was normal.

alviarin
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Re: Should I push for 37/38 week induction?

Postby alviarin » Sat Nov 07, 2015 06:57 pm

From the 2013 ACOG Working group report on Hypertension in Pregnancy:

“For women with mild gestation hypertension or preeclampsia without severe features at or beyond 37 0/7 weeks gestation, delivery rather than continued observation is suggested.

Quality of evidence: Moderate
Strength of recommendation: Qualified "

http://www.acog.org/Resources-And-Publi ... -Pregnancy
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)

alviarin
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Location: Texas

Re: Should I push for 37/38 week induction?

Postby alviarin » Sat Nov 07, 2015 06:33 pm

Did you happen to have an early 24 hour urine run as a baseline? I started my last pregnancy with higher than normal levels of proteinura, so my OB was going more by my change in proteinura (plus any other symptoms) to help determine my induction date.

When was your last 24 hour urine run? You could you request another, to see if your proteinura levels are trending up (or not). The tests are pretty cheap to run as lab tests go. How often are your appointments now?

My OB was ok waiting until 38 weeks for delivery in my last pregnancy, *if* we were just dealing with high blood pressure alone. My MFM reccomended delivery at 37-38 weeks just based on my history of preeclampsia and elevated pressures. The MFM also laid out a more frequent monitoring/appointment schedule. Could you ask your doctor for a referral to a MFM for a second opinion, since you are high risk?
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)

warren1980
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Joined: Sat Nov 07, 2015 12:50 pm

Should I push for 37/38 week induction?

Postby warren1980 » Sat Nov 07, 2015 06:07 pm

I had pre-e with my first pregnancy. PIH from 32 weeks to 38 weeks. At 38 weeks the wheels fell off the bus. I had high blood pressure (170/110) and protein in my urine, blood work was fine and was induced that night. No mag needed. Uneventful labor and delivery. Discharged 48 hours later with bp 140/90. That night my bp spiked into the 170/110 again, this time protein was off the charts and bloodwork showed that my kidneys and liver were failing. I was in the ICU and on mag. Took 12 weeks for body to regulate and bp to go back to normal (110s/60s). Second pregnancy was uneventful, BP never went about 125/80, induced as a precaution at 39+4. I'm now in my third pregnancy. All was well until 32 weeks, when my blood pressure started going up again. At 33 weeks I had multiple home and office readings in 160s/110s, headaches, breathlessness, flu like symptoms, and vision changes. No protein, good blood work. This time we tried labetalol. I'm now on 200 mgs 2x per day. I'm also on modified bed rest and I stopped working. Over the past 3 weeks I've had a few scary bp spikes, a few trips to triage and two borderline 24 hour urine catches (290 and 270). My bloodwork is still normal. Since Tuesday (so about 5 days), my blood pressure has been very stable. 120s/80s-130s/80s, and the protein is gone. Baby looks great on NSTs and growth is perfect. I was 36 weeks on Friday. Before I was stable, Dr was dead set on inducing me at 37.0 "if I made it that far." Now that i'm stable, dr won't give me an induction date and based on my last appointment I"m worried she may try to push me past 38 weeks.

I agree that if I remain stable I should go past 37 weeks. I'm educated about pre-e enough to know the signs and to know when to go in if something changes drastically before 38 weeks. And I really am stable -- bp is good, protein is good and virtually no symptoms. But I think going a single day longer than 38 weeks is playing with fire and the risk to me and the baby far outweighs the reward of another week. Especially because I didn't really get bad with my first pregnancy until POST partum. But I'm not sure how hard to push the issue.

Should I really push back and "demand" she induce me at 38 weeks (assuming all is well before then)? Or if I'm really this stable should I just keep going until 39 weeks because that extra week is so much better for baby (assuming the wheels don't fall off the bus again before then, which they honestly might)? Thanks for any advice.


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