Preeclampsia according to dr.

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alviarin
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Re: Preeclampsia according to dr.

Postby alviarin » Tue Nov 08, 2016 05:22 pm

Hi Cassi,

Welcome to the forums. I'm glad you are being monitored so frequently. For me personally, during my second pregnancy, my pressures were mostly normal mid pregnancy but trended higher as time went on. (In my first pregnancy my pressures shot way up virtually overnight). My doc would have me measure pressures morning and night. I would type into an excel spreadsheet but now they even have apps you can put on your smart phone to help record pressures. Has your doc given you and guidelines on what symptoms or pressures to call in about?

Here's a link to our signs and symptoms page if you haven't seen it already: http://www.preeclampsia.org/health-info ... n-symptoms

I would also recommend talking to your health care provider about kick counting. http://www.countthekicks.org

Here's some more info on how to take your BP:
http://www.heart.org/HEARTORG/Condition ... CII6WWhT9A
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)

jwhampton
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Re: Preeclampsia according to dr.

Postby jwhampton » Wed Nov 02, 2016 02:30 pm

If you look at the ACOG guidelines, you'll see that the majority of it bases delivery on how both you and sproglette are doing.

I'd recommend- for sanity's sake- establishing a routine (breakfast, lunch, dinner?) of checking your pressure and then stashing the machine out of sight unless/until your provider tells you to step it up. It's simply to keep you sane, to not let constantly checking your blood pressure drive you up the wall. I can't give you a hard and fast answer about when your next 24h will be, since it's mainly now just to keep a tab on overall functioning and not being used as a diagnostic aid. Make sense?

As far as the kicks-are you doing the kick counts yet? I'm sure you know all the tricks about turning up the music, having a glass of OJ, poking and prodding to wake her up...The general rule is still 10 in an hour. BPPs M/Th are a good schedule.
Thank you, I have BP monitor at home and I have started taking my bp more regularly since last weeks swelling incident and spotty vision. some days they are on the high side like yesterday and today they are well within normal range. Yesterday at ob it was 149/93 and I have never seen it that high. I have 4 boys at home and livestock that I have to care for. my dr does not feel we will make it to term and is somewhat doubtful we will make it to 34 weeks. I have had a (20w twin to my 30w) 30w, 35w, and 36w. so I am not really worried about delivering early, just wish there was some sort of kinda timeline and I know that there is no answer to that. I am not sure when my next 24 hour urine collection is, but I see my ob every Monday and Thursday with BPP those days as well. Not sure how much movement I should be feeling right now as she used to move all the time but the last week or so she has not moved near as much, I know she has moved to head down from frank breach so that could have some impact on it I guess.

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cassi.haughton
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Re: Preeclampsia according to dr.

Postby cassi.haughton » Wed Nov 02, 2016 01:11 am

Thank you, I have BP monitor at home and I have started taking my bp more regularly since last weeks swelling incident and spotty vision. some days they are on the high side like yesterday and today they are well within normal range. Yesterday at ob it was 149/93 and I have never seen it that high. I have 4 boys at home and livestock that I have to care for. my dr does not feel we will make it to term and is somewhat doubtful we will make it to 34 weeks. I have had a (20w twin to my 30w) 30w, 35w, and 36w. so I am not really worried about delivering early, just wish there was some sort of kinda timeline and I know that there is no answer to that. I am not sure when my next 24 hour urine collection is, but I see my ob every Monday and Thursday with BPP those days as well. Not sure how much movement I should be feeling right now as she used to move all the time but the last week or so she has not moved near as much, I know she has moved to head down from frank breach so that could have some impact on it I guess.

jwhampton
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Re: Preeclampsia according to dr.

Postby jwhampton » Wed Nov 02, 2016 01:03 am

Sadly, no. Part of the immune conflict between your immune system and the placenta means certain chemical factors between cells are being differently regulated as compared to a non-hypertensive pregnancy; it's this dysregulation that's damaging a filtration membrane in your kidneys that would ordinarily filter the metabolic proteins back in. The rampant blood pressures we see also don't help, simply because they overwhelm several of the safety mechanisms the kidneys have in place to account for swinging blood pressures. The PCOS does also cause/predispose/contribute towards blood pressure issues, by the bye.

This has nothing to do with lifestyle choices. You're not doing anything wrong to cause this or not avoid it, this is just how this is playing out between the placenta and your immune system.

The IC/cerclage in conjuction with the superimposed preeclampsia diagnosis is probably why your physician is cautioning you that you may not make it to term: ACOG's guideline for hypertension is between 34-37 weeks at the latest, sooner if things start going seriously sideways. The expectation is being set so that if you make it longer, he looks fantabulous and you're pleasantly surprised and if you don't, then you're not caught off guard. If you don't already have one, you may want to consider purchasing a home blood pressure monitor on your next trip to your local drugstore of choice; your physician may well have you start monitoring at home with directions on what to do at certain readings.

Here's the ACOG playbook your physician is currently operating from:
http://www.acog.org/Resources-And-Publi ... -Pregnancy

And two primers that may help you to understand the preeclampsia diagnosis:

http://www.newyorker.com/magazine/2006/ ... sia-puzzle

https://aeon.co/essays/why-pregnancy-is ... r-and-baby
I am not currently on any medications to help with bp. My normal bp is 120's / low 80's. Which is where I have been most the time. I have tried to be on my feet less this past week to try and keep bp down. Is there anyway to decrease the protein in the urine or things to avoid to keep it from rising? I also have IC and have a cerclage in and PCOS and during 1st trimester screaning I had a very low Papp-A

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cassi.haughton1
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Re: Preeclampsia according to dr.

Postby cassi.haughton1 » Wed Nov 02, 2016 00:51 am

I am not currently on any medications to help with bp. My normal bp is 120's / low 80's. Which is where I have been most the time. I have tried to be on my feet less this past week to try and keep bp down. Is there anyway to decrease the protein in the urine or things to avoid to keep it from rising? I also have IC and have a cerclage in and PCOS and during 1st trimester screaning I had a very low Papp-A

jwhampton
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Re: Preeclampsia according to dr.

Postby jwhampton » Wed Nov 02, 2016 00:33 am

What you can probably expect is increased monitoring from here on out that may likely progressively intensify as you get closer to delivery. You don't mention whether or not you are currently taking medication to manage that blood pressure, but medication is usually prescribed to help keep that blood pressure from getting too ugly too quick-it doesn't change the overall course of the disease, it just...tries to slow things down some to hopefully get you more time. That you're not on bedrest means your physician is following current recommendations to avoid it, since it hasn't been shown to anything good and carries its' own set of risks (stark raving boredom, depression, blood clots, muscle loss...)

S'far as you being 1 out of 4 total pregnancies and developing this now rather than four pregnancies ago...that has to do with whatever your partner coded for on the invasive/outer layer of this particular placenta triggered your immune system to read it as something not-welcome. That your diagnosis is "superimposed preeclampsia" also tells me that outside of pregnancy, you've struggled with blood pressure issues; preexisting hypertension is a risk factor for preeclampsia.

I am sort of head tilting over the steroid injections this early, but that could simply be you have an ultra-cautious physician.

I'll link you the two primers that help explain preeclampsia and finish it off with a link to the ACOG guidelines for how to handle the hypertensive disorders in pregnancy. There's lots of research and clinical practice suggestions and recommendations in it and helpfully organized by section with hyperlinks so you don't have to read the entire monstrosity if you don't want to. The other interesting tidbit in the guidelines is that there's an entire chapter dedicated to timing of delivery/indicators for when to deliver that you may find interesting.

Welcome to the sisterhood. The people are cool, but the induction process hasn't caught up yet.

https://aeon.co/essays/why-pregnancy-is ... r-and-baby

http://www.newyorker.com/magazine/2006/ ... sia-puzzle

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

Last week at 27+1 I was sent to l&d because of swelling. Urine sample showed trace protein on stick, bp was 120's/80's. They did lots of bloodwork which all came back basically normal, and was sent home to do 24 hour urine collection. Saw my dr friday at a follow up and she is saying I have superimposed pre e based on my bloodwork and urine and so she has moved for me to have twice a week bpp and weekly bloodwork. Found out yesterday at my appointment that bp was 149/93 and I have never had it that high and I check mine several times a day. Also 24hr Urine came back at 340 and my baseline was 220 at 8 weeks. I have got my first steroid shot yesterday and second today. I have never had Pre E this is my 4th pregnancy so I really have no idea what to expect, except I will probably not make it to term, and dr is kinda doubtful we will make it to 34 weeks.

I guess I really do not understand any of this Pre e stuff since my bp is most the time normal. I am am not on any bed rest or anything like that either.

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cassi.haughton
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Preeclampsia according to dr.

Postby cassi.haughton » Tue Nov 01, 2016 07:20 pm

Last week at 27+1 I was sent to l&d because of swelling. Urine sample showed trace protein on stick, bp was 120's/80's. They did lots of bloodwork which all came back basically normal, and was sent home to do 24 hour urine collection. Saw my dr friday at a follow up and she is saying I have superimposed pre e based on my bloodwork and urine and so she has moved for me to have twice a week bpp and weekly bloodwork. Found out yesterday at my appointment that bp was 149/93 and I have never had it that high and I check mine several times a day. Also 24hr Urine came back at 340 and my baseline was 220 at 8 weeks. I have got my first steroid shot yesterday and second today. I have never had Pre E this is my 4th pregnancy so I really have no idea what to expect, except I will probably not make it to term, and dr is kinda doubtful we will make it to 34 weeks.

I guess I really do not understand any of this Pre e stuff since my bp is most the time normal. I am am not on any bed rest or anything like that either.


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