by hfwarner3 (141 Posts), Mon Dec 18, 2006 02:34 pm
I finally found a website that consolidates a decent amount of information on PIH, pre-e, and eclampsia into one page.
I wanted to run my understanding and experiences past everyone here and see what you all think since it seems that a third of the posts revolve around "when are we going to deliver this baby?!?!"
Pre-e is broken out into mild and severe.
Mild is generally defined by the following symptoms: two BP readings 140/90 or higher 6 hours apart, headache, visual disturbances, epigastric pain, hand and foot edema (least reliable since edema is absent 33% of the time).
Severe pre-e is generally defined as REFRACTORY (stubborn) BP readings over 160/110, more than 5 grams of protein in urine per 24 hours, urine output decreased to less than 500 ml in 24 hours, increased serum creatinine, decreased platelet count, and Pulmonary edema.
Delivery gestational age goals:
1. Mild Preeclampsia
1. Delivery by 40 weeks if unfavorable cervix
2. Delivery at 38 weeks if favorable cervix
2. Severe Preeclampsia
1. Delivery after 32 to 34 weeks
2. Based on Fetal Lung Maturity
3. Severe refractory Preeclampsia with signs morbidity
1. Delivery in <24 hours regardless of gestational age
So it seems to me that we have a couple of different issues in play when a doctor decides if today is the day to induce / c-section. First is the word REFRACTORY - by whose definition? Some doctors are saying that two readings over that mark combined with protein in the urine are severe pre-e. Other doctors seem to think that you are still mild if they can get you relaxed and get that number back under 160/110. Some doctors seem fixated on edema as if you can't have pre-e without having swelling but this is clearly shown to be a POOR indication of pre-e. Also, in my experience, the OB would only do a "dip strip" for protein in the urine instead of a 24 hour urine test. I would think that they would do a 24 hour urine the minute they suspect pre-e and anytime your BP goes up or your symptoms get worse.
Lastly, there is the whole issue with the "lay on your left side" thing. A blood pressure taken on the right arm of someone who is lying down on their left side is a worthless and invalid BP reading. The preferred position is sitting up, feet on the floor, cuff equal level to the heart, no talking or moving. I have simply lost all respect for any medical professional who even suggests that you are fine if they can "control your BP" by taking your BP reading like this.
What I walk away from here is the 38 week mark. If you have pre-e, are 38 weeks or later, and your cervix is favorable, I do not understand why a doctor would wait. Once you get into the realm of severe pre-e, it seems to all come down to lung maturity - get them out as soon as the lungs are done.
So that is my take on things. I am not a medical professional and by no means an expert. This is just my research and experience being summed up in a single post.
Anyone care to comment, add, refute, or correct?