When To Deliver?

[hfwarner3]

I finally found a website that consolidates a decent amount of information on PIH, pre-e, and eclampsia into one page.

[url]http://www.fpnotebook.com/CV164.htm[/url]

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?

[laura]

Nope, I think you have a pretty good handle on it, and my thought is that your opinion on delivery matches many of the doctors on our MB!

That being said-- there are many women out there who want the least amount of medical intrusion in their birth process, and what this does is lay out the pararameters for the longest you can reasonably risk holding off. For some women, the potential that their induction might turn into an emergency section is worth the risk of waiting to them and for some docs who are worried about liability, the risk of a child being born with 'wet' lungs and needing assistance is not worth delivering any earlier than obviously necessary. Talk about a balancing act! Nice to 'see' you around again, and thanks for sending your lovely wife our way. Be careful or we might just have to recruit you folks.

[hfwarner3]

The waiting balance in an effort to avoid a c-section could be a whole separate conversation. [:)]

A mom with pre-e seems to have a million emotions and thoughts running around inside her head. The fear of the "failure" to deliver vaginally. The fear of getting a c-section. The fear for the loss of this little person who has been with them 24 hours a day, letting her know "I'm here!" with every kick. The anger that this is happening. On and on.

For me as a dad, it came down to fear and anger that fed on each other. I was afraid that my wife would die. I was angry that no one took my fear seriously. The more angry I became the more it fed my fear. Every time I looked in my wife's eyes, I could see the pain and fear she was experiencing. Everything inside you tells you to be strong for your wife and family but you are going nuts because no matter how much you want to fix this, you can't, and the only people who can "fix it" are not taking your input into account. It was one of the hardest places for me to be emotionally in my entire life.

Ironically, once we started the induction and got the epideral, my wife and I were able to sit a watch a movie together. My stress was gone. For the first time in months, I was alone with my wife and was not worrying about her - it was being "fixed". Guy brains are strange like that. Anyway, I loved our daughter's birth because my wife and I got to bond and just have a romantic moment and it set the perfect tone for the birth. A few hours later and I was holding our little girl and just glowing. It was great.

I'm rambling, but my point is that I know that guys sometimes want to "fix" their wives when they are sick and the rules seem to always change when you talk to the OB. I hope this post lets some future dad know that it is confusing, others have been there, it is alright to be angry and afraid, and there are some guidelines you can look to, but they are guides for the DOCTOR (not you) and not a roadmap. At the same time, we, as husbands and fathers, are called to be strong champions for our wives and children, including protecting the birth experience our wife desires to the best of our ability and control.

It must have been a lot easier when the dads just sat in the waiting area until some one told them to hand out either the blue or the pink cigars. [:D]

[blythe]

I LOVE fpnotebook [;D]. And I think your summary is amazing. Thank you so much for your work and for sharing the Dad's struggles!