PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

[rerskine]

This is my first post here, and I am really anxious about some recent developments. I which I would have known about this site when my daughter was born, but now I think I may need some advice for our second. First a bit about us.

My wife, Julie, had PE with our first daughter, Isabel, July 29, 2004: Due date was August 28th. Her BP's in the hospital were about 145/95. Her 24hr urine had more than trace amounts of protein, she was a bit edemic, and a sonogram showed that Isabel was about a week behind. All of this happened in about one week. Her weight was the most obvious 6 lbs. in 8 days. She was induced, was allergic to the drug that softens/dilate the cervix) then the petosin. 22hrs of watching the little needle go straight up and straight down(with no breaks between contractions) as her uterus spasmed from cervix softening drug was truly the worst; I felt helpless. At that stage she had only
dilated to I believe 2-3mmm, so they decided to break her water. It was like a switch going off, and she went into immediate labor. They then had a hard time determining her bp from the baby's and they brought in the internal fetal monitor, and then the vacuum. I am sure you know all of this from her medical record, but what is not on there is the really awful memory for Julie of the magnesium, which she had to have put in three or four different times because her veins collapsed, snaked. She was so incredibly uncomfortable. The IV became very sentitive and she was in pain every time it moved. Everytime Julie takes her blood pressure now, it is almost as though she re-lives it, but this time she feels like it is starting earlierand it makes both of us really worry for our baby's health as well as her's.Everything was fine in the end Isabel,(4lbs 12 oz) with great 1 and 5 min APGAR scores.

Julie is pregnant again, due May 3rd. This pregnancy has been great. No morning sickness, no edema, no rapid weight gain, no blurred vision, no headaches, no protein in the urine, nothing like before until two days ago. She did a 24hr urine test early in the pregnancy so we would have a baseline to compare if symptoms surfaced; it came back at like 102 or something. Her BP is always really high at the doctor’s office (white Coat syndrome) For example, her BP was 108/72 on March 12 and then 144/82 at the Doctors. Later that night we took it again and it was 109/74. Both the doctors and Julie and I always just attribute that to her psychosomatic reaction to the doctor, and the doctors have always looked over our home readings and been pleased with her BP. Her BP which had been routinely 110-115/67-75 has now risen to the high 130’s a few over 140, and between 85-94 diastolic. We have never had either number remain either over 140 or 90 in two readings over a 6hr period and she feels great with no other symptoms of PE.

The problem is that my wife is reluctant to go in to the doctor immediately because the last time she did, they induced labor within 24 hours or so. Currently, she is in the beginning of her 34th week, and given her (White Coat Terror), she and I are nervous about going in, because her BP will probably be in the scary high 160/110 range. Tonight her BP was 133/89 after resting on her left side for about 1.5 hrs. We are going in to the doctor tomorrow, and I really need to know what to expect. I also want to know what I need to demand for her safety and our son. Julie wants to deliver at 37 weeks at the earliest. Can they treat her BP with meds? If so, which ones and in what dosages? Bed rest in the other forums has been touted as a beneficial and one expert suggested that it increased the rate of morbidity in PE pregnancies. Any advice would be great.

[annes]

I wish that I had the answers for all of your questions, unfortunately I do not. I delivered my son at 33 weeks with an emergency c-section after being induced, I can relate to your wife's nervousness. I can say that, in my non-medical opinion, I would take those BP numbers seriously, and ask the doctor about them, that is a big jump from her normal low numbers, and as you know this disease can move fast. I would also ask the doctor about steroids for the baby's lungs, and bedrest options. I had the magnesium, and hated it, but it does have a real use in helping prevent seizures. I'm sure someone with better knowledge will jump in here soon. There is a whole link to signs and symptoms that I cannot find, but is very informational. Good luck with everything.

[blythe]

Thanks for posting. I'm so sorry you and your wife are going through this again.

My story has some similarities to yours- traumatic first birth (for different reasons), panic attacks leading to higher doctor's office bps (though not as high as hers), and my bp held nice and steady and low, but mine went up at 36 weeks and my doctor and I decided to induce.

The differences in our stories start with the timing - 34 weeks is too early to induce unless she is much sicker than your post suggests. However, I'm not a doctor and she needs labs and a 24-hour urine, and non-stress tests and possibly biophysical profile ultrasounds for her doctor to determine how sick she actually is - and if the baby is showing any effects from the disease. BP is only one symptom of the disease. She really needs to go in to the doctor and get the whole picture.

I know she's scared. Best case scenario is that she'll develop PE slowly and may hold on until 37 weeks, but she needs to be watched really closely in the meantime. She'll probably have tons of doctors appointments with home bedrest, or some time on hospital bedrest. Worst case, though, is that she could have multi-organ failure, or the baby will start struggling, or any number of horrible complications in a very short period of time. Some women here have gone from healthy to near-death in less than 24 hours. Luckily, those women were in the hospital!

One thing about the white coat hypertension - posters and experts here seem to agree that it doesn't matter "why" your bp is up, the fluctuations and high readings reflect an underlying instability in the blood pressure regulation system (possibly reflecting a tendency to develop chronic htn later in life, for example, and could predispose her to have a higher risk of PE.)

At those pressures (145/95) most posters here don't seem to have been put on meds, but that's a question for your doctor, too. Bed rest is a long-running debate here [;)] - it might not do anything, but many women swear by it. If it brings your wife's pressures down, it might buy her those 3 weeks she wants. The increased morbidity, from my readings, seems to be from longer than "just" 3 weeks bedrest - but again, another point to get your doctor's views on the pros and cons.

I love hfwarner3s summary of "when to deliver":
http://www.preeclampsia.org/forum/viewtopic.php?t=20234

Finally, it may help you and your wife to know you aren't alone in having flashbacks to a previous traumatic childbirth. If she isn't put on bedrest, it might help to talk to a supportive therapist - though I personally wouldn't suggest any "trauma work" until her pregancy is long over. Trauma work can be incredibly healing, but you basically have to relive the trauma to get there, and that's not something to do when you're in the midst of a complicated pregnancy. Here are a few links I like about traumatic childbirth:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14726774&dopt=Abstract
"RESULTS: Four themes emerged that described the essence of women's experiences of birth trauma: To care for me: Was that too much too ask? To communicate with me: Why was this neglected? To provide safe care: You betrayed my trust and I felt powerless, and The end justifies the means: At whose expense? At what price? CONCLUSIONS: Birth trauma lies in the eye of the beholder. Mothers perceived that their traumatic births often were viewed as routine by clinicians."

http://www.birthtraumaassociation.org.uk/what_is_trauma.htm - a lot of good information. Again, most of it is for AFTER pregnancy, though. I'm adding it because I think the information will help validate your wife's fears and let her know she's normal and not alone.

http://www.birthtraumaassociation.org.uk/help_pandf.htm - same site for husbands and partners

http://www.intermid.co.uk/cgi-bin/go.pl/library/article.cgi?uid=22679;article=BJM_15_1_39_45
You cope by breaking down in private: fathers and PTSD following childbirth
"Four themes encapsulated their experiences: it’s not a spectator sport; it’s about being included; it’s sexual scarring; it’s toughing it out."

It sounds like you know the symptoms to watch for and that your doctors are on top of things (from doing an early 24-hour urine and reviewing the home bp readings you've brought in - if they suggested the home bp monitoring, even better!). They also don't sound "trigger happy" considering that they have been reassuring about the white coat htn. I really think they will do the important tests tomorrow and be able to give you a better picture of the next weeks of her pregnancy. I would even suggest calling and asking if she should come in today - they might be fine waiting until tomorrow, but let them decide!

One more thing - I would suggest taking a tour of the NICU. You may not need it, but it helped me a lot the second time around to visit the NICU beforehand. I just felt calmer seeing those tiny babies being taken care of so well. I also prepared by reading up on "kangaroo care" - lots of skin-to-skin contact once baby is stable.

Whew. Sorry for the book! Good luck and keep us posted!

[rerskine]

Wow,
Being the night owl that I am, I did not expect to see any posts for at least 8hrs or so, but I was so happy to see that someone else is out there to talk to and listen.


I also want to thank parkersmom and Blythe for the responses. Just to clarify a few things, when I wrote about going in to the doctor tomorrow, that meant today. We are going in to the doctor today. Thanks for the support.

[julie f]

Just wanted to welcome you as well, you've already gotten some great info.

One thing I wanted to add was about "white coat hypertension." Our Experts here don't really buy in to that theory - if your bp is up, it is up. Even though you may only see your wife's bp rise when you're at the doctors due to stress/anxiety/fear/etc. That means it is also likely rising when she is stressed waiting in line some where, sitting in traffic, tired from taking care of a toddler and being pregnant, excited because her team just won, fearful as she contemplates her upcoming delivery, etc. And I don't mean to imply that she can control this, she can't. My peri explained to me that in a "normally" functioning body, it can handle the sudden spikes in anxiety or what not. With a woman suffering from labile blood pressures, the body loses its ability to control that. Does that make sense? Here are a few links:
http://www.preeclampsia.org/forum/viewtopic.php?t=1064&SearchTerms=+white+coat
http://www.preeclampsia.org/forum/viewtopic.php?t=19197&SearchTerms=+white+coat (See Caryn's response)


As far as what to expect - it really depends on the big picture (proteinuria, fetal indicators, maternal symptoms, lab values, etc.). Bp meds and bedrest are both hot topics - not all doctors agree. Here is a link to what our Experts have to say about meds: http://www.preeclampsia.org/forum/viewtopic.php?t=1081 . I can see that you've already read the response about bedrest. For some women, it seems to help prolong the pregnancy, for others it may do nothing.

The important thing is to know the symptoms and continue to monitor, http://www.preeclampsia.org/symptoms.asp Don't hesitate to head in should something seem off.

Please let us know how your appt goes today.

[anathor21]

Wanted to add my welcome to the others - looks like they have covered your questions well and given you good advice. It is hard to know what to expect - however, know that PE is a very serious condition and although everyone (the doctors included) would far rather deliver closer to full term, that may not be in the best interest of your wife or son's health if PE progresses too rapidly. PE isn't a good thing to ignore - get familiar with the signs/symptoms and as difficult as it is, work with your medical team.

Please let us know how your appt goes today - you will find tons of good information around here, and since you likely won't have a lot of time to go digging, simply post your questions in this (or other forums) and I think you will find that folks are willing to answer them rather quickly. We have all been there and have a good idea of what it's like to need quick answers....

Best of luck...

E.

[rerskine]

First of all thanks to all of you for the great information and suportive experiential statements.
Julie's BP was 128/89 at our last reading today. Our doctor was not able to meet with us today, but we have an appointment set for tomorrow. I was a little upset about not getting in today, but her BP has not changed and she shows no other symptoms, so we will go in tomorrow. I will report back to all of you when I have some new information.

[blythe]

Thanks for the update - good luck!

[rerskine]

Hello,
I am glad I had to the chance to send in a post before we went to the doctor. After reading everyone's responses, I felt like I would have a better understanding of what would happen at the doctor. I know that the verdict is out on the "White Coat" aspect of BP, but those who doubt its existence need to watch the phycical change in my wife as the seconds tick away before she has her BP checked at the doctor's office.
It is almost as though the cuff envelopes her whole body and squeezes her like a soaked sponge. We had taken her BP before we left to go to the doctor's office and it was 125/83. We drove to the office, parked, walked inside, registered, sat in waiting room, were escorted by the Medical Assistant through the doors and Julie took a seat next to the BP machine. A total of 25 minutes had passed since we had left our house and the confident comfort od the 125/83.I knew as soon as Julie sat in the chair that her BP was going to be high. Her face, upper arms, neck and chest rolled with a thin layer of prespiration, and as the button was depressed and the familiar, grimacing moan of the compressor pushing air into the cuff filled the area. With every passing second Julie's color equally approached a deep scarlet red. The sentence, 153/107--her highest ever. Needless to say, the doctor, who was not our regular doc but who had an available appt that day,directed us to Labor and delivery.
Here is where my reading paid off. As we walked to L&D, I knew and could communicate, clearly, what would likely happen next. Julie had no other symptoms; in fact, she had only put on half a pound since our last meeting, she had a negative protein drip, no sweliing, no headache, pain near her liver. We had a NST, full blood work up, began a 24hr urine test, an ultrasound, and a few more dates with the BP machine. Everything came back normal (waiting for urine results, but her BP after the NST stewed down to 123/82. We went home soon after that, But the doctors recommended that we begin dooing bp's at home. The doctor enrolled us in a home BP hypertension program, adn we scheduled our first appointment for today Wednesday 3-30. Well, this condescending meeting was the pinnacle of frustration. The woman, was late, she seemed to be frantically busy, and when she did speak, she had NO idea that we had been taking BP's for the entire pregnancy, or that Julie had preeclampsia and had delivered at 36weeks when Isabel was born. Her first reading was 141/97. After two more readings in the 90's she called the doctor, and we were sent, again, to L and D. We jsut got back from there and her BP eventually went down to 122/82. We should have never gone in, but becuase I did not stand up to this woman, we went teary eyed to L and D. Everything,once again was fine in the end, but Julie had spend an additional 5 hours at the hospital and on her feet.

We are home now, and Julie is relaxed an asleep. The really great news is that our baby, Eamonn, doing great and measured at 35 weeks and not 34. More to come.

Robb

[caryn]

Robb,

How nervewracking for you both!

I've got to say, though, that I'm glad she got checked out. What our Experts tell us isn't that they don't believe in white coat htn, but rather that if you have it, it means that something about the way your body manages blood pressure is broken. If it weren't broken, your body wouldn't spike pressures in response to stress; since you do spike pressures, the control system that manages bp has something wrong with it.

(Sorry to use the generic "you" there; saying "Julie" every time read strangely too. [:)] )

A good NST and bloodwork and proteinuria should go a long way towards easing everyone's mind. Not that you don't need to continue to keep your eyes peeled for PE, of course, but then you already knew that!

Did they say anything about bp meds? I'm no doc, but it seems to me that if she spikes up high (rarely, or only when they're taking her bp, or whatever) that that's the sort of thing they tend to use low-dose beta blockers for -- they use them for high cardiac output cases, and women with high cardiac output often have white coat htn. They also use them for performance anxiety, which is pretty similar.

I hope she (and you) get a good night's sleep, and that things stay nice and calm around there.