how worried should i be help please

[fishologist]

a couple of weeks ago my wife was sent to the hospital weith swollen ankles after a big italian dinner (loaded with salt) at that time we didnt know about the low sodium thing. so they montor her for about 5 hours while the take blood and urine test. they all come back normal so we are sent home. we go back to the dr office two days later and she says the baby is not being reactive so she sends us back to the hospital and orders a stress test. my wife tried to tell her that this was his quiet time everyday but she didnt listen. so by the time we get to the hospital he is kicking a storm so we get in ther and they want to administer the test. but before they would do it they wanted us to sign this 10 page waiver of liabiality. we thought they should montor her for at least a couple of hours. so we said hold on here, what is this test for, they told us and we said go get a resident dr and have them look at the nonstress test strip. they said the baby was healthy, she went and got another dr they baby was very reactive. so they call our obybn and she said well if the baby is reactive then we can be released. so by now they put her on bedrest and she goes to the dr every other day. they take blood and 24 urin test and everything comes back normal. her blood pressure is usually a little high when she first gets to the dr office because she is scarred of her dr. after 5-10 min its back to nornal.. yesterday she comes in and the first thing that comes out of her mouth is how about next friday for inducing labor, which is 3-4 weeks early.
i have read a lot of post on here and they said this stuff comes on quickly. but everything they do comes back negative. no headaches, no vision problems, nothing. they do ultrasounds and the fluid is great, the baby is practicing breathing, he is reactive. is there any reason to induce early with continued no signs or complications.
i think she jumps the gun but we dont want to say much because we dont want anything to happen to the baby or my wife. i am so stressed about this and its hard keeping my wife calm when she sees me so stressed about not having a medical degree. me and my wife are very eduated people in sciences, just not medical sciences, so part of our problem is our deductive reasoning process.

[fiona]

Hello and welcome.

From what you've told us, it's hard to really grasp why your doctor wants to induce early. Is this a first pregnancy, or does your wife have a history of preeclampsia?

When you say her BP spikes and then settles, what range are we talking about? High BP spikes are always worrisome as they indicate the body is not handling things the way it should be. Did they tell you the actual number of the 24hr urine test?

All I can suggest is that you write down all your questions and concerns and go through them at the next appointment: explain to the Dr that you would like to know what their reasoning is for induction. Tell them that not knowing all the details makes it more stressful for you both.

Please keep us updated and don't hesitate to come back with any further concerns.

[fishologist]

first kid. when we went in the two days abo i think it was 135/90 and within 5 minutes of settling down it was 120/88 i believe. the catch all is a week ago she had a real high blood pressure150/110. but i kinda blame ourselves. that was the first time i packed the car. put in the baby seat, and whe knew she was going to send us down to have the baby taken out shoot my BP was probally sky high to. we just knew we were going to be parents that day,. because up to that point everytime we talked to her it was dooms day. were going to take the baby by emergency c-section. then after the tests came back, well your free to go. this happened twice
the dr has never told us she has PE, tox nothing. me and the wife were talking last night and she said she got the impresion that the dr wanted to take the kid out to relieve her of bed rest and the low sodiun diet. nothing to do medicaly just a comfort thing.

we have a apointment with another dr today but michelle is nervous about switching dr in the same practice. we cannot switch practices because of our prepayment for the delievery. im trying to keep ker calm but its tuff. she is pretty rialed up over this whole situation

there is susposed to be some trust between her and her dr in my book. but there is none and that is troublesome because my wife should feel comfortable with her dr during the delievery

[fishologist]

the 24 hr test
first one after that itailian dinner was a little under 400 2 weeks ago
the second one they said was just normal 3 days ago

they take blood from her usualy every apointment every other day

[blythe]

I'm glad you found us, but sorry you needed to!

It is _hard_ when the doctors don't explain things enough so the patient and husband can understand why they want to get the baby out early.

I love hfwarner's summary - http://www.preeclampsia.org/forum/viewtopic.php?t=20234.

I'll add that while his notes say 38 weeks, I've read about many doctors who consider 36 weeks prime time to get the baby "out", even if symptoms are just starting.

Also, the PE diagnosis, as I'm sure you've read by now, are two readings at least 140/90 and over 300mg protein in a 24-hr urine. It may seem like an over-reaction, but even if stress is getting mom's bp that high and it comes down right away, it's still bad. The other symptoms - headache, URQ (upper right quadrant / under the right ribs) pain, visual disturbances, fluid levels, baby health on NST - are _not_ required for a diagnosis. Many doctors would prefer to deliver before any of those symptoms even appear, because once those symptoms are present, mom and/or baby is *very* sick.

I was very much in the same boat as you in my first birth, not understanding at all why my doctor wanted to induce when everything was great except my blood pressure. My doctor was just very conservative and wanted the baby out before anything had even a chance to go wrong. Other doctors are more willing to keep watching, hoping that giving baby more time inside is worth the risk of complications developing.

We are not doctors but as a whole are pretty obsessive about lab results and numbers [:)]. If you get numbers for bp, etc., we can tell you our experiences with similar numbers (but of course your doctors have to make the final decisions for you - though in my opinion they should explain things well enough that you are happy with their choices!). Please ask lots more questions - it took me over 2 years to wrap my brain around why I had such a tiny 37-weeker when it seemed like everything was fine. I finally understand that, for me and baby #1, my doctor did the right thing.

I hope we can help you understand what is going on - or at least give you more questions to ask your doctors!

[blythe]

It looks like we were writing at the same time! Your italian dinner had nothing to do with the protein, sorry. And my guess is that when the said "normal" for the second, they just meant it hadn't gotten much worse. That's just my guess, though.

It almost sounds like you have the same doctor as I did for #1 - mine acted like she was inducing because she was on call and 37 weeks is "term" and it would just be a convenient excuse to get my delivery off her "to do" list! I was *petrified* that she didn't have a clue about what she was doing. Some doctors, like her, seem to think telling the patient how serious the condition is just scares them unnecessarily. _Not_ understanding scared me more than anything. I hope the other doctor will explain things better. I absolutely agree that trusting your doctor is essential.

[fishologist]

This is fishologist's wife...the trouble maker;) Thanks for all of the helpful advice. I know my doctor is being cautious because PE/Tox are very serious and can get bad fast, but even though we ask questions she sometimes avoids answering them. I think that is one of the most frustrating things right now. My blood pressure has been around the mid- to low 140s over high 80s to low 90s when I first get to the doctor's office. When they take it again after I have been sitting there 10-15 minutes, it is normal - high teens over mid-70s. Up until a couple of weeks ago I have never had high blood pressure. Another thing that bothers me is that she is kind of wishy-washy. On Wednesday she said that she wanted to induce on Friday 4/13 (I'm not superstitious), which is her on-call day. If she absolutely wants to deliver we are pushing for after the 15th due to prior committment that my husband has that weekend. Unless of course there is a medical necessity that we need to deliver then. When we asked why so soon, she just said that we need to get the baby out, but then made it seem that it was more of a comfort thing for me and not a medical necessity to protect our health. Not that I really enjoy bed rest or the low salt diet, but I can put up with it a few more weeks to give Gavin a little more time to develop. He is doing so well so far. One other thing I found odd was that I had two ultrasounds last week to check my amniotic fluid levels. When we asked how big Gavin is the doctor kind of ignored us. I know he is considered to be at term, but I would think that if they were going to induce early and already had the ultrasound machine out that taking the extra couple of minutes to measure him and get an idea of how big he is would be a good idea. I am almost to the point where I am ready to say take him out because I am sick of stressing/worrying about it and I know that is definately not good for any of us. Thanks again!

[caryn]

Nah, you're not troublemakers. [:)] All of us end up trying to figure out what the *heck* is going on when we get this, and doctors are very, very bad at explaining it because it is amazingly complicated, endemic to human pregnancy, and in severe cases they're afraid they're going to lose mom or baby if they don't get going right away, with no time for explanations.

Most preeclamptics had no prior trouble with their blood pressure before the end of their pregnancies (the exception is chronic hypertensives.) A rough sketch of what's going on is that your immune system is beginning to fight with the placenta (which is, after all, half foreign), and the placenta is retaliating. The increased bp is a sign of the activation of your innate immune system and has been shown to have very, very little to do with lifestyle and/or dietary choices.

What you're likely seeing is the tendency for symptoms to come and go during the earlier stages of PE. The current thinking is that the symptoms appear in response to placental hypoxia -- times when the placenta isn't getting enough oxygen, either because the baby's demanding more than the placenta can send, or because your body isn't supplying enough. Sometimes the placenta can grow a bit -- sometimes your undersupply of oxygen was temporary -- it's a very complex set of signals between your body and the baby.

But we know it's caused by the placenta; it won't go away until the placenta is removed and the factors produced by the placenta have a chance to work their way out of your system.

Here's a link to a thread with some much more thorough explanations of the underlying biological mechanisms:
http://www.preeclampsia.org/forum/viewtopic.php?t=16607

Also, I have found that it is easiest to make sense of if you keep the idea of maternal-offspring conflict at the front of your head at all times. Some of our resident Experts (top researchers and clinicians working in hypertensive pregnancy) have been publishing on that aspect recently.

Feel free to ask questions; it's why we're here. And please keep us posted!

[fishologist]

todays results

we go in and her bp is 160/88 she had a small headache, and her feet were swollen a little. they made her lye down and 15 minutes later her bp was back down to normal. ther urine test strip was normal and after all weve been through they .....sent us home.. i dont understand any of this now they wouldnt even let us talk to the dr we were gong in for a second opionion. my wife said today that the stress is getting to her. would it be better for everyone if we let the dr set a date to induce. less stress on the mom and the baby? just a question

[blythe]

(sorry for saying "you" when I'm answering questions that both of you have raised, especially since this is really the Dad's forum! "Mom", we'd be happy to "see" you with your own username, too! And "dad", some other dads should be along soon!)

I'm sorry you had another frustrating visit! 160/88 is *high*. I imagine it's very confusing, though, to have your bp come back to normal so quickly. It's my understanding that in pregnancy-induced hypertension (and even in normal hypertension), bp can bounce up and down a lot before staying consistently high. I'm just glad that for now, it's not *staying* high!

The practice I went to with #1 wasn't much on "second opinions" within the practice. I almost think that's good, though - PE treatment really becomes an art when it's not immediately life-threatening, so the decision to deliver and other choices can vary a lot from doc to doc, and to hear the differences among doctors in the same practice (in my opinion) can actually be more confusing and more upsetting.

That's possibly the wishy-washy-ness you're experiencing, too - that delicate balancing act between giving baby more time vs. getting the baby out to prevent complications is *so* hard. I can definitely understand, though, how you'd like to wait a few more days for the induction if at all possible so that "prior commitment" can be honored. The problem, and it sounds like you do understand this, is that those few days could send you over the edge into severe PE territory - or, you could hold steady like you have been. Personally, after reading all the stories on these boards, I chose to be induced as early as possible with #2.

I have no idea why they didn't measure the baby during the ultrasound. Babies in PE sometimes (often?) are intra-uterine growth restricted (IUGR), and that is another indication that baby is having trouble. On the other hand, since they're already planning to induce, they're just saving themselves some unnecessary work. Ultrasound measurements are also notoriously wrong, as I understand it - someone here recently said their ultrasound showed a 3-pound baby, and within days she gave birth to a 5-pound baby.

As far as I understand it, the stress doesn't affect the progression of the disease, even though it seems to when your /her bp spikes like it has been. I don't think you've said how many weeks you are... Have you gotten a "Bishop's Score" to see how likely an induction would be successful at this point? I hope you are able to talk to your doctor again soon, and hopefully get better answers from her so you can feel better about inducing or waiting to induce!

Keep asking questions! Some other dads should be around soon!