Questions and Frustrations

[padaddy2b]

My wife is pregnant with our first child, a girl, and she'll be 34 weeks this Wednesday. She's been having problems with swollen feet and ankles for most of her last trimester, and her blood pressure has been slowly climbing. She goes to her OB/GYN 2-3 times per week now, she has done a few 24 hour UT's, she get's 1-2 non-stress tests per week, and she got to spend one night at the hospital for observation so far because her BP was up and wouldn't come down fast enough. Her blood pressure today was 140/98 at its highest, and according to her last 24 hour UT (5/31/07) her urine protein was 280. She was in the hospital early last week for ~ 24 hours, and while she was there the doctor gave her two steroid shots to help the baby's lungs develop faster, as a precaution, in case they have to induce her early.

That's the background, now here's my frustration:

I'm a little confused about everything that is going on with her. No one has said she has pre-eclampsia, from what I am told, she's got PIH. I've been doing research on the web about her situation, and I'm terrified now. I go from scared of having my baby delivered and sent to the NICU and having lifelong problems to crying when I read stories of the babies that didn't make it. She's on bedrest now, and gets mad at me for making her stay in bed but for trips to the bathroom and to eat. I'm doing everything that I can around the house, and I'm keeping all my frustration bottled up so as to NOT further upset her. I don't have anyone to talk to, and I found this forum, so I thought I'd post here. I'm hoping someone can help me a bit to feel a little more at ease with what is going on with my wife, to understand what I can do to help, and what I need to know/be afraid of from here until my little girl is born. I welcome any and all comments. Thanks, Jerry

[fiona]

Jerry, welcome. I'm sorry to hear your wife is having complications and can completely understand your frustration and worry.

For a diagnosis of preeclampsia, your wife would need two BP readings of 140/90 or higher, six hours apart plus a 24hr urine count of 300 or more. Obviously, she is very close to an official dx but while her proteinuria remains beneath 280, technically she has PIH or gestational hypertension. That's not to say she isn't sick - she is - and the proteinuria could change at any time.

What's important is that she is being monitored closely - and it sounds like she is. She also has you taking care of her and finding out more about the disease, which is very helpful.

I know 34 weeks sounds awfully early, but in these parts, we consider it something of a result. That your wife has had teh steroid shots too, means that there is every reason to hope for a very short NICU stay if she delivered in the next day or two - and even for no NICU at all. We have many, many positive outcomes at 34 weeks+.

The important thing, as I said, is to keep close watch, log those BPs and find out what readings the OB believes warrants a trip to L&D. Familiarizing yourself with the signs and symptoms of preeclampsia and reporting any new concerns is vital: http://www.preeclampsia.org/symptoms.asp

Please know that we are always here to answer questions or just listen to you let off steam: a precarious pregnancy affects the whole family and we all need support. I'm so glad you found us.

[caryn]

Jerry, I'm thrilled to hear they're monitoring your wife and your daughter so closely. While no one can give a guarantee, the outcomes for babies delivered at 34 weeks are something around 99% chance of survival and 99% chance of what I think they called "uncompromised survival", no complications from early delivery whatsoever.

That's really good news, because as Fiona says, your wife is sitting right at the borderline of a mild preeclampsia diagnosis, and if they do need to deliver, it will be because they want to keep your wife from getting any sicker and/or know that the baby will be better out than in.

Hypertensive pregnancies are very common (at least 10% of all pregnancies), are more common in first pregnancies, and these days are thought to be due to shallow placental invasion during the first few weeks of the pregnancy, probably because of a maternal immune response to the foreign placenta. The best guess these days is that the placenta starts to release some proteins that damage the maternal vasculature, including the kidneys and liver. The damage appears to be 100% reversible upon delivery, although it can "unmask" a genetic tendency to chronic hypertension or an underlying autoimmune disease in some women.

FWIW, my DS was born at 34 weeks on the nose after two steroid shots; he spent exactly a week in NICU, came home breastfeeding, and has been thriving ever since.

Please keep us posted!

(ETA: I'm currently in Phoenix but I live close to Pittsburgh; are you on that side of the state?)

[annegarrett]

Hey Jerry,

I know there are dads around here who can offer you the male perspective but right now I can echo what Fiona and Caryn have said. They're are best people so have (as usual) covered it all and very well.

Most women who had preeclampsia have a safe, healthy delivery and recover unscathed. Our site, due to the random nature of the disease, is largely populated with the "other folks" so our stories are going to be the worst case scenarios, the tear-jerkers, the nail-biters as such. I sometimes think we should put a warning in front of the stories and this forum to remind folks that for the most part--this will not happen to you.

For my own experience--I survived this disease three times and the third resulted in a 36 weeker who didn't even need a moment in the NICU and nursed straight away--so at 34 weeks--you are in (as Fiona says) the positive area. If you had said the same story but she was 24 weeks--we would be all calling one another and settling in for a nail-biter. I wouldn't stress too terribly much about her occasional trips out of bed. The research on bedrest is luke-warm at best and some doctors argue the stress of keeping your house going while in bed may be even less restful than just getting up and doing it. The key is to monitor the BP, keep aware of the signs, and to have your doctor on speed-dial.

I am glad you found us. We started this because we didn't want anyone to ever have to go through this alone again--so I know just how you feel. We are all here (sometimes too much--note the 2:01 a.m. posting time) but you have a good chance of getting some support and answers 24/7. Not doctors and not nurses but just a bunch of folks who learned about this disease the same way you are...which is another goal of ours...to have people actually get this information from their doctors!!

Maybe we should just start with the "being there"...you take care and write anytime. Give your wife a big hug and tell her we (the non-medical, not lawyers, not authorities) at the PF site think there is reason to be very optimistic that all will be just fine.

Hang in there!

[padaddy2b]

Caryn,

Thanks for the reply. To answer your question: I'm actually about 30 miles north of Philadelphia.

Jerry

quote:

---

Originally posted by Caryn

Jerry, I'm thrilled to hear they're monitoring your wife and your daughter so closely. While no one can give a guarantee, the outcomes for babies delivered at 34 weeks are something around 99% chance of survival and 99% chance of what I think they called "uncompromised survival", no complications from early delivery whatsoever.

That's really good news, because as Fiona says, your wife is sitting right at the borderline of a mild preeclampsia diagnosis, and if they do need to deliver, it will be because they want to keep your wife from getting any sicker and/or know that the baby will be better out than in.

Hypertensive pregnancies are very common (at least 10% of all pregnancies), are more common in first pregnancies, and these days are thought to be due to shallow placental invasion during the first few weeks of the pregnancy, probably because of a maternal immune response to the foreign placenta. The best guess these days is that the placenta starts to release some proteins that damage the maternal vasculature, including the kidneys and liver. The damage appears to be 100% reversible upon delivery, although it can "unmask" a genetic tendency to chronic hypertension or an underlying autoimmune disease in some women.

FWIW, my DS was born at 34 weeks on the nose after two steroid shots; he spent exactly a week in NICU, came home breastfeeding, and has been thriving ever since.

Please keep us posted!

(ETA: I'm currently in Phoenix but I live close to Pittsburgh; are you on that side of the state?)

---

[anathor21]

Welcome to the forums - sorry that you are having to deal with a difficult situation, however I am quite glad that you managed to find us.

You have already received excellent advice and comments on things. I have very little to add to the basic facts that have been shared with you. On one hand the facts can be somewhat reassuring - knowing that 34 weeks is a 'good' place to be is nice and just knowing what to watch out for and what to do (which is pretty simple really - get her to the hospital ASAP) if things look at all like they are going downhill helps a lot.

Keeping calm through this is a very difficult thing to do - as the husband and father we have the duty to advocate for our family and insure that they get the care they need. In order to fill this role we have to research so many "what-if" scenarios and thus will read all the "worst case" stories and take them to heart. Luckily these terrible outcomes are the exceptions - not the rule.

The main weapon that we have against these is the information that you are getting now - as you read the horror stories note that a common theme in many of them is the "I just didn't know" factor. Well - at least you and your wife know more than the majority of folks out there already. You know the signs and symptoms (see Fiona's post), and you know what to do if you suspect anything is going awry. So - your chances are already greatly improved. Obviously this does not give you a free ride, nothing will, but you should be able to take some comfort in knowing more about the enemy you are facing.

What to do now? Well, my advice is generally the same for most folks. I'm a big believer in watching that blood pressure at home - checking it several times a day and keeping a written log to share with your medical team at each appointment. Helps to have the history there so you can see changes and when it is written down in a nice, neat way it conveys a sense of professionalism and helps folks take you more seriously.

At 34 weeks, doing kick counts is a good way to keep a somewhat objective measure (log it as well) of how active your little one is. Once again - having a history will help show changes. Sudden changes in patterns can be the first warning signs. Going with objective measures with some care providers (especially those who don't know you like whoever is on duty in the middle of the night) may carry more weight than "I just feel something isn't right" type of complaints (although most of the mothers here will tell you the "bad feeling" is just as valid - so I would never discount it!).

Anyway - please feel free to shoot me an email if you want, I'm always willing to chat or email or post more if you have more questions. Whatever the case, do keep us posted to let everyone know how things are going!

E.

[hfwarner3]

Welcome to the forum!

First, my wife and I have 5 children. She had PIH or pre-eclampsia with all 5 of them, all 5 were early, and my wife actually had eclampsia with the last one. I know that all this sounds scary right now particularly with your first child, but it sounds like you are doing the right things. You are involved. You are asking questions. You are looking out for your wife and child. You are being a great dad and your kid isn't even here yet. So give yourself a pat on the back that you are already on the right path.

34 weeks is a good place to be, but 36 weeks would be better. 37 or 38 weeks would be even better still. That is the mind-set you have to place yourself into now. You take things a day at a time with the realization that once things move they might move very fast or it could stay just where it is until they induce. If things move, you get a new baby out of the deal! Hopefully the baby can stay in for another couple of weeks just to be safe.

Let us know how things work out for you and feel free to post here if you have questions, need to vent, or just feel like you are going nuts. We have all been there!

[blythe]

I love hf's summary of "when to deliver" http://www.preeclampsia.org/forum/viewtopic.php?t=20234

I also like rerskine's advice http://www.preeclampsia.org/forum/viewtopic.php?t=21937
(toward the bottom of the page) on finding out how your baby's birth will be affected by the disease. We're always so focused on the pregnancy, but the actual birth can bring a lot of surprises, and that's somewhere you can also be a huge help to your wife. Good luck!

[padaddy2b]

Hello everyone,

Thanks for all of the information and support - you have no idea how much better I feel now. So here's the latest update... The bedrest seems to be helping my wife. Her Protein is holding below 300, her blood pressure was actually down at her NST yesterday (134/82), the baby's vitals are still all good, and the doctors seem to be confortable with everything at the moment. I have a long talk with her ob/gyn yesterday to try to get a better understanding of where their heads are, and he bascially told me that here is no absolute answer to what will happen. They are monitoring ALL of her numbers, and he says there is no magic number that will determine when they induce her as far as they are concerned. If her BP suddenly goes way up, or the baby isn't responsive enough at the NST, or her protein goes way up, or she starts having headaches/abdominal pain, then we're going to need to talk about taking the baby ASAP. They did tell me, however, that she WILL be here before the due date. They want to take her when my wife reaches 37 weeks to eliminate any possible problems for either of them that might arise if we wait longer. Having said that, we have another NST this Friday as well as an ultrasound to determine size/weight to make sure she's growing OK. If all goes well, my little girl will be here before the 4th of July instead of around the 19th (which was her original due date). I'll try to post again over the weekend if I have some time, but I've been busy putting together all the stuff we got at the shower and finishing up the baby's room. Thanks again for all of your support. -Jerry

[fiona]

Jerry,

thanks so much for the update - I'm so glad your wife is holding steady. Everything you have reported the docs saying sounds absolutely right to me - good to know she is being monitored closely. It really is a balancing act from here on in and the key is catching things before they go haywire (which is why most docs will deliver at 37 weeks anyway, if they haven't been forced to before then).

Good luck and keep us posted.