Very High BP, only trace protein

[sarahhutchens]

Hi. The more I read about pre-e, the more concerned I get. I'm not sure my doc is on top of my situation.

I was diagnosed with pre-e at 28 weeks and put on bedrest. I had bloodwork done then, which came back normal. Since then, I've had only trace amounts of protein in my urine, and lately I've started to have swelling in my hands in the mornings, to the point where I can barely bend my fingers and can't even make a fist. And since then, my blood pressure has gotten progressively higher. My last appt it was up to 160/112, and even after I'd been laying on my side for a while, it only went down to 144/90. Also, about a month or so ago, my doc told me during an ultrasound that my placenta looked like it was starting to wear out.

I also have GD, which we're trying to control with diet and Glycuride. At my last U/S, at 31 weeks, the tech said my baby was measuring two weeks ahead, at an est. weight of 5 lbs.

Other than put me on bedrest, my doc has done nothing about my problems. Zach has been doing well on his NST's, so my doc said he'd probably induce me around 37-38 weeks. I'm just concerned that he's let my blood pressure be this high for this long, and I'm also kinda worried that Zach isn't being measured to see if he's getting too big.

What do you think? Should I try to get in to see a different doctor? I'm already 35 weeks.

Thanks!
Sarah

[annegarrett]

Sarah,

You don't mention where you are but let us know. I am not a doctor and this section is meant to be answered only by our experts so we will have one of those post a response ASAP but in the meantime, as a woman who has has this disease and the director of the preeclampsia foundation--I would advise you strongly to get a second opinion from a perinatologist in your area. To find someone in the USA--check www.nasshp.com and scroll through the addresses. Please let us know where you are and if you found someone on that list. Those numbers are concerning and I want to be sure you get someone who appreciates that.

Take care--



Anne

[expert on call]

Thank you for the query. It is difficult to speak to your case without knowing the specifics of your history, pregnancy, and care. This includes what is meant by "bed rest", whether visits are weekly or even twice weekly, how often and what blood and urine tests are being monitored, and how often are fetal electronic heart monitoring as well as ultrasound studies being recorded. Suffice to say with the information below, the suggested course is to cared for by a maternal fetal medicine (high risk) subspecialist with delivery scheduled at a tertiary center with facilities for prematurely born infants. Concerning the queries below:

During pregnancy mild to moderate hypertension need not be treated the level at which drug therapy is started differing among practitioners. The National High Blood Pressure Education Program's Working Group suggesting level not exceed 160-70/ 100-110 mm Hg.

Many, however start at lower levels such as 150/105 mm Hg. The reasons are that there is no evidence that treatment of lower levels effects outcome, but with higher levels the risk to the mother (e.g. stroke, bleed, heart failure), increases. Since we prefer not to use drugs in pregnancy we believe that as long as mother is not at risk it permissible to wait for higher levels before treating.. Also, note, that if a patient rests on her side "for a while" one must be sure the blood pressure cuff is at the level of the heart as holding the arm up gives a falsely lower pressure.

Concerning bed rest: There is no data to support the contention that strict bed rest prevents the progression of preeclampsia, and such regimens are usually difficult to tolerate. A restful or non stressful environment suffices.

There is also insufficient information to comment on the infant size. However, if you are at 35 weeks and are in the hands of a high risk specialist and being "watched like a hawk" all should end well.

Expert on Call

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