by expert on call (297 Posts), Sat Aug 30, 2003 11:41 am
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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