How long is too long to be waiting?

[expert@preeclampsia.org]

I had severe pre-eclampsia during my first pregnancy and had to deliver at 33 weeks. My blood pressure was at 199/113 and protein was at (if I remember correctly, as those numbers mean nothing to me, 9++). My son was 2 pounds, due to IUGR, and was very sick. I was 33 at the time. Tests were made and it turned out I have antiphospholipids syndrome. When this happened, my doctor told me it would be best if I didn't get pregnant again, but if I did, to make an appointment with her as soon as the pregnancy was confirmed. Now, at age 38, I am pregnant again, but the hospital situation being what it is where I live, I am unable to get an appointment with an ob before I am at 15 weeks. Is this situation safe? Without professional care, what are the signs I should be looking for? (When I had pre-eclampsia the last time, it was discovered by my doctor by chance during a routine checkup. I felt nothing wrong.) Is there a big risk for blood clots early in the pregnancy? Pre-eclampsia showing up before my first appointment? After being cured from pre-e the first time, my blood pressure remained slightly lower than it had been pre-pregnancy (it is now at around 100/60). Is this a good sign, or does it mean nothing? Please advise, as I am feeling very scared.

[expert@preeclampsia.org]

You should see a specialist in maternal fetal medicine right away. You may or may not need heparin based on history and current lab tests. You are at risk for preeclampsia again. It would be very unlikely to happen before 20 weeks. If you need treatment with heparin, it should be started right away.

Where do you live?

[expert@preeclampsia.org]

Currently, from what I've read, I wouldn't prescribe, or even suggest, heparin outside the confines of a clinical trial. The data around antiphospholipids and pre-eclampsia get weaker over time, not stronger. There is an excellent recent review of the strength of association between pre-eclampsia and the inherited and acquired thrombophilias. The Principal Investigator is leading a trial, TIPPS, which is endeavouring to answer the particular question of heparin use in this sort of pregnancy.

OP should continue the aspirin/ASA 81mg/d, there is reasonable evidence to support that approach - it's safe, and somewhat effective, according to the recent PARIS collaboration paper.

I hope that these comments help.

The bottom line is that, generally, if pre-eclampsia does recur, it will tend to milder and later than last time. By definition, it does not arise before 20 weeks (although I've seen it once or twice before that time in couple of cases in over 20 years). OP's 100/60 is reassuring at present.