PIH -What's the protocol for detection/action?

[dmatisse]

I am currently under the care of a high-risk Dr. and have been on Bedrest since Week 23 (after a Preterm labor/incompetent cervix debate - my closed cervixed had shortened from 4.1 cm to 1.5 cm between u/s week 20/23)

2 weeks ago I had a spike in my BP 180/110 (I've spiked 3 additional times 160/100 range) while at the consulting Dr.'s office (we all laughed about my "white coat" syndrome.) The BP did go down after lying down for 5 minutes. {130/80) 1 week ago it read 150/90 at my usual Dr.'s appointment, again going down after lying down. Then on this last Thursday's appointment I spiked again, at the consulting Dr.'s office to the 180/109 range.

I've got a home monitor that shows readings of 130-150/80-90s anytime I get out of bed (taken sitting after 3 minutes rest - but when lying down after 5 mintues I would get lower readings.) During the last 3 days the readings are higher 140-150's/80-99's and take longer to go down and now hang at about 135/85.

I didn't know what tests are used but I've had Lab work done twice with "no significant lowering of my platelets."

My question is - what protocols are in place for my situation? My baby girl is now 32 weeks +3 showing normal growth (30 percentile) at my last u/s. Amniotic fluid 14.5/diastolic reading 1.9.

I'm nervous about waiting to "get critical" before action is taken - and yet I obviously want Sarah to get all benefits of being in my womb.

What lab tests should be done? Are there criteria to induce based on those tests? Are results quick enough to act? I also purchased Albustix (Reagent Strips for protein in urine.) My urine has consistently shown "none" for the last 3 days... however today it indicated Trace (the scale is: none, trace, 30+, 100++, 300+++, over 2000++++. I'm not sure how that corresponds to the 1+, 2+, 3+ I've been reading about.)

The part that is hard to manage besides the issue of exchanging one "problem" for another, (I had such huge relief about getting to week 32 with my crazy cervix to then hear my consulting Dr. say, "I don't think we'll be delivering because of your cervix - I think we'll be delivering because of your high blood pressure.") I really had NO IDEA about PIH, Pre-Eclamsia, HELLP and Eclamsia prior to one weeks ago and the consulting Dr. didn't do urine or order blood work - he just released me back to my Dr. who was on vacation saying he was diagnosing pro-active hypertension (I react to stress and activity with hypertension).

I the nurse at my Dr.'s office and assertively asked for "the appropriate" tests to be run. At this point I know I need more education and to feel more confident about there being a plan of action/observation and feeling confident to "catch" this all in time.

I certainly appreciate and value any and all information.

[expert on call]

The fact that you have had multiple high blood pressures on different occasions is quite concerning, even without the appearance of protein in the urine. Typically even very conservative physicians would begin treating blood pressure that gets up to the 160/100 range or higher. While there are no definite protocols about treatment of high blood pressure in pregnancy it is probably time to begin taking action in terms of treatment with medications or consideration of delivery

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