symptoms in rural WY--2 hours from nearest hospita

[expert@preeclampsia.org]

I am trying to gather the relevant information to make an informed decision about staying on home bedrest in rural Wyoming as recommended by my current OB versus going to an urban area to be closer to a hospital with perinatologists and a level III NICU and/or proactively advocating for hospital bedrest. I currently live 2 hours from the closest small town hospital and an 8-hour drive from closest the NICU. Life-flight options are available, but it is mountainous terrain and weather can be a limiting factor.

Relevant history and symptoms:

mild preeclampsia in first pregnancy 2 years ago (edema, high BP but never over 140/90 with a normal BP of 110/70, no proteinuria--dipstick only, no abnormal blood tests), 3 weeks strict bedrest prior to being induced at 38 weeks. donor egg IVF. otherwise, no other known underlying factors.

currently in week 30 of my second pregnancy, twins, same donor for donor egg IVF, now 30 weeks, rapid onset of symptoms (within 72 hours--edema with increasing pitting, carpal tunnel, and high BP --130-140/80 versus baseline of 110/70, mild headaches, nausea--all have manifested much faster than last time). no proteinuria (dipstick at 29 weeks); elevated liver enzymes (AST=50).

Questions:

is this combination of history and symptoms sufficient to warrant hospital bedrest?
if not, is it sufficient to warrant temporarily moving to an urban area (Denver) under the care of a perinatologist?
should I request a 24-hour urine test versus just the dipstick?
are there any questions i should ask of my providers or other tests i could request that would help in this decision?
Thanks for any input.

[expert@preeclampsia.org]

Moving for the remainder of the pregnancy is certainly a disruption of your normal life. Your risk of developing preeclampsia is high due to your history of preeclampsia in the last pregnancy, the twins, and your rising BP. I think it is only a matter of time until you are preeclamptic. It is just hard to tell how much time. Yes, a 24 hour urine would be helpful.

We frequently recommend bed rest - but there is not much evidence that it protects you.

You are also at risk for premature labor and preterm birth due to twins. It is important to know what your cervical length is.

Based on your description of distances from hospitals, I am guessing you live somewhere beyond Lander. (I have spent some time in Wyoming). There are few places in the US further from care or with more challenging winter weather.

I would go to Denver.