Thinking about 3rd- HELLP then Pre-e event

[toes_in_the_sand]

I have major baby fever right now. We always planned for 3 or 4 children & I would really like to try for a 3rd. I was diagnosed with pre-e with my 1st at 25 weeks & was put on bedrest. I was induced at 35 weeks because of HELLP. Second pregnancy they watched me much more closely & took my high heart rate much more seriously (which I had the first time too but was largely ignored). I was put on bedrest at viability due to a resting heart rate of 120 (while sleeping) & was told to keep my HR below 130. I had some BP spikes that landed me in the hospital for a brief stay & a few spikes of protein during my weekly 24 hr urine tests. I was induced at 33 weeks due to a BP spike that was through the roof (they called it a "preeclamptic event").

When I spoke to my OB she told me that I could try for a third but that I would have to be seen by a high risk dr every week (as well as weekly OB visits) & I would have to go on hospital bedrest at viability & start getting the steroid shots at that same time. She thought that I would deliver around 30 weeks. And that there was a 100% chance that I will have issues again.

Has anyone else had a similar experience with multiple pregnancies with pre-e? How were you handled by your doctors? Bedrest?

[susheli]

Hi there,

I also always dreamed of a large family ... four, five ... more? But I developed PE twice severely, once at 24/5 weeks - though I was able to wait on hospital bedrest until 34 weeks to deliver - the second time at 27 weeks after having been put on modified bed rest at around 16 weeks and then I made it to term on bed rest and meds, but had severe PP PE. I also had a very difficult second section, and both my babies had IUGR. Long story short, my MFM recommended no further pregnancies. My husband agreed and so we went ahead with Essure. It was heart-breaking for me, but now that my younger is 2 1/2 I am coming to terms and feel incredibly lucky to have two healthy daughters despite PE. To be honest, my second pregnancy was so stressful that I would have found a third, knowing PE was almost certain to happen a third time, very difficult. I admire your courage and understand your desire for another - it sounds like your doctor will support you and take good care of you.

Best of luck!
Susheli

[caryn]

Welcome to the forums.

I'm not sure what an MFM would say about hospital bedrest starting at viability, given your case history. But I do know that we don't see that very often - mostly because the evidence supporting bedrest as any sort of therapy is pretty much nonexistent, and so they would only use it if there were good evidence that a) you needed constant fetal monitoring, or b) you were responding very positively to bedrest despite the lack of evidence for it in broad populations.

The tachycardia of 120+ sounds miserable. Did they give you any medication to lower your heart rate? IIRC the way they are thinking about this right now is that sometimes the placenta turns up the maternal pulse.

Since you had it in two pregnancies, odds are you've got some sort of underlying condition that predisposes you to develop preeclampsia when you're pregnant. Have you had a workup to look for autoimmune conditions? Or do you maybe have chronic hypertension?

We've a lot of posters who've weighed their options after a second pregnancy; I imagine more of them will be posting.

[toes_in_the_sand]

I am very curious to see what the MFM says. With my last pregnancy the cardiologist put my on bedrest due to the HR issue. It soars into the 190's when doing simple things like brushing my teeth (while sitting) or swallowing water. It was nuts.

My BP & HR are great when I am not pregnant. And my mother has anticardiolipin antibody so I have been tested for all the lupus related issues. Are there other tests that I should ask about?

I was not allowed to go on the medications that the cardiologist gave me to bring my HR down (beta blockers) because the MFM & the OB both felt that it would mask a preeclamptic event.

I was thrilled when they put me in the hospital last time for a few days because I am pretty sure that no one believed me that my HR was high even in the middle of the night when I woke up to pee. Sure enough- 24/7 my HR was insane for every minute I was in there.

Another question that came to me- for people who have had a 3rd after the 2nd PG went in the wrong direction (a few weeks earlier rather than later)- at what point did they start steroid shots for the baby's lungs? My OB mentioned at 23 weeks (viability at our local Level 3 NICU).

I really appreciate the responses I've gotten. I used to read this site a lot when I was PG with my first & on bedrest. It is such a great resource.

[caryn]

That's something that usually varies by symptom, as well as history and gestational age. Steroids are most effective if given within 2 weeks or so of delivery, IIRC, so they don't want to give them at 23 weeks and then have you hold out to 34! It's something to discuss with the MFM at a preconception appointment - given my history, and the local resources, at what point would you ask me to go on bed rest?

I know a lot of our docs would say tachycardia would need treatment at those heart rates, and that they'd want to monitor you more closely given the potential for sudden onset of preeclampsia symptoms, but I don't know how they would do that given your individual history. I bet the hospital was really a relief, because they stopped calling you a hypochondriac. Jeez.

I'm glad this forum has been helpful for you.

[toes_in_the_sand]

Had my appointment. It went surprisingly well. The dr said that there was a 100% chance of getting pre-e again (with a slim shot at it not happening if I have a boy this time- though he said that it usually went the other way around). He would treat my heart rate issue as a separate issue & I would be under the care of a cardiologist for that issue. I would start getting steroid shots for the baby's lungs at my first pre-e event (usually at 23-24 weeks for me). Bedrest for my heart rate issue starting at viability. And he surmised that I would deliver at 31 weeks. Also, when my DH asked if I would die or if the baby would die the dr said the chance was "slim to none" & when he asked if his wife was in the same position would he try to have another baby- the direct quote "it would not deter me." Now to decide if we want to do it or not.

We would not try until August so we have some time to really figure it out.

[tls562]

I developed HELLP with both my pregnancies and the mf specialist has advised me not to get pregnant again I saw the specialist, had weekly appointments, took baby aspirin with my second preg and still developed HELLP again. I'm also otherwise healthy, normal weight, active....no clue why I keep getting this. Its a personal decision. I did feel better being monitored so closely with the 2nd pregnancy. Good luck with your decision.

[Mari2012]

I developed HELLP with both my pregnancies and the mf specialist has advised me not to get pregnant again I saw the specialist, had weekly appointments, took baby aspirin with my second preg and still developed HELLP again. I'm also otherwise healthy, normal weight, active....no clue why I keep getting this. Its a personal decision. I did feel better being monitored so closely with the 2nd pregnancy. Good luck with your decision.

I had HELLP and delivery at 28.5 with my first and am considering a second. How was your second pregnancy compared to your first? Milder or exactly the same?