What can I do and how worried should I be?

[chrism]

Ok, Probably coming across as the overprotective father etc but I have been reading this forum for a few hours and am becoming more and more worried, not only about the future health of my wife and baby but what I can do...

My wife is 25 weeks pregnant (with our first) and she made a routine visit to the midwife today (which is the first appointment I've not been at her with). Anyway, to cut a long story short the midwife diagnosed her as a possible early onset of pre-eclampsia due to high protein level in her urine, high blood pressure and sever swelling in her ankles. My wife seemed quite calm about i, maybe due to the fact that she has heard of other people who have had it, and ignorance as well I suppose. The midwife has arranged another appoinment for 6 days time to check that protein level is not due to fighting an infection in her system, and to check all her other statistics.

Coming home today, I decided to do a bit of research and was comforted to read that up to 8% of pregnant women suffer from PE. If its that common theres nothing to really worry about with the right precautions I thought. (safety in numbers etc)

But after reading these forums, a lot of her other peculiarities / symptom shes been feeling recently could have more serious consequences. In the past couple of days she has been complaining of a pain in her ribs. She said it was probably just the baby kicking into them so I thought no more of it. Shes always had back pain due to the fact she broke her cocsis (sp?) when she was young.

My questions really are. Should I be more worried? Is it likely she'll have an abnormal birth (ie not last her full term / c section etc)? What more can I do? She is due to work up until week 35. Should I plan for her to finish earlier?

My plan so far includes.

1. Buy a BP monitor to chart her BP over the next week and beyond.
2. No more driving in case she starts to feel dizzy or unwell etc.
3. Rest and sleep as much as possible.


I know to ask the questions about her medical care (ie specialist in high-risk etc) but aside from that I feel all a little helpless. Plus I dont know how much to tell her before next week. I'm always the one who researches these things and fills her in but I dont want to worry her when there's nothing else she can do, pushing her BP higher.

Many thanks in advance

Chris

[kara]

It's great to see a husband coming here to check these things out! That's the first and best thing you can do. Do you know what her BP reading was...the numbers? The combination of protein and hgih BP is concerning, and it depends on what those values are as to how concerned to be, and what the next steps would be. If the blood pressure is near 140/90, or higher, the concern is potentially greater, especially if she normally has lower pressures. A week can be quite a long time, dependant on those readings. Buying a BP monitor and logging is a good idea. We suggest taking the pressures 2-3 times a day, around the same time each time (ex: 7am, 12pm, 8pm..) Requesting a 24 hour urine catch is the most accurate way to determine values of protein int he urine. A diagnosis of preeclampsia consists of 2 BP readings of 140/90 or higher, and 300mg of protein on a 24 hour test. If your wife normally has very low pressures, a rise of 30/15 above her normal would also be cause for concern.

Finding out what those numbers were, including the protein reading will be helpful. The next step is to get to the consultant or OB...preferrably a specialist. I know we have some others that are more familiar with your health care system in the UK, so perhaps they can be more helpful.

http://www.preeclampsia.org/symptoms.asp Become familiar with the signs and symptoms. Any report of headache that won't go away with tylenol, flu like symptoms, feeling off, pain that is in the upper right quadrant of the torso (usually quite intense), very dark colored urine, a weight gain of 2 or more pounds in a week, swelling in the face, hands, eyes, lips, fingers...particularly if it is worse upon waking in the morning, decreased movements from the baby, are all worth a trip to the labor and delivery ward at the hospital and a call to the consultant.

Stress will not cause blood pressures to go up and remain up, and most women here would rather be aware (especially the signs and symptoms), because they knwo their body,a dn know when something is not right. I would urge you to share theses signs with her, so she can be aware and help decide if something is worsening. The stress will not cause her to get worse. And have her start doing kick-counts for the baby.

Some women develop preeclampsia and muster along for many weeks. Some can make it to 37-38 weeks which would be considered full-term. Others require intervention earlier and must deliver prematurely. Natural delivery is the first choice, but sometimes a c-section becomes necessary. The most important thing is to get a healthy baby here, with a healthy mom. The only way to stop the progression of the disease is to remove the placenta (which means delivering baby). And often times it is healthier for mom and baby to have baby be born, even if it means a premature birth (as is was in my case).

Unfortunately there is little rhyme or reason as to how a woman's body reacts to the disease process, and what to expect. It is often a day by day situation.

I am happy to hear that your midwife has noticed these symptoms, and is going to monitor closely, hopefully under supervision of the consultant. I know that i was quite calm about the situation when I was diagnosed because I actually felt quite fine, and didn't see what the big worry was. Little did I know that preeclampsia can be very dangberous and it has the potential to move quickly...or slowly.

Let us knwo about those numbers, and we will try to help you guys along.

[catherine]

Those are great questions Chris, and I think that you are wise to be concerned. I have to admit that I'm a little disappointed that the midwife wasn't more proactive about checking things a little more closely. Protein in urine can be measured quantitatively (although ickily) by collecting all urine output for 12 or 24 hours and a blood draw will reveal information regarding the presence or absence of warning markers such as elevated liver enzymes, lowering platelets etc. If the protein were not related to preeclampsia but due to a kidney infection, that should have warranted follow up because these infections during pregnancy can trigger pre-term labor, also very undesirable.

So, I would not hesitate to take her to the ER to be evaluated if she should complain again about a pain in her ribs, nausea, vomiting, a bad headache etc. There is a list of signs/symptoms on the main pages that you might want to print out and keep handy. You might also want to go ahead and call your GP/health care provider and ask about having her evaluated by a specialist. Yes, lots of women experience preeclampsia, but mostly late in their pregnancy. Early-onset of symptoms such as your wife is experiencing needs very careful evaluation and monitoring and the sooner you can establish that the better.

We're no experts on the NHS and how to work that particular system, but we do have other UK posters who might be able to advice and you should also be able to contact our sister organization APEC, they are extremely helpful and will be able to guide you much more expertly than we can.

We also have some expert Dads who have been through this before and who will be able to guide you towards the best balance of caution and support! Hopefully they'll all show up here before you know it.

In the meantime, welcome.

[caryn]

Chris, welcome to the forums.

What were her blood pressure and protein readings? The diagnostic line for a preeclampsia diagnosis is two readings of 140/90 and a 24-hour of 300 mg (dipsticks are unreliable, and we don't recommend taking them at face value because they can swing wildly with hydration levels.) Our Experts (top researchers and clinicians who work on hyeprtensive pregnancies) also say that women with a rise of 30/15 above their initial values "merit close observation."

I agree with you; you'll want to get a high-risk MFM to oversee the rest of this pregnancy. On average, delivery is two weeks from diagnosis, although some women limp along for months and some women develop full-blown severe PE or HELLP syndrome and have to be delivered within a few hours.

I'm not sure how that works in the UK, but here's a link to a site that will let you find a maternal-fetal medicine specialist near you: http://www.smfm.org

The thinking is that this disease is more common in first pregnancies and in women with underlying disorders like autoimmune diseases or chronic hypertension, likely because the immune system response to the foreign placenta prevents the deep embedment of the placenta. That's why stress and work and driving aren't thought to have much effect on the progression of the disease.

If she's already been told she's likely a preeclamptic, and she's having abdominal pain or pain referred into her shoulder, she would be best evaluated by a specialist at L&D immediately. Liver rupture presents with those symptoms (not to scare you, but it's worth checking out and letting the *real* experts take a look at her.)

And monitoring and logging her bp is a great idea; it will let them spot trends and spikes.

Six days seems like an awfully long time to wait to evaluate her, to me. If she is really developing preeclampsia, it won't go away until the placenta (and thus the baby) is delivered and she has a chance to recover. Has she started a 24-hour urine catch? I appreciate why the midwife is saying that this might be a UTI or something, but there are quicker ways to evaluate that than just sending someone home over the weekend!

Please keep us posted.

[sarab]

Hi Chris,

It looks like you have gotten some wonderful info already, but I just wanted to say "hi" and welcome you to the forums. It sounds like your wife is very lucky to have you, and I applaud you for taking the initiative to learn all you can about this disease. I also want to echo the others and encourage you to get her to the hospital right away in if she develops any of the symptoms mentioned above.

Please don't hesitate to post if you have any other questions, and do let us know how things are going. We tend to worry around here if we don't hear anything for awhile. [:)]

Good luck to you and your wife.

[onesock]

I just wanted to say hello and welcome to you too, Chris. I applaud your concern and efforts to learn more about what may be going on with your wife...lucky lady! You have and will continue to get great advice on here...come anytime and ask anything, there is always someone to help give advice or just listen. Keep us posted...like Sara said, we get worried when we don't hear anything!!:) Good Luck!

[fiona]

Chris, you've been given some great information. My first two pregnancies were in the UK, so I wanted to add a little from that perspective.

I agree that six days is too long to be hanging around to see if this is early onset pe and not a UTI. I would do one of two things: either get in to see your GP first thing. Have a BP check and a urine dip. Ask for a 24hr urine and an immediate refferal to a high risk consultant - my GP phoned and made the appointment while I was sitting in her office.

The other option is to head into the walk in check up at the maternity unit your wife is booked in with. Have them run checks and stay put until an OB sees her. Again, I would be looking for a 24hr urine, bloodwork and an u/s to check the baby's growth.

Any problems, our sister organisation in the UK, APEC should be able to offer advice: www.apec.org.uk

You are right to be concerned. Don't let anyone convince you otherwise. If the pain in her ribs intensifies, she starts having visual disturbances, is nauseous or vomiting, or any of her symptoms seem to be worsening, head straight into the maternity unit.

Good luck and please keep us posted.

[chrism]

Thank you so much for your kind words and encouragement. If nothing else it gives me something to direct my energy towards rather than feeling rather helpless.

The wonderful thing about the NHS and our care plan is that it is shared care between the hospital and our GP and as such we get to keep our chart at all times so I can track what is being noted.

Her BP was measured as 140/80. The protein level was not quantified, just that it was away to get checked, possible UTI etc. We had a re-scan 2 weeks ago and everything was normal. She had her blood pressure taken as her ankles were (and still are) very swollen, but it was normal then.

Like I said before, its hard not to look at everything thats happening as a symptom, like when she was getting out of bed at the weekend from an afternoon nap, she got nauseous and started to heave for about a minute. I asked her this morning if she was feeling any more nausea but she said no, just some dizziness (another symptom).

I'll test her BP this afternoon and if its still high I'll take her to the maternity ward.

Its probably just a case of being safe rather than sorry I suppose but still the uncertainty is a very unsettling feeling.

[fiona]

Better safe than sorry is our mantra around here ;-)

[sam]

Hi chris, welcome

So glad to see a caring and protective father on here, your pro active care for your wife and baby is to your credit.

I am from london, if you want to chat plkease feel free to email me at samhayman72@yahoo.co.uk.

the midwife should refer you immediately to a high risk doctor if she suspects PE. Your wife needs more careful monitoring now with those symptoms, and i concur with all the ladies here, that 6 days is a little too long.Not to frighten you but some gals can limp along with PE and others require more urgent intervention.

I think it was caryn who posted about signs and symptoms, please keep an eye on these, and also check out APEC's website (action on PE in the uk), or if you want to you can call Liz who runs it on her helpline the number is 0208 427 4217, she can answer any of your questions and concerns regarding your wifes and your baby's care. All hopsitals and NHS trusts in the uk must now follw the PRECOG guidelines, a protocol for women with suspected PE or PE. I suggest you visit APEC's website and get your ink cartridge flowing and print these off, so you can see what the uk's criteria are and if it is being followed by your midwife. I carry a copy in my ante natal notes all the time, just in case, thankfully this pregnancy i haven't had need of them.

As everyone else has said please if anything changes/worsens please get yourself off to maternity/delivery and they can carry out blood work, and check everything is ok, that is what they are there for. wishing all three of you the "best of British"

keep us updated when you can, and as i said you can contact me directly if you wish.

take care, best wishes