PE or not and how about Aspirin?

[markbures]

My wife had a check up about a week ago. The doctor was alerted by a few things:
* Weight gain last month of about 6 pounds
* 'High' blood pressure (my wife does not recall the reading)
* Doppler fluxmetry indicating problems in blood flow to the placenta

We are in our 28th week. Until now, everything was fine. Now the doctor thinks it's PE and asked for some blood sugar test and blood protein tests.

In the meantime, she has prescribed 100mg per day of aspirin.

1) Does the blood pressure HAVE to be done twice, six hours apart, to be valid? Should we insist?
2) Aspirin - good/bad? Some Spanish study seems to recommend taking it at night
3) What else can we do? I am studying up on how we can cut salt out of our diet
4) Have not ready anywhere here about Doppler Fluxmetry as a diagnostic tool for PE - thoughts?

Thanks!

[kara]

Sorry to hear that your wifes doc thinks she could be developing PE. I'm glad you've found us. You'll get some great responses from people with lots of experience with PE.

The time frame for the two BP readings does not necessarily have to be exactly 6 hours apart...just more than one reading of 140/90 or higher at "least" 6 hours apart, to make sure it wasn't a fluke, or an adrenaline response. It coud be taken 2 weeks apart and still count. The weight gain is concerning, and we normally tell our gals to be on the lookout for 2lbs or more a week, or 6lbs weight gain in a month as being potentially concerning, assuming she's been eating normally. The doppler scans seem to be a decent screening tool.

A 24 hour urine catch would be important to accurately determine protein in the urine, which measures kidney function, and if the disease is having an impact on the kidneys. It does not predict severity though. Preeclampsia is not known to cause permanent kidney damage, and function generally returns to normal within a few weeks to a few months after baby is born.

An official diagnosis of preeclampsia comes with at least 2 BP readings of 140/90 or higher..at least a few hours apart AND 300mg of protein, or more in a 24 hour urine catch.

Aspirin has been shown to have some effect on those with blood clotting issues, which could be the case with poor placental blood flow. Though I usually see docs say to take a baby aspirin or low dose aspirin which is 81mg. But I'm not a doc, so you should take it in the dose your doc has prescribed. :-) It won't prevent preeclampsia or make it go away, but it may help get more blood flow to the placenta and buy time for the baby.

While some people are sensitive to salt and it can make them retain water, cutting out salt will not prevent preeclampsia, either. If it helps your wife with swelling and makes her more comfortable than it's probably ok to try and cut out those obvious salt ridden foods. 'Chesley's Hypertension Disorders in Pregnancy' says,"Sodium restriction is likely to aggravate the preexisting plasma volume contraction and is not routinely recommended for women with preeclampsia."

Reducing salt, or anything else we try will unfortunately not prevent preeclampsia, as it is a disease process originating of the placenta, that is thought to start at implantation. We all want and expect a great and normal pregnancy, and when something goes wrong we assume that we have done something wrong, or that we can do something to prevent it, but we haven't and we can't. It's a disorder that has no one cause, or known cause, and currently no cure other than delivery of the baby and placenta. There are some management tools out there (bedrest, bp meds, aspirin, etc, but nothing can prevent it. And even then, only certain management strategies work for any individual.

I'm putting in a link to our signs and symptoms page, and to a thread on doing kick counts below, as reference for you and your wife. Please look over the signs and symptoms and have your wife notify the doctor if she experiences any additional symptoms, if symptoms get worse, or if she feels "ill", or "off", or "not right". Of great concern are visual disturbances such as blurry vision, sparkles or flashes of light in the eyes, headaches that won't go away with tylenol, pain in the upper right abdomen area - under the ribs or breastbone, right arm, or right shoulderblade, and flu like symptoms. Those are symptoms that would warrant a trip directly to Labor and delivery at the hospital for further evaluation.

Preeclampsia is very unpredictable, and can move slowly or quickly, so keeping a close eye on things is very important. It sounds like her doctor is being proactive and watching out for her, so that's good.

If I were in her shoes I would fidn out exactly what those BP numbers were, I'd want a 24 hour urine catch, and a PIH or Preeclampsia blood panel (which it sounds like you might be getting). You've just had the doppler it appears, but a biophysical profile of baby would be something I'd be asking about to...it helps determine how baby is doing.

I would also be doing daily kick counts to make sure baby's movement is consistent. You can also buy digital BP monitors for home use at any drugstore, if she wanted to keep track of her Bps between appointments. If she has any concerns, or worries, she should call her doctor, day or night.

Hopefully it won't progress for her into preeclampsia, but it's great to be educated and prepared, in case it does develop. Please post back with questions and to let us know how she's doing. WHen is her next appointment?

http://www.preeclampsia.org/forum/viewtopic.php?t=5216 (kick counts, Laura's response)
http://www.preeclampsia.org/symptoms.asp (signs and symptoms page, main website]

[fiona]

Mark, welcome.

I'm sorry your wife is experiencing complications.

From what you've said, your doctor's action seems entirely appropriate - certainly a 24 hour urine to check protein output is vey important.

As to your questions:

1) The six hour spacing of the diagnostic BP is, I believe, to check that the pressure is sustained. What is important, however, is to keep track of her pressures - you might consider getting a home monitor and logging readings 2-3/day.

2) The jury is still out on aspirin. Current thing is that it best helps women with early onset pe which, if your wife is diagnosed at 28 weeks, would be appropriate. I'm not sure of any advantage to time of day.

3) Removing salt froma pregnant woman's diet is not recommended and may be counter productive. Certainly removing heavily processed foods from her diet can only be good for her general health , but cutting salt completely should not be attempted without medical approval.

4) One of the serious consequences of high BP/pe in pregnancy is reduced blood flow to the placenta resulting in IUGR (intra uterine growth retardation) of the baby. Finding notching/ resistance in the uterine artery is a marker for pe.

If the urine testing does indicate preeclampsia, then my advice would be to make sure her caregiver is well practiced in managing high risk pregnancies. If not, ask about a referral to a high risk OB or peri. Questions to ask would be around management (anti-hypertensives/ bedrest/ steroid shots for the baby's lungs).

The average time between diagnosis and delivery is two weeks - that's only an average (many women limp along for weeks), but you need to be aware that pe can develop very rapidly. please take a moment to read our signs and symptoms page (http://www.preeclampsia.org/symptoms.asp).

Please keep us posted and come back with any further questions.

[fiona]

Kara and I were obviously working simultaneously ;-) Apologies for the repetition.

[markbures]

Thanks for the extensive and helpful answers. We are going to begin kick counting tomorrow. A couple of follow-ups if I may!:

1. Next appointment is Sept. 19.
2. We heard from the doc who did our recent fetal Doppler ECG that aspirin potentially could contribute to complications at birth both for the baby and the mother. Specifically, by inhibiting prostaglandin - which can limit the proper closing of certain parts of the heart, leading to hemorrhaging and other serious complications. So we were on the fence about taking the aspirin. Any thoughts? Any such risk?

[caryn]

Mark,

September 19 is quite a ways off, so I would like to encourage you and your wife to take her pressures two or three times a day, and log them. That way you'll be alerted to upwards trends and spikes if they appear.

Here's a link to a Pubmed abstract, recent research on aspirin: http://tinyurl.com/39lem9

You'll notice it says Antiplatelet agents had no significant effect on the risk of death of the fetus or baby, having a small for gestational age infant, or bleeding events for either the women or their babies. The hope is that it will inhibit prostaglandins, and thereby reduce clotting. Preeclamptics are usually tipped too far along towards the clotting side of the spectrum, and antiplatelet agents can improve blood flow to the placenta in some cases, pushing delivery back and shortening NICU stays.

A lot of docs do want the aspirin discontinued a few days before delivery, to cut down on the odds of postpartum issues (hemorrhage, PDAs that are slow to close) and I would expect your care providers to discuss that with you as delivery approaches, which hopefully won't be for some time.

Keep us posted, and welcome to the forums.

[markbures]

Went to try to get blood pressure taken today (Sunday). One pharmacy had a machine that does this - it returned 113/70 this morning but with a high rate of 111 beats per minute. This afternoon, we found an attendant at another pharmacy who used a digital monitor on her wrist and returned 100/60. Her normal (pre-pregnancy) pressure was pretty good - in the range of 110/70 to 120/80.

So, don't know how trustworthy these readings are. Going to try to find a better way starting tomorrow. If they are correct, then we have a few things yet to understand:
* What the doctor meant by high in the first place (will follow up)
* The true meaning of the 'notches(?)' (doing my best to translate 'incisura' - we don't live in the US) found in the maternal uterine arteries in the Doppler Fluxmetry (this is what contributed to the original diagnosis - the umbilical and cerebral fetal arteries tested fine by the way)

[heather j]

Do you have a fire station or the like nearby? If you can't monitor it at home, a location such as that would likely get you a more accurate reading (drugstore monitors can be off, though I imagine the cuff that the pharmacy attendent used was accurate). Also, I would call the OB and ask the nurse to pull her chart and give you the bp that initiated this in the first place. It would be useful for you to see what s/he is considering high. I'm not sure how accessible it is for you to purchase an at-home digital monitor, but here in the states they are very reasonably priced.

The notching is (very!)basically an indication of how blood is flowing in relation to the placenta. PE decreases the blood flow to the placenta and this restriction is what is referred to as "notching." FWIW it is VERY good that you're OB is looking for this as there are many who do not. Doctors will look for notching around 20 weeks or so, and if it present...it could point in the direction of impending PE. Sometimes, it resolves and corrects itself, though. I'm not sure what the implications of seeing it at 28 weeks is, though; it sounds like your doctor is handling all this very well.

As for the aspirin, I was on 81 mg for my second pregnancy and discontinued it at 34 weeks for the reasons that Caryn listed above.

As Fiona mentioned, too, I would inquire about steroid shots for babe's lungs.

Hope you can get some answers and lots more growing time. If you can get your wife to rest on her left side, it can improve blood flow as well. Hang in there!

[markbures]

Thanks! We are looking into buying a blood pressure monitor and have found a few models:
* Traditional manual/analogic used on the arm
* Semi-automatic digital used on the arm (you pump it up, but it deflates automatically)
* Digital used on the wrist

Any suggestions on which might be the best / most reliable? We have no medical training - so if we go manual or semi, we will need to figure out how to use them.

[kara]

I would go with the semi automatic digital arm cuff. The wrist cuffs are notoriously inaccurate, and the manual's are difficult to use unless you have formal training. The semi automatic can be used by your wife, by herself if she needs to as well.

How's she feeling?