by blythe (3060 Posts), Thu Oct 02, 2008 00:04 am
Donald, we're not doctors and I hate to second guess your care providers and add to your doubts at such a stressful time... That being said, I absolutely understand your desire to induce at 36 weeks - my doctor agreed to an induction for me at 36 1/2 weeks with my second when my bp hit diagnostic levels, rather than wait for more symptoms. However, your wife developed chronic hypertension early in her second trimester, and that's at least one reason the management of your wife's pregnancy is going to look at lot different than someone like myself. Her doctors are probably waiting for more signs of "superimposed" PE (Caryn just had a great explanation just today about what that is - http://www.preeclampsia.org/forum/viewtopic.php?t=31102 ), such as over 300mg protein in a 24 hour collection, visual disturbances, upper-right quadrant pain that shows up as liver failure in bloodwork, headache that doesn't go away with tylenol... I strongly recommend that you and she familiarize yourselves with the "signs and symptoms" http://www.preeclampsia.org/symptoms.asp and continue to trek to L&D for reassurance - or delivery.
Women with chronic hypertension in pregnancy (and your wife qualifies according to the definition - hbp before 20 weeks gestation, even if her bp is normal outside of pregnancy) are often allowed to run much higher pressures before the doctors get really concerned. I would be interested to hear what your doctors think about adding another bp med - many of our members seem to benefit from med changes when their pressures start to rise like that. Those diastolics (lower number, how hard the heart is beating at rest) over 105 make non-doc me really queasy - my understanding is that when the heart is beating that hard she is at risk for a stroke, pre-eclampsia or not.
http://acogjnl.highwire.org/cgi/content/abstract/105/2/246 (though this study was on a population of severely pre-eclamptic and eclamptic women, not women with chronic htn in pregnancy like your wife. I'm having trouble finding a study to back up my statement of "over 105" as especially dangerous... so again, not a doctor here, but I have been reading stories on this board for quite a few years now and diastolics that high just always seem bad.)
All that aside, the decision to induce at 36 weeks is not as clear-cut as it might seem. Although one of our members just had a 34-weeker room in with her and go home immediately, my 37-weeker spent 4 days in the NICU and definitely seemed like a "preemie" in many respects. As Wendy said, your doctors are walking a tightrope between giving baby more time and keeping mom healthy.
Please keep asking questions, and invite your wife to join us as well!