PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Are you worried about your partners pregnancy? Has your partner already had preeclampsia? Do you have advice for other dads who could be going through similar experiences as yourself? Post here!
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caryn
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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby caryn » Thu Mar 29, 2007 02:31 pm

I can add a link to a list of normal values:
http://www.healthcarecontent.com/reports.html

However, decisions about delivery are pretty flexible and subjective, because of that 'medicine is both art and science' thing. They'll probably take things like a headache or reported epigastric pain just as seriously as a change in liver enzymes, because they can also signal a significant change in the mother's condition. Similarly, deliveries take place for fetal indicators (baby stops moving, stops practice breathing, stops urinating, starts having heart decels) even when lab values are great...

There's a discussion of delivery indicators on page 19 (I think!) of the NIH Working Group Report: http://www.preeclampsia.org/forum/viewtopic.php?t=1918

anathor21
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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby anathor21 » Thu Mar 29, 2007 10:18 am

I'll take the easy one first [:)] - since you already have the BP numbers down (over 140/90) right? So, the second important number to know for PE is the 24hr urine test. The first number to know is 300 - that is as in 300mg/24hr and that is the total amount of protein in the sample. Once you cross over this line, you are offically in PE territory. Less than this, you are not yet in PE territory. However, "Normal" is zero so anything above zero found is not quite normal, but not quite PE so it all depends on how excited folks want to become (and really on history - rate of change, other factors etc).
The obvious next questiion you will have is "how does this relate to the dipstick test" - well, the dipstick measures the concentration in the sample that is being tested. Thus, if there is a high concentration in the sample then the dipstick will register a higher level than if there is a lower concentration in that sample. If a person is putting out zero protein, then the sample will have zero and the dipstick will register zero and all is good. If a person is putting out a large amount of protein then the concentration in any given sample will be higher than zero and thus the dipstick is very likely to register something above zero, with a higher reading more likely as the person is dumping more protein. Now I'm sure you have noticed that I am using some uncertain language here - and that's not an accident as the concentration of protein in any given sample is dependent on two factors - the amount of protein and the amount of other liquid (i.e. concentration being protein/otherliquid) thus if someone is very well hydrated (drinking a lot) and their kidneys are processing it well and putting a lot of liquids out then the concentration can be affected and thus artifically reduced. On the flip side, if a person is not well hydrated and/or their kidneys are not processing the water very well and pushing it out then the concentration can go higher artifically. The strips for the dipsticks are calibrated for a "normal average" range of expected concentration and as such are a good screening tool. However, they cannot be used to diagnose PE in the end. Just keep this in mind - many folks (and you will hear great tales if you wish to read them) have had very interesting experiences with them and thus have low level of trust in them. The 24hr collection is the only way to really know if the protein being spilled is in the diagnostic level for PE.

How's that for first number to learn? 300 is the line for protein in a 24hr.

Will try to get to the various blood tests next, but have to look them up (don't know them off the top of my head) and I'm at work right now, heh.

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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby rerskine » Thu Mar 29, 2007 04:27 am

I know people believe White Coat syndrome exists, but I wish the medical community would at our HMO would communicate better with one another when a patient has repeatedly demonstrated this condition, so they don't start up all the alarms everytime she registers a high initial BP. I know they have to be careful, but I brought out readings from home in an excel spreadsheet showing her bp's at home, and at the docs throughout her pregnancy and they are always at least 20point higher on both. Instead of asking some questions and listening to what we have to say, they revert back to static numbers. I am just really sensitive to it because when they ramp up for an hour of testing, it ramps Julie up for 4hours of distress.

We talked to the doctor about meds and he said that if her bp went that high and stayed that high after an hour they would try to use meds.

I know that somewhere in this forum the various readings from the blood tests and urin samples are explained, but can someone explain them or send a link. Today the doctor said her tests values looked great, and when I asked what the numbers were, they first responded by asking me if I knew what they would mean. I really just need to know the guidelines for detemining when they are too high or too low.
quote:
Originally posted by Caryn

Robb,

How nervewracking for you both!

I've got to say, though, that I'm glad she got checked out. What our Experts tell us isn't that they don't believe in white coat htn, but rather that if you have it, it means that something about the way your body manages blood pressure is broken. If it weren't broken, your body wouldn't spike pressures in response to stress; since you do spike pressures, the control system that manages bp has something wrong with it.

(Sorry to use the generic "you" there; saying "Julie" every time read strangely too. [:)] )

A good NST and bloodwork and proteinuria should go a long way towards easing everyone's mind. Not that you don't need to continue to keep your eyes peeled for PE, of course, but then you already knew that!

Did they say anything about bp meds? I'm no doc, but it seems to me that if she spikes up high (rarely, or only when they're taking her bp, or whatever) that that's the sort of thing they tend to use low-dose beta blockers for -- they use them for high cardiac output cases, and women with high cardiac output often have white coat htn. They also use them for performance anxiety, which is pretty similar.

I hope she (and you) get a good night's sleep, and that things stay nice and calm around there.


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caryn
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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby caryn » Thu Mar 29, 2007 04:05 am

Robb,

How nervewracking for you both!

I've got to say, though, that I'm glad she got checked out. What our Experts tell us isn't that they don't believe in white coat htn, but rather that if you have it, it means that something about the way your body manages blood pressure is broken. If it weren't broken, your body wouldn't spike pressures in response to stress; since you do spike pressures, the control system that manages bp has something wrong with it.

(Sorry to use the generic "you" there; saying "Julie" every time read strangely too. [:)] )

A good NST and bloodwork and proteinuria should go a long way towards easing everyone's mind. Not that you don't need to continue to keep your eyes peeled for PE, of course, but then you already knew that!

Did they say anything about bp meds? I'm no doc, but it seems to me that if she spikes up high (rarely, or only when they're taking her bp, or whatever) that that's the sort of thing they tend to use low-dose beta blockers for -- they use them for high cardiac output cases, and women with high cardiac output often have white coat htn. They also use them for performance anxiety, which is pretty similar.

I hope she (and you) get a good night's sleep, and that things stay nice and calm around there.

rerskine
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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby rerskine » Thu Mar 29, 2007 03:09 am

Hello,
I am glad I had to the chance to send in a post before we went to the doctor. After reading everyone's responses, I felt like I would have a better understanding of what would happen at the doctor. I know that the verdict is out on the "White Coat" aspect of BP, but those who doubt its existence need to watch the phycical change in my wife as the seconds tick away before she has her BP checked at the doctor's office.
It is almost as though the cuff envelopes her whole body and squeezes her like a soaked sponge. We had taken her BP before we left to go to the doctor's office and it was 125/83. We drove to the office, parked, walked inside, registered, sat in waiting room, were escorted by the Medical Assistant through the doors and Julie took a seat next to the BP machine. A total of 25 minutes had passed since we had left our house and the confident comfort od the 125/83.I knew as soon as Julie sat in the chair that her BP was going to be high. Her face, upper arms, neck and chest rolled with a thin layer of prespiration, and as the button was depressed and the familiar, grimacing moan of the compressor pushing air into the cuff filled the area. With every passing second Julie's color equally approached a deep scarlet red. The sentence, 153/107--her highest ever. Needless to say, the doctor, who was not our regular doc but who had an available appt that day,directed us to Labor and delivery.
Here is where my reading paid off. As we walked to L&D, I knew and could communicate, clearly, what would likely happen next. Julie had no other symptoms; in fact, she had only put on half a pound since our last meeting, she had a negative protein drip, no sweliing, no headache, pain near her liver. We had a NST, full blood work up, began a 24hr urine test, an ultrasound, and a few more dates with the BP machine. Everything came back normal (waiting for urine results, but her BP after the NST stewed down to 123/82. We went home soon after that, But the doctors recommended that we begin dooing bp's at home. The doctor enrolled us in a home BP hypertension program, adn we scheduled our first appointment for today Wednesday 3-30. Well, this condescending meeting was the pinnacle of frustration. The woman, was late, she seemed to be frantically busy, and when she did speak, she had NO idea that we had been taking BP's for the entire pregnancy, or that Julie had preeclampsia and had delivered at 36weeks when Isabel was born. Her first reading was 141/97. After two more readings in the 90's she called the doctor, and we were sent, again, to L and D. We jsut got back from there and her BP eventually went down to 122/82. We should have never gone in, but becuase I did not stand up to this woman, we went teary eyed to L and D. Everything,once again was fine in the end, but Julie had spend an additional 5 hours at the hospital and on her feet.

We are home now, and Julie is relaxed an asleep. The really great news is that our baby, Eamonn, doing great and measured at 35 weeks and not 34. More to come.

Robb

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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby blythe » Tue Mar 27, 2007 09:21 am

Thanks for the update - good luck!

rerskine
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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby rerskine » Tue Mar 27, 2007 05:02 am

First of all thanks to all of you for the great information and suportive experiential statements.
Julie's BP was 128/89 at our last reading today. Our doctor was not able to meet with us today, but we have an appointment set for tomorrow. I was a little upset about not getting in today, but her BP has not changed and she shows no other symptoms, so we will go in tomorrow. I will report back to all of you when I have some new information.


anathor21
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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby anathor21 » Mon Mar 26, 2007 02:41 pm

Wanted to add my welcome to the others - looks like they have covered your questions well and given you good advice. It is hard to know what to expect - however, know that PE is a very serious condition and although everyone (the doctors included) would far rather deliver closer to full term, that may not be in the best interest of your wife or son's health if PE progresses too rapidly. PE isn't a good thing to ignore - get familiar with the signs/symptoms and as difficult as it is, work with your medical team.

Please let us know how your appt goes today - you will find tons of good information around here, and since you likely won't have a lot of time to go digging, simply post your questions in this (or other forums) and I think you will find that folks are willing to answer them rather quickly. We have all been there and have a good idea of what it's like to need quick answers....

Best of luck...

E.

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julie f
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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby julie f » Mon Mar 26, 2007 02:05 pm

Just wanted to welcome you as well, you've already gotten some great info.

One thing I wanted to add was about "white coat hypertension." Our Experts here don't really buy in to that theory - if your bp is up, it is up. Even though you may only see your wife's bp rise when you're at the doctors due to stress/anxiety/fear/etc. That means it is also likely rising when she is stressed waiting in line some where, sitting in traffic, tired from taking care of a toddler and being pregnant, excited because her team just won, fearful as she contemplates her upcoming delivery, etc. And I don't mean to imply that she can control this, she can't. My peri explained to me that in a "normally" functioning body, it can handle the sudden spikes in anxiety or what not. With a woman suffering from labile blood pressures, the body loses its ability to control that. Does that make sense? Here are a few links:
http://www.preeclampsia.org/forum/viewtopic.php?t=1064&SearchTerms=+white+coat
http://www.preeclampsia.org/forum/viewtopic.php?t=19197&SearchTerms=+white+coat (See Caryn's response)


As far as what to expect - it really depends on the big picture (proteinuria, fetal indicators, maternal symptoms, lab values, etc.). Bp meds and bedrest are both hot topics - not all doctors agree. Here is a link to what our Experts have to say about meds: http://www.preeclampsia.org/forum/viewtopic.php?t=1081 . I can see that you've already read the response about bedrest. For some women, it seems to help prolong the pregnancy, for others it may do nothing.

The important thing is to know the symptoms and continue to monitor, http://www.preeclampsia.org/symptoms.asp Don't hesitate to head in should something seem off.

Please let us know how your appt goes today.

rerskine
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Re : PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

Postby rerskine » Mon Mar 26, 2007 11:24 am

Wow,
Being the night owl that I am, I did not expect to see any posts for at least 8hrs or so, but I was so happy to see that someone else is out there to talk to and listen.


I also want to thank parkersmom and Blythe for the responses. Just to clarify a few things, when I wrote about going in to the doctor tomorrow, that meant today. We are going in to the doctor today. Thanks for the support.


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