PE or not and how about Aspirin?

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!
markbures
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Re : PE or not and how about Aspirin?

Postby markbures » Sat Sep 01, 2007 11:50 pm

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?

fiona
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Re : PE or not and how about Aspirin?

Postby fiona » Sat Sep 01, 2007 10:55 pm

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

fiona
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Re : PE or not and how about Aspirin?

Postby fiona » Sat Sep 01, 2007 10:53 pm

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.

kara
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Re : PE or not and how about Aspirin?

Postby kara » Sat Sep 01, 2007 10:44 pm

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]

markbures
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Joined: Sat Sep 01, 2007 09:31 pm

PE or not and how about Aspirin?

Postby markbures » Sat Sep 01, 2007 09:43 pm

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!


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