MFM consult on poss. pregnancy #2

[Brysonsmomma]

Hello,

Although I follow the discussions and forums often, this is my first time posting. I'm sure this post is similar to previous ones but I wasn't sure where I should start...so here I go, typing away!

To tell you a little about me and my preeclampsia journey. I delivered my very first baby at 28 weeks due to severe pre-e. I was 28 and my healthy former preemie is now 20 months. My symptoms started at approximately 25 weeks and went ignored by my Dr. office phone calls until I found fluid on both MY lungs and begged my OB office to send me to triage. (I'm an ultrasound tech. so a co-worker scanned me because I was having severe lower back pain and difficulty breathing). That day I went to triage and delivered after my body worsened a few days later. I had a c-section. We went through a 2 month NICU stay that was pretty uneventful, but none the less very traumatic for myself and my husband.

I wasn't sure if I would get to the point of feeling "ok" enough to discuss future pregnancy but I did and I recently went to a MFM consult. This Dr. saw me in the hospital and is recommended on the basis that he has special interest in pre-e. I had a LIST of questions, all of which he answered before I even asked him.

In conclusion he said:

-Pre-e will happen again. I could likely get you to 32 weeks-ish, but goal is healthy mom, healthy baby.
-Consult with hypertension specialist for further work up to add to the puzzle. (because my pressures are still all over the place and he's pretty sure I have something else underlying at this point)
-Baby aspirin and extra calcium would be started off the bat.
-Bed rest doesn't control or help pre-e.

Although I was ready for this information and feel like the visit went extrememly well. I'm now working in this hypertension work-up and not sure of what will come of it. Anyone else had this sort of thing?

When I return to visit with the MFM after this, am I crazy for wanting him to TELL ME the best choice? I know he cannot make decisions but I am having a heavy heart dealing with the possibility of me having to decide if I should give things a go or not. I said I didn't want to risk my life or the life of an unborn child to give my son a sibling, but now I don't know what to do.

[libby123]

Hmmm, I beg to differ on the bedrest not helping part. I think that there are different severities of pre-e, and maybe the kind that you had wouldn't be helped by bedrest.

My blood pressure shot up at 26 weeks, and I went on modified bed rest at 29 weeks and strict bedrest at 32 weeks. My protein went up very slowly, and I wasn't officially diagnosed with pre-e until 36 weeks. My doctors said that it was my strict bedrest that kept me going for so long and kept my proteins going up slowly and not quickly. At the end, right before I delivered, my blood pressure would be in the 150s/90s laying on my side, and 190s/120s sitting or standing.

I'm not saying that bedrest ALWAYS helps, but it CAN help in certain situations.

Kudos to you for going to the MFM consultation by the way. That must have taken a lot of bravery. I hope all goes well for you!

[caryn]

The data say bedrest doesn't help broad populations, which is why your doc (and our Experts) say that bedrest isn't really useful: http://www.preeclampsia.org/forum/viewtopic.php?t=10150

As for you being crazy: no. Of course it would be easier for someone else to be responsible, and it feels like we're responsible for quite enough already. But ethically no one else can make this decision for you. You've got to weigh the risks and benefits as you see them, and make a decision. If your doc said "Go for it!" and you had an event-free pregnancy, you'd love your doc... and if your doc said "Go for it!" and you lost your baby to a silent abruption while in the hospital being monitored at 25 weeks...

One thing that's worth considering: the risk to *you* is less than the risk you run driving to the grocery store. The risk to the baby is more varied.

[Brysonsmomma]

Thanks for the helpful replies guys.

Libby123, I feel that bedrest could have some benefit as well...I guess at least it wouldn't hurt things. I started developing my signs of pre-e at 25 weeks, the ankle/foot/hand swelling was there overnight, I then knew to check my pressures and they were higher than normal and kept going up. I was working full time and on my feet for 8 hours, lots of walking (which I kept up a brisk pace the whole time) so I'm sure that didn't help matters.

We shall see if things change at all after the hypertension consult. I'll be hoping and praying for positive news!

[libby123]

I think that the reason that my blood pressure was lower laying on my left side was because it took preesure off of a certain blood vessel in my back (that is what my doctors said).

So while it didn't stop me from getting pre-e, it definitely lowered my blood pressure to the point where I could continue with the pregnancy.

I was in the hospital a couple of times on bedrest, and then at home with it, but I was very strict with myself.

Caryn, , what you said about it being less of a risk to go to the grocery store was really encouraging to me actually, because I guess you are right, most women don't die of preeclampsia with today's medical care. I guess that is something for me to consider too, because I've been so set on not having another baby because I am afraid to leave my daughter without a mom, but that likely wont happen even if my pre-e is more severe.

[sam10]

Perhaps you can ask him for the chances of YOUR personal recurrence rate. Everybody is different and many factor contribute to the recurrence rate. You'll need to have all data ready for that (so it is good that your BP issues are being checked), so he can look at all your possible underlying conditions. I had early onset ( around 20 weeks) and am very scared, not only to develop PE again, but also for my life. Since a doctor cannot make decisions for us, you can ask him if he feels that another pregnancy could bring a serious risk to your health? I am sure if your doctor feels it is too risky, he'd let you know. I told my doctor that I am afraid to lose my life, but he said that this is very unlikely and also gave me the green light to try again. I have a 30ish recurrence rate, no real underlying conditions and based on that, we have made the decision to try again.

[caryn]

Even lowering blood pressure doesn't necessarily mean you can continue the pregnancy, kwim? Bedrest didn't lower my pressures, but drugs did - but when they did, they also wrecked my son's BPP numbers. The placenta is raising pressures in order to adequately perfuse itself and supply sufficient oxygen to the baby; lowering pressures can compromise that. (The Working Group Report has more on this.)

I started bedrest when we first picked up signs of a problem; four days later I was admitted to ICU care and they started the IV meds. My son scored an 8/8 on admission even though I was crazy sick. 48 hours later my pressures were pretty well-controlled at 150/90, but he scored a 4/8 on the subsequent BPP and then had a big 'ol decel. We moved straight to theatre and delivered for fetal indicators, and that's one other reason I always sound so awfully firm about this when it comes up.

[Brysonsmomma]

All great points! Thanks!

[flori]

Like Caryn, it wasn't bedrest that controlled my bp, it was the insane amount of Methyldopa, Labetalol and Norvasc I was on. My bp was actually completely normal when I was told that I developed HELLP and had to deliver.. but of course it skyrocketed soon after being told the news.

Because my pressures had gotten so out of control around 20 weeks (leading to being hospitalized for 3 days), my medication was increased greatly and I think that's why my daughter fell behind growth-wise around that time. At 22 weeks I was put on strict bedrest but the IUGR, oligohydramnios, and HELLP didn't care. I delivered 3 weeks later.