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What is the difference between severe and mild pre-e?

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Re: What is the difference between severe and mild pre-e?

Postby caryn » Thu Jul 21, 2011 10:30 am

by caryn (10124 Posts), Thu Jul 21, 2011 10:30 am

It doesn't really matter - because all that matters with respect to these classifications is that someone with one reading over 160/100 will be classed into the "severe" group for the purposes of data management. People can have severe PE and really excellent outcomes, considering, or technically mild PE right up until everyone dies.

So really "severe" and "mild" don't map well at all to a lot of the measures we're really more interested in here. All of our posters want good outcomes regardless of how the data will be sliced and diced in the research papers!
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
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Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy
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Re: What is the difference between severe and mild pre-e?

Postby blythe » Thu Jul 21, 2011 10:54 am

by blythe (3060 Posts), Thu Jul 21, 2011 10:54 am

The research and practice definitions are very specific and consistent -
http://mail.ny.acog.org/website/SMIPodc ... sisMgt.pdf - full text of the American College of Obstetricians and Gynecologists Practice Bulletin - Diagnosis and Management of Preeclampsia and Eclampsia
http://www.aafp.org/afp/2004/1215/p2317.html - full text of American Academy of Family Physicians Diagnosis and Management of Preeclampsia
http://emedicine.medscape.com/article/1476919-overview - emedicine summary article
http://www.acog.org/acog_districts/.../ ... gnancy.ppt - a very nice power point from ACOG (may have to google ACOG preeclampsia for the correct link, it shows up third in my search)

They all define "mild" as
"Blood pressure of 140 mm Hg systolic or higher or 90 mm Hg diastolic or higher that occurs after 20 weeks of gestation in a woman with previously normal blood pressure
Proteinuria, defined as urinary excretion of 0.3 g protein or higher in a 24-hour urine specimen


and "severe" as
Preeclampsia is considered severe if one or more of the following criteria is present:
• Blood pressure of 160 mm Hg systolic or higher or 110 mm Hg diastolic or higher on two occasions at least 6 hours apart on bed rest
• Proteinuria of 5 g or higher in a 24-hour urine specimen or 3+ or greater on two random urine samples collected at least 4 hours apart
• Oliguria of less than 500 mL in 24 hours • Cerebral or visual disturbances • Pulmonary edema or cyanosis • Epigastric or right upper-quadrant pain
• Impaired liver function • Thrombocytopenia • Fetal growth restriction


I do wonder if one of the criteria for "severe" is changing - some of the references don't include "on bed rest" for the bp criteria - just "two readings at least six hours apart" (and note that *either* 160 *or* 110 and you meet the "severe" criteria - you don't need both), and I've seen many research articles about preeclampsia reference this study:
http://www.ncbi.nlm.nih.gov/pubmed/15684147
Women with preeclampsia had strokes at bps lower than they expected - 155-160 systolic, and less than 105 diastolic.

and this article -the second author is one of the top Experts in preeclampsia research - references that same study and says
Our practice is to initiate treatment when BP is ≥150 systolic and 90 to 100 mm Hg diastolic.

I think Caryn has absorbed those numbers because she's been saying 160/100 (instead of 160/110) for "severe" for forever :-D.

So Libby, if it helps, you meet the criteria for "severe". I see what you mean by you having a higher baseline than other women, but the criteria don't take baseline into account. That might be a question for the experts as to why a higher baseline doesn't matter, feel free to submit that as a question and it might catch their eye.

I am a bit baffled by those of you who were told "before 32 weeks" automatically equals severe - maybe that's part of hospital management for your particular hospitals? I've never seen that distinction for severe vs mild in any of the research I've read, and we've had posters meet the bp and proteinuria criteria very early (20-24 weeks) yet *stay* mild and induced at 37 weeks. One poster even went against medical advice and insisted on waiting until 38 weeks because she was so stable. I have seen "before 32 weeks" as a cutoff for determining recurrence rates in subsequent pregnancies, maybe that's why they referenced 32 weeks?
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH
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Re: What is the difference between severe and mild pre-e?

Postby caryn » Sat Jul 23, 2011 03:23 pm

by caryn (10124 Posts), Sat Jul 23, 2011 03:23 pm

I think that Laura and Catherine both told me that 160/100 was what the Experts had told them to use. :lol:
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies? Lectures from researchers?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy
User avatar
caryn
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Posts: 10124
Joined: Fri Jun 25, 2004 06:36 am

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