24 weeks & 5 days...should they be doing more?

[Teresa1234]

Hi ladies. I just want to say once again how gratful I am to have all of you to turn to when I'm unsure or just need to vent. I've posted my story here before and after reading some of your stories I feel EXTREMLY blessed BUT also more aware of preeclampsia...I've learned so much here. When I was diagnosed at 36 weeks with my third child, I had never heard of pre e and had no idea the damage it could do. Anyways, after a week on hospital bedrest and days of mag (that was the worst), I delivered baby number 3 @ 37 weeks gestation (vaginally) weighing 7lbs & 1oz. With my first baby, I developed extremly high blood pressure suddenly and because I was already 40 weeks was sent in to be induced immediatly....looking back and knowing what I know now....I'm sure I was developing pre e (the bp and swelling is enough to indicate that), however, I don't remember the drs ever saying anything about protein. My 2nd pregnancy was completly normal.

Here I am now baking the 4th and final baby. I was diagnosed in my first trimester with chronic hypertension and prescribed 250mg of mytheldopa twice daily. That seemed to help for a little while. At about 18 weeks, I developed the worst migrane accompanied by severe vomiting. After seeing my dr that morning, I was sent home with anti nausea pills as well as loratab for the pain. Because of the vomiting, I was unable to keep any of it down. My fiance took me to labor and delivery that evening. Once we arrived my bp was immediatly taken and read an alarming 160/115. I was given a shot of morphine and antinausea meds. The morphine only took the edge off of the headache. By the time I was sent home, my bp was down to 150/100....and although the headache was still present, the vomiting had subsided. My bp meds were upped to 500mg 3 times per day.

As I mentioned, I am now 24 weeks and 5 days along. I am feel extremly blessed to have made it this far and I know everyday is a milestone. This past Thursday my bp at home reached 150/105. I reported to my Dr and was seen that afternoon. My bp was 149/102 when I reached the dr office, but no protein was detected in my urine. However, a moderate amount of blood was. The midwife who was seeing me that day (my dr was booked), told me that a urine sample needed to be sent off to the lab. I have no symptoms of a uti or kidney infection...and I have no clue why I would have a moderate amount of blood in my urine. After lying on my left side for an hr in the dr office, my bp was down to 148/96 which is not bad for me. I also reported to the midwife that I have been having moderate braxton hicks contractions for days on and off and more so in the evening. After a cervix check, she reported that there was no change in my cervix but to go to l&d if I had contractions lasting blah blah blah blah blah.

Anyways, I am still only being seen once a month. I really feel that I should be seen more often because I know how suddenly pre e can creep up. My dr doesn't seem as concerned as I'd like her to be. I will not be seen twice a month until 32 weeks...and I will not begin receiving growth scans of the baby until then. I can my bp at home and I do pretty often but it's always high. I'm unable to check for protein in my urine though...and I would hate to have something going on and not know it for a month. I want to catch pre e as quickly as possible to give my baby the best fighting chance.

I just don't feel like enough care is being taken....and I have a bad feeling all of the time. My braxton hicks seem to be worsening, escpecially today. I'm just worried...and I don't want myself or the baby to be sick...I need to be healthy for my other 3 children. What should I do? Should I demand to be seen more often? Should I see another dr? I'm so confused. Please give me your opinion.

Thank you very much for reading. I'm sorry it was so long.

[caryn]

Have you had an MFM consult?

[Teresa1234]

Hi Caryn. No, I have not. I have only recently learned what a MFM is and I don't know how to get in contact with one. My dr. has not refered me to anyone and just doesn't seem concerned. She keeps saying "preeclampsia doesn't develop this early, it normally doesn't develop until late pregnancy." But I know from all of you that it can happen much earlier.

[blythe]

Sorry you're having to deal with a doctor who isn't quite as current as an MFM might be! You can still get good care, you just might need to push a bit more. In your shoes I would go back very soon and ask for a 24-hour urine collection and baseline labs, and if they refuse, you can politely ask to have your request and their response written in your file. And then ask for a copy of the note. Your doc is right that preeclampsia *usually* happens later in pregnancy and *usually* isn't as bad in later pregnancies if it does develop... but remind your doc of Michelle Duggar, the mom with 18(?) kids who developed it and had to deliver at 24 weeks with baby #19(?) (sorry, only have a minute before picking up my little ones so don't have time to google to be sure #s ).

Can you find out which hospital nearest you has a III NICU? Please keep watching your signs and symptoms, especially headache that doesn't go away with tylenol, pain under the right ribs, visual disturbances, and decreased baby movement.

Hang in there and feel free to ask more questions - we'll do our best!

[blythe]

Can you call your insurance provider and see what you need to do to get an MFM consult or transfer of care? Today?

[Teresa1234]

Hi Blyth! You are always the greatest! I checked my bp after posting and it was 150/110. I laid down with my son for an hour and checked again and it was 142/110. I called my dr. and told her of my bp readings, dull headache (which I was taken tylenol for and it hasn't helped), and my braxton hicks contractions. She upped my bp meds again and told me to come in if my contractions worsen....she also once again said "preeclampsia is extremly rare this early in pregnancy." Don't get me wrong, I like my Dr a lot, she has a great personality and she takes the time to talk to me...I just don't think she is as up to date with pre e as she could be.

As far as the level III NICU, I have tried to google what level my local hosptial is and I can't find it. I should just call. I know that we do have a great NICU as baby's are sometimes transfered there...but also babies are transfered from there to better hosptials. I live in Lynchburg VA btw.

I am a full time student, so my insurance is medicade. I'm just so clueless when it comes to speaking with them or finding an MFM myself. It's frustrating.

[MomTimesThree]

Oy! I'm so sorry to hear of all the symptoms you are having, especially so early on, and while sure more rare, why your doctor wouldn't be uber concerned is concerning. I second the thoughts of others that requesting a referral to a MFM is critical, or at the very least be monitored much much much more frequently. Are you starting or have you started weekly 24 hour catches?

I would also ask for a minimum that your doctor would want you to be in L&D. I forget what ours was, but our MFM gave us strict orders, your BP reaches XX/XX amount, you do not pass go, you do not collect $200, you go to L&D.

Sending low bp vibes your way!
Lauren

[kmokashi]

Your gut is telling you what you need to do. You are having classic signs of initial preeclampsia and as MANY people on this forum have posted, it CAN happen at 24 weeks. You need to see either ANOTHER doctor, or go to L & D, or the ER if your blood pressure does not go down. This is nothing to be cautious about and worse case, an extra trip to the doctor/hospital.

As my doctor has told me, they can treat the high blood pressure, but once the protein starts spilling in the urine, your time will be limited.

Just my 2 cents worth- it is better to be safe than sorry!

[caryn]

Try www.smfm.org to find an MFM - search by state. I *really* don't like those pressure readings. Don't hesitate to head in for a once-over at the drop of a hat, because no pregnant woman should be walking around with numbers like that! Pregnancy relaxes the vasculature; you should be just coming off the second-tri dip at your gestational age.

[Teresa1234]

Thank you ALL! I knew I didn't have this feeling for no reason at all. I checked my bp again last night before bed (and after taking my upped does of bp meds) and it was 150/113. My heart started pounding at the thought of going to bed and not waking up due to that pressure. So, I woke my fiance and had him take a warm bath with me. After I got out and checked again, it was 142/98 (which is what it normally is in the dr office).

I just checked my pressure again and it is an alarming 159/116...after taking it 3 times in a row, there was little to no change. I called my dr office straight away and asked to speak to a nurse. The receptionist replied (I can have a nurse call you in the morning). I replied "My blood pressure is 159/116 and I need this to be reported to my dr." She said "Okay, your dr will be here in the morning and I will leave a note in her folder". I just hung up because I was so frustrated. My fiance will be home @ 5 and he is going to take me to labor and delivery.

Oh, a nurse just called from my dr office and told me to go straight to labor and delivery! DUH! Anyways, I will let you all know how it goes. Thank you all again so much for your support. There is a lot more I want to respond to and I will when I am able.