Pre-e at 29 weeks, and doctor not concerned?

[smz1789]

Hi ladies, I'm so glad that I found this forum! I hate that any of us are here and have experienced this disease, but I'm grateful that there is a place for us to talk about our experiences with one another.

A little background... I had pre-e with my daughter 3 years ago. I was diagnosed around 34-36 weeks. It was mild, and i wasn't put on any restrictions or given any medications. They induced me at 39 weeks, saying she was full term, and it was better to get her out than to wait and have things possibly take a turn for the worse. I was induced with pitocin, and gave birth vaginally 8 hours later. Both my daughter and myself were healthy, and suffered no complications from the pre-e.

I am now pregnant again, just shy of 29 weeks. My bp is usually around 120/60, but since my second trimester began I've been averaging about 130/80. I went in because I began seeing flashing lights last week. My bp was 130/80, and there was no protein found in my in office sample. Because I saw the flashing lights my doctor ordered a 24 urine collection to get what she called a "baseline". I went in today to go over the results. My bp today was 120/70. My results from the 24 hour said that my protein was 319. My red count is on the low side. And all other labs came back normal.

After hearing this, and being only 29 weeks along, I was expecting to hear that she would want weekly checks, and perhaps modified bedrest. Instead she said she really isn't concerned and wouldn't be until my protein was over 3,000?!?! And she just wants to see me in 2 weeks at my next appointment? I may be over reacting.... but I'd really hoped that they would keep a close eye on me! I'd rather keep close tabs on it and start taking precautions sooner rather than later... Pre-e can go from mild to severe in hardly anytime at all, can't it? Do you ladies feel like this is an appropriate approach? Or should I be seeking out a second opinion and possibly a new doctor? A lot can happen in 2 weeks with pre-e... and I really feel like they aren't taking it seriously enough. But maybe this is standard procedure, and I'm just overly concerned?

Any advice or words of wisdom would be so appreciated. I'm feeling pretty lost, and alone. I have no idea what to expect when diagnosed this early on, so I welcome your stories and experiences!

Thank you!

[libby123]

I had a similar situation during my pregnancy. When I was 29 weeks pregnant and went to the triage after recording high BP at home, they got a reading of 190/120 there while I was sitting up but 150/90 laying down. Therefore, my OB said that I should just go home and "take it easy" and lay on my left side for a few hours a day. I felt very confused because I knew my blood pressure was at stroke levels and I thought I should be monitored.

So I took the situation into my own hands. I bought a home blood pressure cuff and began monitoring my pressures at home. And then I went back to the triage unit a few days later and spoke with another doctor until someone would take me seriously.

I would urge you to do the same. It would be a good idea for you to take your blood pressures at home. And perhaps get a second opinion. Are there other OBs in your practice? Can you find a new practice? Can you speak frankly with your doctor and tell her your concerns?

Now, your blood pressures were not concerning. Blood pressure will change throughout the day. So a reading of 130/80 followed by a 120/70 is not concerning. And you said that your doctor did order a 24 hour urine and bloodwork, which means that they seem to be taking you somewhat seriously. The protein in the urine is one of the least concerning parts of pre-e, even though it is the hallmark symptom.

So right now, I would monitor at home, and of course go to the triage if you become swollen, have a horrible headache, have very high BP readings, or have extreme vision changes. You may even be able to buy protein strips at your local pharmacy, though I never found them to be particuarly accurate. You weren't diagnosed until 34-36 weeks with your first pregnancy you said, and even then it was mild and you were able to have a natural delivery at term with a healthy baby. So the chances of you developing severe pre-e early in this pregnancy are very slim. But continue to monitor and ask us any questions you have!

[trish]

Welcome!! Sorry you had to find us but glad you did! I think you are correct in thinking you should be monitored more closely. I think they best thing we have as moms is our "sense" of when things just aren't right. Sometimes (and far too often it seems) we have to be advocates for our own care. I would think they'd have wanted an u/s to see how baby looked, maybe have said they'd start NST's soon & do at least do a BP check & a dip next week to see how protein looked (although dips are fairly unreliable - as you've already seen).

If you don't already have a BP cuff I'd recommend getting one so you can check your pressures at home - no more than 2-3 times a day but keep a log and see if you can see any trends starting. And you can then share that with your OB. Have you ever seen a MFM? Just with having had PE previously and being diagnostic for protein already in this pregnancy it wouldn't be a bad idea to get in to see one. They are specialists and more familiar with PE so hopefully you'd get more support.

Just keep an eye on symptoms and do not hesitate to call or just head in to L&D if anything new starts. Hang in there!!! (((HUGS)))

[smz1789]

Thank you ladies so much for your responses! It really means a lot to me to be able to connect with other mom's who have been where I'm at.

I do plan on getting a BP cuff for at home use, and I'll keep a log to share with my doctor. I plan on trying to take it easy. I'm a SAHM, but just because I'm home with DD doesn't mean I'm relaxing all day! I'm going to make a point to take more breaks, put my feet up etc...

I know first hand that sometimes doctors aren't as on top of their game as we'd like to think they are... Before conceiving this pregnancy, I was a few weeks pregnant and experiencing a feeling of uneasiness. I knew something was wrong, but had no distinct symptoms to report. I called in and said I needed to be seen, but they wouldn't take me seriously. I ended up contacting another OB office (the one I'm at now) they saw me first thing the next morning and we discovered that my last pregnancy was ectopic,I had emergency surgery and lost my pregnancy and my tube. The doctors said that in another day my tube would have ruptured...

I don't believe we have any MFM doctors in my area... if we did, I'd certainly be interested in seeing one! My current office has 7 OB's, and I'd bet money each one has a different opinion on what they should do with me... and I find that incredibly frustrating. Because I'm high risk now, I can't see a midwife which is what I'd really like to do... and I'm not comfortable going back to my old office. There are a few other offices in the area, but I've never heard rave reviews about any of them either. I feel really stuck... My appointment in 2 weeks is with the doctor that took care of me when I was having my ectopic pregnancy. I feel the most comfortable with her, hopefully she will either take this more seriously than the doctor I saw this week, or she will at least "humor" my concerns and order some extra testing between visits! I just hate feeling like a ticking time bomb...

[smz1789]

Update:

I had my appointment last week (1 every 2 weeks). The doctor that I saw that day, was on top of things. She knew my results, and we talked a bit. She said that because my blood pressure isn't terrible (usually 130/80 but that's using a giant BP cuff, not sure why they always use that even though my arm fits in the normal one...), she isn't too worried about me. She ordered a repeat 24 hour urine test, and said that they still just want to see me every 2 weeks, and to call if anything alarming happens in the mean time... She also said if my BP stays below the alarming line that she didn't see a reason to induce before my due date.

Got a call about my 24 results from last week today. They said my level was 384, up from 319, 2 weeks ago. They said this is considered "stable" and to just keep my next appointment for a week from now. Is that really stable? I mean, I can see that it is rising slowly, and I'm glad for that, but it is still rising. Or does protein really not matter, and it's more about the BP?

I really wish that they would do something to try to make sure that LO is doing alright and getting what he or she needs to grow properly! They measured my stomach at my last appointment and said that I was measuring fine, and used the doppler for HB check which was also fine... but that was it. I guess I'll be asking if something more can be done to make sure he or she is really alright at my next appointment. I probably come across as paranoid, but I'd much rather be safe than sorry. Something I'm sure you ladies can relate to!

[caryn]

My guess is that they are treating you like someone with a little underlying kidney damage, and watching for a bp increase but trying not to "overreact" to a slowly rising proteinuria - especially if growth is on track and there's no IUGR.

But I so understand why you'd want closer followup, especially with a history! Here's a link to help you find the closest MFMs (search by state; the search engine sometimes seems to omit docs I know are close by if I search by city.)

[smz1789]

Thanks Caryn!

Can they know that LO's growth is on track and there is no IUGR just by measuring my stomach? Or would I need a sono? I haven't had one since the anatomy scan a few months back. The doctor I saw last time, was the most open about talking about what is going on. But all my orders come from my actual doctor even though I have not seen her since the beginning of my pregnancy. The doctor that I saw last time, was surprised/shocked that my doctor had not ordered a repeat 24... I feel a bit more comfortable with her at the moment, as she seems to feel it's important to keep tabs on what may or may not be happening.I was thinking I should request to see her specifically from now on.

I looked up the MFM's and the closest one is about 3 hours away...

[alexis]

Fundal height has a definite margin of error. My OB preferred to monitor me with monthly ultrasounds (I did not have PE in my 2nd pregnancy, but medicated chronic hypertension). Personally, I would be more comfortable having ultrasounds, and I did have mine done by MFM. They had a system whereby one of the MFM sonographers would be at the office I usually went to once a week, and the images were electronically transferred to the MFM in the hospital for him to review, which saved on travel time for me--I don't know where else they do it this way.