superimposed PET versus severe pre-e

[mom29]

This was on my d/c summary:
"ch HTN with superimposed PET, induced 10 days after steroids, mag. OP, foley induction"

Is it less severe than severe pre-e? Just sorting this out in my mind. What would the OP stand for?

[alexis]

Neither, really.

Superimposed preeclampsia only means that you had preexisting hypertension (BP rose prior to 20 weeks of pregnancy). It isn't a descriptor of severity. Superimposed PE could be either mild or severe, according to the regular criteria (BP over 160/100, 24 hour protein over 5,000, I think there are some others).

My PE was superimposed, but also severe.

Superimposed preeclampsia is a warning for future pregnancies, because chronic hypertension is such a risk factor (of course, so is previous PE of any stripe). I've not found good statistics on the likelihood of recurrence in that specific scenario, but my OB was very cautious.

[lemons]

I think the OP stands for "occipital posterior" position, meaning that your baby's back was against your spine and face was facing your belly. It is apparently (according to the internet) not the preferred position for a vaginal delivery and this might be why you needed the Foley induction. I am just guessing.

I think the whole thing means: Chronic hypertension with superimposed preeclampsia, induced 10 days after steroids, on magnesium sulfate. Baby was in occipital posterior position and foley induction was needed. So as Alexis said, the report states that you had both chronic hypertension and you had preeclampsia. It doesn't mean one was more severe than the other or that together they are worse. Each case is different.

Sorry, that I can't offer any more real help as you sort out your situation.

[mom29]

Thanks, your definition of OP sounds right (had a previous baby sunny side up). For whatever reason, they do foley inductions at this hospital frequently. Glad I had the epi. so I didn't feel a thing.

[lemons]

Glad to help! I didn't know what a foley induction was- it doesn't sound overly pleasant!

[caryn]

The NIH Working Group Report has this:

There is ample evidence that preeclampsia may occur in women already hypertensive (i.e., who have chronic hypertension) and that the prognosis for mother and fetus is much worse than with either condition alone. Distinguishing superimposed preeclampsia from worsening chronic hypertension tests the skills of the clinician. For clinical management, the principle of high sensitivity and unavoidable overdiagnosis is appropriate.The suspicion of superimposed preeclampsia mandates close observation, with delivery indicated by the overall assessment of maternal-fetal well-being rather than any fixed end point. The diagnosis of superimposed preeclampsia is highly likely with the following findings:

In women with hypertension and no proteinuria early in pregnancy (<20 weeks), new-onset proteinuria, defined as the urinary excretion of 0.3 g protein or greater in a 24-hour specimen.
In women with hypertension and proteinuria before 20 weeks gestation.
Sudden increase in proteinuria.
A sudden increase in blood pressure in a woman whose hypertension has previously been well controlled.
Thrombocytopenia (platelet count <100,000 cells/mm3).
An increase in ALT or AST to abnormal levels.

[MomTimesThree]

Caryn, Thank you so much for posting this. I had asked a similar question in the biology of PreE and wow, this answers it completely! My doctor and I just had this conversation yesterday... is it superimposed or just worsening CHT. The agreement was at this point it doesn't really matter, we'll monitor closely and take precautions anyway. Nice to see our plan inline with the report!

[mom29]

"There is ample evidence that preeclampsia may occur in women already hypertensive (i.e., who have chronic hypertension) and that the prognosis for mother and fetus is much worse than with either condition alone."

Caryn, can you venture a guess as to why the prognosis would be worse with both conditions present? Higher rate of adverse outcomes perhaps?

Believe me, I am thanking God that the mfm I had took the time to sort out exactly what was going on with me.

[caryn]

This is what I had, and the word they used was "fulminating", Which I gather means you just both get so sick, so fast, that the odds are not on your side. (They were drawing labs every hour, on the hour, with constant fetal monitoring and an automatic cuff going off every half hour. My bloodwork was bouncing along just above the HELLP threshold and I had crazy clonus and pulmonary edema. Oscar went from 8/8 to 4/8 and quit bothering to move or practice breathe and then started decels. We're fine now, of course.)

So yes, my understanding is that decompensation of some organ or another is very likely, and sometimes in a way where there won't be a recovery, like severe stroke.