22 weeks with second questions( first was 26 weeker)

[bethjoy]

Hi ladies! this is my first post here. My first was delivered at 26w6d due to severe Pre E/ HELLP (now he is a perfectly healthy 21 month old). Now I'm 22 weeks pregnant with our second and have been a little bit nervous about how my doctors aren't treating my case very "high risk"- I am not seeing a MFM dr and am on the same schedule as a normal pregnancy as far as my visits and have not been told to take anything different this time such as baby aspirin or an increased dose of folic acid. The only difference is they did a 24 hr urine at 12 weeks to get a baseline for future tests. I am being seen by different doctors this time (further away but they give the option of VBACing) and have only seen them a couple of times since I transferred from my local practice. The local practice said I would likely be seen every two weeks starting at 20 weeks since I got Pre E so early and severe with my first son. but the practice I'm at now it ok with sticking to the routine schedule of monthly appts, only with the direction to get my blood pressure checked once a week. Should I ask for closer monitoring or just keep track of symptoms at home and consider that what they are doing is enough? Also, I started getting slight swelling in my hands with week, not enough to be visibly noticeable but I can tell. Is this a time in pregnancy when normal swelling generally happens or should I be concerned that it could be a sign of pre e starting?

[kerisue]

Do you have an option to have a consult with a MFM? If so, if I was in your situation I would def. want that- for anyone who previously had PE, but especially those who had it early and severe. The MFM might be in agreement with your OBs plan, but s/he might also have some ideas about increased monitoring and I would want to have those recommendations from a high risk pregnancy expert before making decisions. Good luck and I hope everything continues to go smoothly for you and baby 2!

[danielsmom]

Hi! So glad your son is doing well. Sounds like you are too. It looks like we delivered within 6 days of each other gestation-wise. I had HELLP too.

First off, I had blood testing before I got pregnant again (actually it was done before I left the hospital when I had my son), and the only thing that turned up was MTHFR, and it's not the worst type. That's probably half the reason why I'm on extra folic and baby asprin. Otherwise, I've taken that plus lovenox injections purely just because of history of pre-e/HELLP/pre-term birth. The science isn't really strong saying these things help, but some doctor's are for it. We also suspected a luteal phase defect with me which messes with implantation, something that might be a pre-cursor to pre-e. So I also took supplemental progesterone at ovulation and continued that to 8+ weeks.

I'm 31 weeks today. I also haven't seen the MFM yet this pregnancy, but I consulted with him before. He recommended a plan in agreement with my OB, and my OB doesn't treat me like a normal patient. He consults with the MFM, sees me frequently, and I go to a special room for high resolution ultrasound at every appointment. If I had anything show up suspicious with growth, blood flow, protein, BP, fluid, or anything - he'd refer me to the MFM for a second look, but so far all has been completely normal. You mentioned monthly appointments... I definitely think that's going too long, especially at 22 weeks. The longest period between appointments that I've had is 3 weeks, and that was at 14, 17, and 20 weeks, where the risk of miscarriage or pre-e is low. I'm now at 2 weeks and will probably go to 1 week pretty soon. I had some swelling in my ankles around 26 weeks after some shopping and a road trip, but my doctor wasn't concerned because it can be normal, it's not in my face and otherwise I'm healthy. It went away and hasn't returned. It is good that you're having your BP monitored weekly, but I'd want growth, fluid, and blood flow monitored at least every 2 weeks from now on out. Maybe your OB could up the frequency, or put in a referral to an MFM to see you every other time (they each see you once a month or so, but you see either the OB or MFM every 2 weeks)?

They should be very understanding about doing whatever to calm your fears. You don't have a long rapport with them and you've been through a lot! My OB just told me he'd think I was nuts if I wasn't at least a little anxious about this.

[caryn]

A history of PE before 28 weeks gestation does put you at very high risk of recurrence - over 60% - and while that second case is often much later, and much more mild, and doesn't happen in 4 of 10 pregnancies, it's still more than sufficient to justify following you more closely for subtle symptoms. Just in case. Blood pressure monitoring is one way to do that, of course, but that's only one symptom, and as you probably know from HELLP, not always present.

Look for an MFM in your area here (searching by state often works better) or ask your OBs office for a referral to someone they work with closely?

[bethjoy]

Thank you so much ladies for your support and encouragement!! I am going to get a blood pressure cuff today and my mother in law just so happens to be coming into town this evening for through the weekend and she is a nurse so I will make sure we are doing the readings correctly. My blood pressures have been on the lower end this pregnancy usually around 100/65 so I know what would be on the high end for me and I'll be tracking it a couple of times a day and watching for upward trends. I am going to keep this up until my next visit and only call the doctor if there's reason to be concerned. I think at the next visit on the 26th I'll make sure to schedule future visits no more than two weeks out.

Those that recommended a visit with the MFM dr how does one go about scheduling this appt? Do you ask you doctor for the recommendation or call them yourself to set up an appt. I know where I would be seen since I was seen by MFM during my hospital stay and after the birth of my 26 weeker.

Thank you all so much for your suggestions, advice and encouragement, it is so very appreciated!!