Is this really Pre E?

[jessicahaley]

I am 28 weeks along in my first pregnancy. Years ago I self diagnosed myself with 'white coat syndrome' and have high bp at the doctors office every time I go. It never alarmed me. At around 23 weeks my reading at my routine ob appointment was 156/93. Understandably, my midwife was concerned and sent me home with a 24 hour urine. The results came back at 624. Since that day (April 2nd) I have been put on bed rest. I do weekly 24 hour urine tests and see my midwife every week. My protein has been increasing. The trend so far is 624,676,724,767. I feel normal with no symptoms. My bp at home is normal. Last Tuesday I went to a to see a mfm specialist far away from my town. I had a level two u/s done to check for growth, placenta function, ect. Everything was perfect. I was relaxed and did not expect to get my bp taken. I also gave a urine sample for them to check mulitple things. My bp was 125/80. The mfm specialist told me I had NO proteinuria. I was hoping he would suggest that I be taken off bed rest but after looking at my liver enzymes and past readings he said it was best to keep me in the bed. He stated that my enzyme levels have slightly increased this past month. On Friday, I turned in another 24 hour urine test and had more blood work done. I am currently waiting for the results and will call tomorrrow find out.

I am so greatly confused and frustrated by my situation. I am 23 and have always been highly active and healthy. I have done lots of research in these last few weeks and I don't find much information relating to my situation. How could my proteins be going up and then be nothing at the mfm place? Is it because the 24 hour urine tests are more accurate? I would assume this 'high tech' facility would have the best equitment to detect proteinuria in pregnant women. I understand Preeclampsia can progress very rapidly or creep up slowly. It's very unpredictable. Why does it happen? Is it really problems in the placenta, or genetic predispositions? I am assuming is it a variety of factors, just none of them make any sense to me. ha. damn you preeclampsia.

[MomTimesThree]

What your MFM might have meant was that on the UA that they did at the office there was no protein. When we do urine dips at the doctors office mine always come back trace or negative, even though my 24hrs for the last month have been at 400. Reading posts from others here it seems the one time dip can be very inaccurate and I would trust the 24hrs over a dip.

I wish I could say a healthy pre-pregnancy promised a healthy pregnancy. We had zero risk factors for pre-e... and yet found ourselves with it. You're right it's very very frustrating, and bp can be a funky thing. A friend of mine that was hospitalized with pre-e for 4 weeks had beautiful BP... except for the middle of the night when it spiked to awful numbers even with medication.

I'm sure other folks with more experience will chime in with other info. I'd say regardless, something is up to make your kidneys so unhappy spilling protein.

[alexis]

It is possible to have preeclampsia and get a clean random dip. The dipstick measures concentration, not quantity, so if your urine is very concentrated or dilute, the dipstick is not accurate. The 24 hour urine is the standard.

I once got a freak low BP reading--at 36 weeks after my BP had been gradually rising for weeks. I would, tbh, put more stock in the 24 hour and the trend, but speak to your midwife. You can feel absolutely fine with preeclampsia even when very, very ill. I did not start feeling ill until I was so sick my daughter needed to be delivered.

[momma2four]

My office dipstick was negative for protein but my 24 hour urine and bloodwork came back abnormal and I was induced at 37 weeks. You don't have to show protein in your urine with a dipstick because they don't correlate well.

It sounds to me like yes, you have pre-e and bedrest does help. (at least it helped me) I was borderlining pre-e at 23 weeks with high bp and protein. I was put on strict bedrest (only bathroom and shower privlidges) and stayed that way until delivery 14 weeks later. The more I stayed on bedrest the lower my protein dropped. The MW's theory was that the decrease in activity helped to slow the strain on my kidneys which helped my BP and the protein. I actually had a few weeks where my BP was stable and protein was almost back to zero. Then it reared its ugly head again very quickly.

Pay attention to your body. I felt "off" and insisted that they do another 24 hour urine and check on me. They admitted me to do it and I ended up staying for 2 days before delivering. Because I was there and monitored, I was able to avoid Mag.

[caryn]

Did you get those test results back?

[jessicahaley]

Yes, I did get my results in. My protein has decreased by 100 and is back down to 656. My bloodwork came back normal as well. Maybe after weeks of bedrest I am finally seeing the results? who knows... I wasn't scheduled to do another 24 hour this week. I am now set up to begin twice weekly nst's and bi weekly ultrasounds until I deliver. I am 29 weeks today and very excited about that. I am hoping I can make it full term. I still have no symptoms and my bp is around 110/70 at home. The hardest part about this is wait and the unkown. Its a scary and diffcult time. Thank you ladies for all your responses! I really appreciate it.

[jessicahaley]

I just wanted to give an update and ask for some more advice. I will be 31 weeks tomorrrow. My protein has gone back up from the 656 it was at on May 11th. May 17th is was 699 and today it is 784. I have been getting twice weekly nst's and once a week I get an ultrasound to check fluid levels. At my appointment today my midwife said that I do not have pre eclampsia like she had thought but I do have severe proteinuria. I do 24 hour urine tests every week. I am wondering if there is anything that is influencing these tests. I know they test for quantity and not concentration. Could eating a heavy protein diet the day I do the 24 hour have an effect on the test? Laying in bed all day or getting up frequently? I wish I would have started doing these "experiments" awhile ago. I think this coming week I am going to lay off on the protein the day of and see if that changes anything.... does this sound like a good idea?
My midwife also informed me today that I will be recieving corticosteroids on Monday and then again on Tuesday. I don't know what to think! I thought that these are only given are in preterm labor, or if it is thought that you will deliver within a two week window. She never said anthing about me delivering within the next few weeks. It is to my knowledge that I am still going to be induced at 39 weeks! Does this sound like a good idea? I have tried to do some research on the steriods with no luck. I don't think there is any side effects....they couldn't hurt right? Any response would be great!!

[angieb]

I am not a doctor, but it sounds like you are one of us "unusual"/atypical girls. Or possibly you started your pregnancy with some underlying conditions like maybe kidney issues that you've never known about that are showing up now.

I went into the hospital with severe upper right quadrant pain. My blood pressure was normal and I was not spilling any protein (at least not on a dip test.) They did bloodwork and it was mostly normal with my liver enzymes "just slightly" elevated but not particularly concerning. Six hours later they re-did my bloodwork and my platelets had dropped by 100,000 and my liver enzymes had more than doubled from their previous "slightly elevated" levels...I was in full blown HELLP without high blood pressure or to their knowledge spilling protein. (With HELLP, there is a strong risk of liver rupture or organ failure, blood platelets can drop so low that it requires transfusions, etc., so the recommendation is almost always *IMMEDIATE* delivery.) With *most* people, the progression goes preeclampsia to severe preeclampsia to HELLP, but that's not always the case, so it's a very good thing they are keeping a close eye on you.

Regarding white coat syndrome, my blood pressure is always higher in the office than it is at home, but even so, it's never been as high as 150/100. It is definitely not good for your numbers to be that high even if you believe it's just because you are at the doctor, because it probably means your numbers creep up there when you are stressed or busy at home too. Are you monitoring your blood pressure at home at all?

Steroids are given to help develop the baby's lungs. The last week they are usually given is 32 weeks, after that, most doctors won't do them. The average onset from diagnosis to delivery with pre-eclampsia is 2 weeks, but that's just an average with people like me thrown in who deliver hours after being diagnosed and then there are people who limp along for weeks and weeks. In my second (healthy) pregnancy, I was given them at 32 weeks for "just in case" because I was having some up and down blood pressures and swelling, nothing super alarming yet but we knew we were delivering at 36 weeks and I was hoping they might help his lungs out. (He had no trouble breathing at all and roomed in with us.) Even though you hopefully will not have to deliver within 2 weeks, things can change VERY quickly and the 2 doses of steroids have to be given 24 hours apart. Ideally they do want to give them as close to delivery as possible, but if they wait until you have sky high blood pressures, etc., then you may not have time to get both doses without putting your health and the baby's health at serious risk. It's better that they give them "just in case" when a few things are looking off than you have to deliver early and not get them at all because they don't have the time to wait. So I personally think it's a really good thing they are giving you the steroids.

[JB]

What have your blood pressures been like lately? There are other reasons for protein in urine, but if your blood pressures have been high and you have that much protein in your 24-hr urine then I would think that would be a positive diagnosis for preeclampsia. Other common reasons for high protein in your urine are infection, fever (any type of infection or fever can increase the protein in your urine), or other kidney disease. For people without kidney disease, a high protein diet shouldn't really affect the protein levels in your urine, but if you have some underlying kidney disease or if you have PE and it is affecting your kidney function you might want to avoid a high protein diet. Has your midwife/doctor checked your kidney function lately (blood creatinine levels)? When I was hospitalized my 24-hr protein levels were over 1200 mg and my blood creatinine levels had increased to a level that indicated I was beginning to experience kidney failure.

[jessicahaley]

thank you for the responses! I do realize how fast things can change and my condition can get very serious over night. I'm starting to think the steroids will be a good idea and if they help mature babies lungs then it can't be a bad thing. I had two high bp readings during 22/23 weeks at the hospital that prompted the initial 24 hour. But I know I have had anxiety when my bp gets taken since I was a teenager. Since those readings my bp has been great. I get it taken 3/4 times at each nst 2x a week. It's always normal. I also take it at home frequently and it's just fine. maybe I am headed towards hellp... My kidneys are definitely doing funky things. It's possible I had an underlying issue although I've never been effected by it. I got more blood work done today and will find out tomorrow what it looks like. I'm hoping for the best.