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3rd Pregnancy (long)

Are you pregnant again after having preeclampsia once already in a previous pregnancy? Post your thoughts/concerns here - there are others who share your feelings. This is also the home of our Bedrest Buddies Support group.

3rd Pregnancy (long)

Postby mllewellyn » Mon May 28, 2012 02:00 pm

by mllewellyn (61 Posts), Mon May 28, 2012 02:00 pm

Hello! I am so glad I found this forum! My story: I developed pre-e and then HELLP in my 1st pregnancy. My daughter (Genevieve) was stillborn at 24 weeks. It was later determined that I was heterozygous for two genetic clotting diseases. I got pregnant with my 2nd 2.5 years later and with a different father. I was told that I should have a milder case and maybe no problems. I was put on lovenox as soon as it was confirmed I was pregnant (about 7 weeks). I developed PIH and was medicated (aldomet) at 20 weeks. The dosage was doubled at 23 weeks. I spent a few hours in L&D triage for high blood pressure (only because it was a weekend). I was induced at 38.5 weeks and had a healthy baby boy (Alex). In November, we were surprised with another pregnancy. I had just turned 39. I will still be 39 when my due date comes along. This is also a boy. I am on lovenox (40 mg/day). I did not take BP meds until week 25. Up until that point, I was working out moderately and was in the best health of my life (I lost a lot of weight, got BP down to low numbers, but not planning a 2nd). At 25 weeks, I was put on 250mg 2x/day of aldomet. It worked for about 2 weeks. My dose was increased to 500 mg 2x/day. That worked until earlier last week. Then, my BPs started creeping up again. I spent a few hours in L&D triage. The baby is doing fine. My BPs ran about 140/90 +/- 5 in either direction, even while relaxed. So, my aldomoet was increased 500 mg 3x/day. So far, my BPs are below 140/90 averaging 128/80. How much more aldomet can I take if it comes down to it? I have read on other posts that some take aldomet along with other drugs to help. What is the max dosage of combined meds? I am currently at 30 weeks 1 day. I made it to 28 weeks (which was my goal at 25 weeks). However, I read up on preemies and I know that the longer they stay inside the better. I am very anxious and I know this is not helping with the BP. I do not have elevated protein in my urine nor PIH panel (liver enzymes, platelets, etc). At this point, my dic is reluctant to say I have pre-e just PIH. I do have swelling but it is mild in my feet and hands. The hands pretty much swell at night and then go down throughout the day. Feet during the day but get better at night. I am on a modified bedrest. I spend most of the time on couch and bed, but I do go to work and sit in a recliner with feet up. Actually, my BP is lowest at work, if you can believe that.
Has anyone had more problems with #3 than with #2? It just seems so odd that it would be worse this time. Same father, new baby. I would think my body would get around to doing what is right for once. I have an ultrasound and OB appointment tomorrow (Tuesday) to check on weight and growth. I'll update when I know something. Thanks again for reaidng and replying.
Mistie
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Re: 3rd Pregnancy (long)

Postby aajatwins » Mon May 28, 2012 02:24 pm

by aajatwins (476 Posts), Mon May 28, 2012 02:24 pm

Welcome! glad you found us!
I'm not sure about the dosages on the meds, as I have never taken them. So I will let someone else answer that :) For the official diagnosis of PE, it does take proteinuria of 300 and 2 BP readings of 140/90 or higher. So your doctor is right about that - you should fall into the category of PIH only. We love to encourage everyone that the typical subsequent pregnancy sees PE later and less severely, but we definitely have posters who have experienced differently. I'm sure they will share with you what they've been through!
It sounds like you have a good doctor taking care of you and I'm glad to hear that. I hope you can make it to term without too much craziness :) and again, glad you found us for support until then!

Oh- and to ease your mind a bit, stress can definitely affect your BP, but it will not affect your PIH/PE! PIH/PE is a placenta problem, so while you definitely don't need the stress, it is not affecting things like you'd think it could.
Anna (28) - endometriosis
Hubby (27)
Aidan & Jordan - 7.2.09 at 36 weeks. Induction turned emergency c-section due to eclampsia. big healthy toddlers today!
Asa - 10.23.11 at 39 weeks. NO hypertensive issues!! successful VBAC :)
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Re: 3rd Pregnancy (long) Update

Postby mllewellyn » Tue May 29, 2012 01:18 pm

by mllewellyn (61 Posts), Tue May 29, 2012 01:18 pm

So, I went to the OB today. We had an ultrasound to do measurements. He weighs 3lbs 1 oz which is the 39th percentile. Three weeks ago, he was in 49th. This is a little worrisome to be honest, but my OB said it wasn't serious. The second thing she mentioned was a lowered amount of amniotic fluid which she said wasn't an issue since the ultrasound may be off some and hydration can replace missing fluids. However, I drink 8-10 oz of water every hour most of the time. So, this also worries me some. When I looked into it, placental problems was a reason for having low fluid levels. Obviously if I do have pre-e (which right now, I don't, just PIH) then I would be having placental problems. The OB booked me for induction at 39 weeks while telling me I would go before then. Her "hope" is to reach 37 weeks. I am feeling down and a little doubtful about making it that far. I am also worried about the baby if he is small, it would be a harder fight for him. I have read that many survive at less weight and time inside the womb, but I still feel anxious and worried. If you have an experience that you would like to share, I would love to read about them. Thanks in advance for allowing me the opportunity to just get it off my chest. I don't know anyone who has been through a similar experience and most don't seem to understand my feelings or how troublesome this is for me.
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Re: 3rd Pregnancy (long)

Postby aajatwins » Tue May 29, 2012 02:20 pm

by aajatwins (476 Posts), Tue May 29, 2012 02:20 pm

It is definitely easy to worry about percentiles and fluid levels dropping. I wouldn't say you're perfectly ok, but I wouldn't freak out yet either. If he's in the 39th %-tile, that's better than the 9th %-tile. I would be more concerned, personally, with the fluid levels. But that does depend on how the US tech measures and could be normal again at your next visit. Ultrasounds are not an exact science, for sure.

I would agree that is seems bigger babies do better, but I'm sure that's not an absolute, either. (Ya gotta love the lack of absolutes here in PE-land.) A recent baby born to one of our posters was 35 weeks (PE-free, though) and a few days and did great. I had my twins at 36 weeks to the day and they did great (one need NICU for a few days for rapid breathing). But some 37 weekers need more NICU time. It is such an unknown! I do hope that you're able to keep cooking that sweet baby for 7 or 8 more weeks with no hiccups! And I hope you'll stick around the forum and keep us updated!
Anna (28) - endometriosis
Hubby (27)
Aidan & Jordan - 7.2.09 at 36 weeks. Induction turned emergency c-section due to eclampsia. big healthy toddlers today!
Asa - 10.23.11 at 39 weeks. NO hypertensive issues!! successful VBAC :)
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Re: 3rd Pregnancy (long)

Postby MomTimesThree » Tue May 29, 2012 02:48 pm

by MomTimesThree (570 Posts), Tue May 29, 2012 02:48 pm

I'm very sorry for the loss of your lil' Genevieve.

I'm also not sure about the dosages. We're currently on our third pregnancy, second dealing with pre-e. With our 2nd we developed pre-e at 29 weeks... with this lil' one 25 weeks, and needing medication. So I guess this one is "worse", but I'm very grateful that in both cases we seem to be the lucky ones who have very slow moving pre-e. Our doctors are thinking that whatever happened with the second certainly left some underlying issues which might have caused things to happen sooner this time around (we had ridiculous BP spikes at 18 weeks, and protienuria at 10 weeks).

I think with each subsequent pregnancy we as mommies also get wiser, so while things might be a lil' more rocky this time around, you're also so much more well prepared having already been through so much.

I'm hopeful you'll see 37 weeks and then maybe a week or two more! :)
2008-Our Baby Girl, PTL born too early at 30w6d, Fought so hard... Forever Loved & Missed
2010- Lil' Bro, Pre-E at 29 weeks... Induced at 36w6d, Born 37w
2012- Lil' Sis, Super-imposed pre-e at 25 weeks, PTL & GD at 35 weeks, Evicted 36w
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Re: 3rd Pregnancy (long)

Postby danielsmom » Tue May 29, 2012 03:08 pm

by danielsmom (290 Posts), Tue May 29, 2012 03:08 pm

If I were you, I'd have my radar tuned up a little, but I wouldn't be really stressed or worried yet (I know it's hard). Reason being, you've got some positive things going for you right now.

First off, 39th percentile is great! That's just a hair left of normal, and at this stage, it's likely to change a lot. Babies do have growth spurts, and ultrasound is subject to error. With my current pregnancy, I went from 82% to 52% to 32% at 24, 28, and 32 weeks, then it rebounded back up in the 50s and now it's settled into the 40s. And honestly, I think any neonatologist would agree that growth doesn't help their fight as much as development does. My little man was born at 27 weeks, but was the size of a 22 weeker, or below the 0 percentile. He had some touchy beginnings, but did very well. In the NICU, every specialist that saw him would look at his birth weight first (470 grams), get a confused look, and then revert back to his birth gestation for risk assessment because development occurs at gestation milestones and not necessarily with growth. He's now 3 and completely normal in every way, except he's really tall, like above the 90th percentile. Go figure!

Secondly, congrats on 30 weeks! You are now leaving the really really scary NICU stuff (typically). Get through the next few weeks and you should feel even better. My nephew was born at 34 weeks & 0 days, and he only spent 10 days in the NICU, mainly just learning to eat while they watched his temp and breathing (which was very good).

And lastly, do you know what your amniotic fluid level is? An AFI of 5 is usually cause for delivery. It might just be on the low side of normal, and yes this is a placental function, which can correlate to pre-e. It's something that should be watched closely, but it doesn't necessarily mean that you're going to get pre-e. I've had low-normal levels for 3 weeks now (my AFI=7 to 8), and it's been pretty stable. I also drink a lot of water, so I was surprised by the dip. I rest more now, not bedrest, just no crazy errand or shopping days. Has your OB looked at cord flow? 4 things to watch vigilantly: your BP, cord flow, amniotic fluid level, and growth.

Hang in there!
Miscarriage Feb 05 & Dec 07
Daniel born Feb 09 at 27w5d, 1 lb 1 oz/12 inches (severe IUGR) due to Severe Pre-E & HELLP. Now tall for age and no complications.
Diagnosed with MTHFR
Cornual Ectopic miscarriage Mar 11
Natalie born 6-5-12 at full term, 7 lb 11 oz & 21.5 inches, progesterone 2-8 weeks (for suspected luteal phase defect), lovenox 6-29 weeks, lda 0-36 weeks, folic.
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Re: 3rd Pregnancy (long)

Postby mllewellyn » Wed May 30, 2012 05:50 am

by mllewellyn (61 Posts), Wed May 30, 2012 05:50 am

You have all been so encouraging. I can't thank you enough for the positive words and your stories. I know all pregnancies are different, but you all have given me hope from each of your experiences.
The OB told me that my fluid levels dropped from 12 three weeks ago to 9 yesterday. I gather this is not too bad? The OB didn't seemed very concerned with all of it and I may be overreacting some. My stillbirth had IUGR and measured 3 weeks behind so I think it is a little frightening to think that my little guy is also small. I did a little researching last night and found that at 30 weeks, the baby should weigh between 2.8-3.8 lbs. So, he is on the lower side, but not below normal.
I do have a question about swelling. In the last two weeks, I have gained 8 lbs. I am sure it is mostly water because everything is swollen. My feet start off mostly normal, but then swell throughout the day. My mom loaned me her compression socks to help. I'll try them out this week and see how it goes. My hands swell at night but get better on and off throughout the day. My face is puffy as are arms and legs. My OB checked my ankles yesterday and wasn't concerned. I know what to look for, too. How much did you swell or gain from what you think was water? Is there anything I can do to minimize the swelling other than lying around? I am lying around and even at work, I am in a recliner.
Thanks again for everything!
Mistie
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Re: 3rd Pregnancy (long)

Postby caryn » Wed May 30, 2012 05:51 pm

by caryn (10124 Posts), Wed May 30, 2012 05:51 pm

So much of this is genetic - I'd guess this placenta has genes more like the first placenta had!
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies? Lectures from researchers?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy
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