New and pretty overwhelmed

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blythe
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Re: New and pretty overwhelmed

Postby blythe » Sat Jul 14, 2012 09:56 am

That does sound scary, especially after all the information we're giving you about how serious headache, etc., can be! I still want you to take your symptoms seriously and report them, but I also want to say that your description also sounds like how I've felt when I was pregnant and didn't get enough (or the right things?) to eat or drink and my system just got all wonky. It also sounds like how I felt when I stood up too fast - my doctor called it a vasovagal response? I'm not a doc and absolutely not diagnosing you in any way, and I'm definitely not minimizing what you experienced, I'm really glad and impressed that your nurses took you so seriously, but just explaining an alternate explanation if your labs come back clear. One of the really hard part of this disease is that so many of the symptoms look just like normal pregnancy symptoms. I wonder if your docs are less panicked about you because you are such an attentive patient and they know you'll call them and go to L&D with any problems.

Robinscj, thanks for the info on the creatinine! It seems to be a newer test that I didn't get so I don't now much about it - by any chance do you have any good links for me / us about how it relates to preeclampsia?

Please let us know your labs and 24-hour results! One tip about the 24-hour if you haven't heard it already - put the jug in a bucket of ice in your bathroom, that way it doesn't smell as bad!

I'm glad you've gotten some good information about your NICU, etc. You've got me curious now about the ABO incompatibility. I'm trying to remember my biology classes, I think you have a 50% chance of having another A baby, but I didn't think just having a different blood type was enough to have that much a dramatic effect... I have vaguely heard of the Coombs test, is there another factor involved?

What other questions can we help you with?
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

sam10
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Re: New and pretty overwhelmed

Postby sam10 » Sat Jul 14, 2012 09:38 am

I agree that a MFM/peri should be pulled in to your care. Either you see one directly and/or your OB consults with one. As has been said, the MFM specializes in all things "complicated" during pregnancy. That is all they do, and have a lot of experience with us "complicated" PE ladies :-)

I am glad that labs were ordered, as sometimes BP alone is not the only indicator that something is not right. If you do feel like this again (dizzy, just feeling off, spots/lights, nauseous) , please don't hesitate and go to L&D immediately.
~Julija (42)
MC 3/2009 and 3/2011
H (1/1/2010-1/7/2010) - forever loved and missed; severe PE with Hellp; partial placental abruption, classical c-section at 25.6 weeks
M (Nov. 2012, born at 35.4 weeks) - severe PE


Our pain has been put into words, placed into empty cradles, to remember that all our babies lived, that they mattered and always will. - Field of Cradles http://www.fieldofcradles.org/

MomTimesThree
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Re: New and pretty overwhelmed

Postby MomTimesThree » Sat Jul 14, 2012 03:24 am

What a scary incident, I'm really surprised to hear you're not being monitored at least overnight at the hospital. What were your pressures during that incident?

A MFM is a doctor that specializes in high risk pregnancies. They do fellowships (extra work after becoming OB/GYNs) under other MFMs and live and breathe high risk mommas. So they have a wider range of experience when it comes to all things complicated. You can search for ones in your area here: https://www.smfm.org/MFM%20Member%20Loc ... e.cfm?ht=p
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

arwen
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Re: New and pretty overwhelmed

Postby arwen » Sat Jul 14, 2012 03:14 am

I went to my doc appt today, figuring this was a chance to see if maybe they'll take this more seriously. I had a headache as I got to the office and started to feel more "off" as I was in the waiting room. I felt like I had teeny lights that were darting around and when I stood up when my name was called, the world started to tilt a little sideways. I had 3 nurses on me immediately, who got me back and started checking BP, asking lots of questions, etc. I felt rather out of it and my BP was all over the map. I also was fairly nauseated, and wasn't sure if I was going to vomit or not. After a while they got me back to the NST room and hooked me up to the monitors. The baby was fairly quiet but did eventually move enough to satisfy the doc. The lights stopped darting around and I felt a little more "with it" eventually. The doc basically said if that happened again to go to the hospital. She was reluctant at first to order tests, under the idea that my BP was still within the realm of normal and my other tests were "normal" (I know they were considered borderline by another doc in the practice), but I told her I really don't care how inconvenient tests are, I'd rather know. So she ordered a bunch of labs and a 24-hr urine test, which starts tomorrow morning. I suspect they'll reveal this has gotten worse.

I had creatinine of 1.9, yes...no idea what my baseline is. I've had shortness of breath for months...aside from lung irritation, it's hard to tell why. Isn't pulmonary edema a problem for c/s as well? I don't know how well an induction would go if I'm anything like I was earlier today, I couldn't think straight and felt weak and awful.

I didn't know ABO is worst with the first; we had to supplement my daughter in the hospital because we had a positive Coombs test and my milk was nowhere near enough in to provide the hydration she needed. I'm O+ and my husband is A+, I have no idea how likely it is to have another A+ baby. I was going to ask the doc about that but with everything else going on, I didn't get to.

Our NICU apparently handles babies from 28+ weeks, I found out. It's a smaller NICU but it may be nicer than the larger ones that are handling extremely early babies.

Forgive the ignorance, but I'm still not feeling 100%. What does a Maternal Fetal Medicine doc do that an OB/GYN does not?

Robinscj
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Re: New and pretty overwhelmed

Postby Robinscj » Fri Jul 13, 2012 07:34 pm

I would request a maternal fetal medicine consultation rather than a switch. If the lab you are quoting is a creatinine of 1.9, that is really high for pregnancy. Induction of labor is not as likely to be smooth as fluid maintenance and magnesium levels will need to be monitored carefully. If you get any shortness of breath, let your nurse know. You can get pulmonary edema with a Cr that high. Is that your baseline?

alexis
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Re: New and pretty overwhelmed

Postby alexis » Fri Jul 13, 2012 06:09 pm

ABO incompatibility is an issue for me (I am O+, DH is AB-, so I am guaranteed an incompatible baby).

Both of my children have been jaundiced; both were born by CS without labor. I haven't heard that PE is a risk factor, but prematurity absolutely is. My first was worse, but she was earlier and I was told ABO incompatibility is worst with the first (I don't know how this works; I know it's the reverse for Rh and Kell)
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!

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l412angel
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Re: New and pretty overwhelmed

Postby l412angel » Fri Jul 13, 2012 03:10 pm

Hi there I live other Chicago area and interviewed just an every high risk doc and on out there to get through my second pregnancy. Please email me at @ L412angel aol dot com.nthanks Angie for bringing this to my attention!
Laura Angel (Factor V Leiden)
Mommy to Cara Angel 2LBS 11OZ 16 IN. Born at 30 weeks due to Severe PE & HELLP.
"My life went with you sweetheart the day angels called you home"

Our Rainbow Baby Carter born March 5 2011 7lbs 7oz 20.5in 36 weeks 4days PE FREE

Baby #3 due June 2012

blythe
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Re: New and pretty overwhelmed

Postby blythe » Fri Jul 13, 2012 12:16 am

And I assume you've seen this already, but please watch your signs and symptoms and especially call your doc if you get a headache that doesn't go away with tylenol, visual disturbances, pain under the right ribs, or decreased baby movement.

http://www.preeclampsia.org/health-info ... d-symptoms
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

blythe
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Re: New and pretty overwhelmed

Postby blythe » Fri Jul 13, 2012 12:13 am

One of the things I told my doctors that seemed to make a difference is that I feel a lot more relaxed when I have as much information as possible - that the unknown is a lot harder for me than a scary reality. They don't always have time to give that kind of attention and explanations, though, so ask away and we'll do our best to fill in more info.

Jaundice - prematurity is a risk factor for jaundice, and if I'm understanding right ABO incompatibility can cause very bad jaundice (were you able to breastfeed at all?). Here are two good links:
http://kidshealth.org/parent/pregnancy_ ... dice.html#
http://www.aafp.org/afp/2008/0501/p1255.html
I haven't seen inductions mentioned as a risk factor for jaundice unless it was connected to prematurity.

The right side pain "URQ / upper right quadrant pain" can be normal, or it can be an indicator of the liver having problems in HELLP - a fast-moving form of PE. Bloodwork is how they check to see if there is liver involvement.

I had intense Braxton Hicks contractions throughout my pregnancies, as long as your doctors aren't concerned in your shoes I wouldn't panic about them - or ask when they *would* be concerned. My guess would be if they get to be regular, like contractions, or if baby doesn't do well with them in the NSTs. Google for ways to handle BH too - I think hydrating more is helpful, and I'm sure there are more things to try.

The c-section issue is one I was confused about in my first pregnancy and induction - wouldn't induction raise my bp?? But I've come to learn that while sections are lifesaving, and many women here have had them, doctors prefer a trial of labor and hopefully a vaginal delivery in PE, because PE means you are sick and they would prefer to not do major surgery in a woman who is already sick. That recommendation comes from the Working Group on Hypertension in Pregnancy -http://www.nhlbi.nih.gov/guidelines/archives/hbp_preg/ to download the pdf . The WGR is out of date now but our Experts (top researchers and clinicians in hypertensive pregnancies) have told us that the report's recommendations are generally still correct.

The "lung squeezing" part of a vaginal delivery is something I've heard of before, and I know full term c-section babies who had to go to the NICU because their lungs hadn't been "squeezed" enough, but I don't know much about it other than that.

Inductions generally go better in hypertensive pregnancies - you automatically get a +1 added to your Bishops score (likelihood that your induction will result in a vaginal delivery) if you are induced for hypertension.

Magnesium sulfate / MgS04 / "mag" is a nasty drug to experience but if they give it to you it's because it's lifesaving for you and baby. (edited to add - it's not guaranteed to make you miserable, some women don't even notice and we've had a few here feel *better* on it, but in general people like me do complain bitterly about it - as I did in my early posts :) ). The reason they give it to preeclamptic women is because it cuts the risk of eclamptic seizures in half. If you need to be on it they'll give it to you during labor and 12-48 hours after, because labor and immediate post-partum are the riskiest times for eclampsia. Research has also shown that mag during preterm labor is protective for babies' brains. The side effects disappear once the drug is out of your system, the only concerns I know of is that you can overdose - easily reversible - so they can't always use it in third world countries where it could save many lives, because it does take professional hospital monitoring.

As for would *I* switch in your shoes? I'm not sure if I would. Having a doctor I trust and can communicate with me was essential in my subsequent pregnancies, but in my first pregnancy in the middle of all the confusion and new information I'm not sure *any* doc would have been good enough for me. In your shoes I *would* ask for an MFM consult, and ask if steroid shots would be appropriate (they may not be in your case) to help mature baby's lungs.

As for the NICU, 32 weeks seems terrifying, but it's actually a very good gestational age to be at. There are no guarantees, we've had full term babies have bad outcomes, but in general I think the odds are like 95% of babies will be fine long term, and it seems like most 32-34 week babies have issues figuring out breathing and eating for a little while then do fine. We've had a few 34 week babies room in with mom with no NICU time at all. In your shoes I'd call the NICU at your hospital and find out if they can handle a baby at 32-34 weeks and ask about any other specific concerns. I'd narrow it down to 2-3 main questions, nurses are busy!, and call back after you process those answers and have more questions.

In your shoes I'd start with asking for an MFM consult. That way you're not changing your providers completely, while at the same time getting a more specialized doc to weigh in on your specific case.

And in the meantime, breathe ;). This is a ton of information to dump on you all at once, and it's probably why many docs don't explain things.
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

arwen
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Re: New and pretty overwhelmed

Postby arwen » Fri Jul 13, 2012 11:13 am

My mom is on the warpath because she feels these docs haven't taken my situation seriously. My husband is very scared of switching doctors at this point and feels that maybe I'm just reacting too strongly to some bad examples of bedside manner. I'm not thrilled about the idea of basically a total stranger delivering our baby and managing all the health concerns with doing so, but I'm feeling like the practice I thought I knew has done a total 180 and I don't even recognize their attitudes. I keep trying to explain that yes, their level of concern and compassion bother me, but I'm also very worried about what they're NOT telling me--we're not doctors and don't always know what to ask. You don't always know what you don't know.

The rock hard uterus feeling is pretty much all over. I haven't had any more pain on my right side than left. They did tell me to look for that, although they really didn't tell me why, it was just in passing. I hate having to use Dr. Google to find out what the significance of some of these "just in passing" things are.

When my daughter was born 2 years ago, I was told her jaundice, which was fairly bad, was because we had such a long labor. The nurses said my labor was pretty close to how an induction typically goes--my body just wasn't ready but my water was so badly broken we couldn't not deliver. We had ABO incompatibility, too, which no one really explained to me despite my asking for explanations, I had to find out on the internet what it was. Is jaundice typically an issue for a baby when mom has preeclampsia, if there's a long induction? I feel like the jaundice made things hard on her in the beginning, especially since she didn't want to eat, and I'm wondering what effect that has on preemies who typically struggle with eating in the first place.

I heard from a friend of mine that they give magnesum sulfate during L&D for moms with preeclampsia. She said it's a horrible drug and they won't let you out of bed for a full day after getting it. Again, I'm frustrated with my docs for not laying stuff like this out for me, and it's not like I would have thought to ask!! I can find lists of side effects on websites for prescription medications but have no idea the significance of those effects.

I'm in the Chicago area, and will pm you both with more info. Again, THANK YOU SO MUCH for your help, I was starting to feel like I'm crazy!!


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