Question regarding "atypical" Pre-E

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Question regarding "atypical" Pre-E

Postby danaecgross » Tue Jun 19, 2012 04:19 pm

Sooooooo.....
My last pregnancy had low BPs at first appt, 100/60 on average and slowly rose to 130/80 by 31 weeks. At 32 weeks, it was confirmed I had proteinuria but kept getting the run-around on whether or not I had preeclampsia since my BPs were not hypertensive. By 35 weeks, my daughter was IUGR (growth rate over 3 week period was less than 3rd percentile) and proteinuria went up, even though BPs were still around 110-120/70-80. I was diagnosed with severe preeclampsia (according to the hospital records) even though it seemed very atypical! I have some unilateral renal scarring, but kidney function is not impaired during pregnancy or post pregnancy. They did a baseline during that pregnancy and protein was under 100mg so any increase was considered significant.

Fast forward to THIS PREGNANCY... Has been pretty identical except this baby is more average sized than my last (always kind of small but not IUGR until that 35 week ultrasound). My BP at my first appt (4 weeks to confirm + HPT) was 100/60. Prior to pregnancy my BP was around 110/70. BP stayed around 100/60 until my 16 week appt when I was back to 110/70. They also did a 24hour and it came back under 100mg. I am now 22w5d and have had a few readings each day around 130/80. I am somewhat nervous since I delivered with these pressure readings, even though my BPs are completely normal. My new Dr office doesn't seem to do anything until BPs are hypertensive and/or I dip + for protein. I never had a + spot protein with my last pregnancy because I have polyuria and the urine is always diluted. The only reason they requested a 24 hour urine before was because the protein/creatinine ratio was above normal...my spot urine was always negative.

I read that BPs were suppose to stay normal in the 1st trimester, drop in the 2nd, and rise back to normal in the 3rd. I also read that the body/placenta/baby adjust to the 1st trimester BPs and any significant increase might create a problem. Maybe I am understanding this wrong, I'm somewhat confused! Is it possible that my renal scarring has left me "sensitive" to any BP increase and I am more likely to spill protein, despite normal (although elevated) BPs? I'm not sure how to approach my Dr about this, especially because the clinic seems somewhat "lazy" already. I had to request a baseline 24hour and HELLP labs at 16 weeks! Part of the reason I am nervous too, is because my daughter pretty much stopped growing after that 32 week ultrasound and preeclampsia diagnosis. I don't have normal symptoms so I am unsure of how my body might be reacting! Maybe I'm just being anxious but any input on my questions is greatly appreciated.

Sorry if I was all over the place! :oops:
Danae
DD born 06/13/10 at 35 weeks, 4lbs 13oz, IUGR & Preeclampsia
PREGNANT AGAIN! EDD 10/18/12
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Re: Question regarding "atypical" Pre-E

Postby MomTimesThree » Tue Jun 19, 2012 06:17 pm

I wonder if you framed your desires for your doctor under the guise of worry from what happened during your last pregnancy- might be more receptive to that reasoning than the real, "um... symptoms are looking so similar and you're not doing anything" :) And request a 24hr and PIH labs. Hopefully everything comes back right where it should... at the same time, your peace of mind is worth it. With a history of IUGR I'd also be wondering about closer u/s monitoring at least every 4 weeks (20w, 24w, 32w) if not doing so already...

We also have an atypical presentation and it's definitely frustrating since it seems to leave some providers not sure of what to do- we're thankful that we've had providers that unsure of what to do just throw the kitchen sink at us. :)
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: Question regarding "atypical" Pre-E

Postby caryn » Sat Jun 30, 2012 08:22 pm

Danae, I'm really not sure - I don't know much about how that kind of renal scarring might affect proteinuria output or endothelial health.

How are your pressures this week? Did you get an opportunity to ask your docs about monitoring? In your shoes I think I'd want a 24-hour every month or so, just because as you say your urine is too dilute to get an accurate dip in the office.
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)
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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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Re: Question regarding "atypical" Pre-E

Postby danaecgross » Tue Jul 24, 2012 12:59 am

Hey ladies!

I was out of town for a few weeks and haven't been on in awhile. It was fun, but I've realized that being close to 28 weeks REALLY does limit what I can and can't do! I'm glad to be home for good until baby boy arrives :D

My average pressures in my left arm are between 110-120/75-80. Sometimes I get one as low as 100/70 and other times they are 130/85. I have another appt this Thursday for the glucose test so I'll get a chance to talk to the Dr that seems most proactive in this practice/office.

Caryn - I asked the Dr at my last appt about the renal scarring affecting preeclampsia and he said that it would have NO factor in preeclampsia....HMMMMM.... every Dr is so different! I was looking through my paperwork from the last delivery and they had stated "superimposed severe preeclampsia" and it is IMPOSSIBLE to be superimposed from hypertension (seeing I never really had a hypertensive pressure reading before).

I've had a few other symptoms (that may just be normal pregnancy symptoms but I don't know!) so I am going to talk with them about these issues... I have had some spotting after my flight out of town. I've had this upper abdominal pain that I can only explain by saying it feels like something is tearing inside because it burns so bad. It usually goes away during the morning and early afternoon but seems to come on every evening and into the night. It probably is just my body growing but I know it's something worth mentioning, just in case. ALSO, my pelvic bone aches, as if I have been riding a bike for hours on end. I don't remember these symptoms with my last pregnancy so everything feels weird.

That's it for now... I'm hoping to get some more information at my next appt!
Danae
DD born 06/13/10 at 35 weeks, 4lbs 13oz, IUGR & Preeclampsia
PREGNANT AGAIN! EDD 10/18/12
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Re: Question regarding "atypical" Pre-E

Postby lemons » Tue Jul 24, 2012 02:41 pm

Danaecgross- I was just reading the "active" posts and saw your latest post. I am glad that you are still feeling okay and that your pressures have been staying steady. However, I am concerned about the spotting that you mention- As far as I know, ANY bleeding after 20 weeks should be immediately reported to your OB. That includes spotting. The OB will want to know, at a minimum: how much, was it bright red or dark red/brown, did you recently have intercourse (and probably much more)! One of the serious complications related to high blood pressures (and I know that your BPs are not hypertensive, but you started with a low baseline) is placental abruption, where the placenta prematurely separates from the uterine wall. Worse case scenario is that baby doesn't have adequate blood flow and dies and/or mom can hemorrhage uncontrollably.

Another thing that really concerns me it the pain that you are reporting. Upper right quadrant (URQ) pain is a serious sign of HELLP syndrome. Heartburn is a frequent symptom of pregnancy but it is often confused with the URQ pain of worsening HELLP. So, I am really concerned for you. Again, these are worse case, but please call your OB to see if he/she wants you to come in sooner than Thursday!
Diana, happily married since 2007.
Miscarriage at 10 weeks (June 2009).
DD at 30+0 weeks weighing 2lbs 9oz (October 2010) due to PE and IUGR. Today, a happy and healthy toddler.
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Re: Question regarding "atypical" Pre-E

Postby sam10 » Tue Jul 24, 2012 03:00 pm

I agree with lemons that some of your symptoms you are describing sound concerning (especially the spotting and/bleeding and the upper right quadrant pain) and you might want to check with your doctor before Thu.
I wonder if you have what is called Symphysis Pubis Dysfunction (but I am not a doc), that causes your pelvic pain. Ligaments and joints loosen during pregnancy, to prepare for birth, and can cause this type of pain. In any event, please mention this to your doctor, so you can get a proper diagnosis of what is causing this pain.
~Julija (40)
MC 3/2009 and 3/2011
Henry (1/1/2010-1/7/2010) - forever loved and missed; severe PE with Hellp; partial placental abruption, classical c-section at 25.6 weeks
Matilda (Nov. 2012, born at 35.4 weeks) - severe PE


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Re: Question regarding "atypical" Pre-E

Postby tree » Wed Jul 25, 2012 09:59 am

I was also diagnosed with HELLP/Pre-E last pregnancy without ever having diagnostically high blood pressures. It can happen, and you can get sick pretty fast (or not). I agree with the previous posters recommending that you get the upper right quadrant pain checked out soon. The blood work is simple, cheap, and fast, and it will let you know if you have any reason to worry. I had the pain before my BP shot up. The bleeding is probably also worth a phone call to your doctor. They should be watching you pretty closely this time, and they can only do that effectively if you report your symptoms. I wasn't good about that, and it caused me to get really sick. I am now a "better safe than sorry" convert.
I hope it is nothing to worry about! Many PE symptoms can be normal pregnancy stuff, and it is important to get the lab results so that you don't have to guess.
Daughter born April 2009 at 35 weeks due to Class 1 HELLP
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Re: Question regarding "atypical" Pre-E

Postby danaecgross » Thu Jul 26, 2012 11:07 am

Went to the dr today!

My BP was 118/74, which is elevated but still good! I told my dr of all my symptoms and after a urine sample and pelvic check, everything came seemed normal. I even reduced my normal water intake so my urine would not be diluted!

They did a glucose test today... I failed :(
They wanted glucose under 140 and hemoglobin over 11. Mine were 163 and 10.6...
Anyone know what this means? Obviously I am going to do the 3hr test now, next week in fact. Not sure how GD might affect the pregnancy though... I'll be doing a lot of research today!!!
Danae
DD born 06/13/10 at 35 weeks, 4lbs 13oz, IUGR & Preeclampsia
PREGNANT AGAIN! EDD 10/18/12
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Re: Question regarding "atypical" Pre-E

Postby alviarin » Sun Jul 29, 2012 04:18 pm

I failed the one hour bad enough this time around that I was diagnosed with gestational diabetes. I've had to change my diet somewhat but that seems to be keeping my glucose levels in check for now.

One study found treatment of even mild GD lowered pregnancy risks: http://www.preeclampsia.org/forum/viewt ... 50&p=35668

Good luck on your 3 hour test!
Hypothyroid mom to Connor and Claire
(severe pre-e at 38 weeks & "mild" pre-e at 37 weeks)
& baby Annabelle
(chronic HTN & GD, superimposed pre-e @34 weeks, induction @37 weeks)
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Re: Question regarding "atypical" Pre-E

Postby danaecgross » Mon Aug 06, 2012 08:59 am

I had my 3 hour test and passed THANK GOD! I am now 29 weeks. I ended up having what looked like "bloody show" a week ago but after getting checked out, it ended up being nothing (or at least not preterm labor). I'm not sure what caused it but unless it happens again, I'll just chalk it up to being overly active that day!

My BPs have still been somewhat consistent, with only a slight increase. They now range from 115/75-130/85. I wish I knew how my BPs progressed last pregnancy, but in all reality, I will still feel like a ticking time bomb until that 31/32 week mark where I got diagnosed last time. I have an appt this week right at 30 weeks and an ultrasound at 32 weeks so we'll just have to wait and see what happens! At least now I'm on every other week appts!
Danae
DD born 06/13/10 at 35 weeks, 4lbs 13oz, IUGR & Preeclampsia
PREGNANT AGAIN! EDD 10/18/12
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