Why not 37?!?

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Why not 37?!?

Postby Ecrc84 » Fri Aug 03, 2012 01:48 pm

2nd pregnancy, had son via emergency at 32 wks 4 yrs ago yesterday due to severe pre e. Am currently 35 wk 4 days and diagnosed mild pre e at 26 wks. Got steroid shots at 26 wks. Been on modified bedrest. Bps okay on 100mg/2x a day of labetalol. Protein fluctuating between 220-500 weekly for 8 weeks. All bloodwork normal except last 2 weeks my uric acid was 6.4 and 6.3. So, I get biweekly nst and have seen specialist mfm at 32 and 34 wks. My dr told me at 26 weeks we would deliver at 35 weeks today then, 2 weeks ago she said we would do c-section Aug 15th at 37 weeks. Well I was in yesterday and she is now saying 38 wks because the specialist suggested it and she said she can't go against the specialist. Okay.... why can't she?! I have no more appts with specialist and she isn't my dr or even at hosp I am delivering at. I understand 38 wks is further, but due to my history and current symptoms, I would feel better doing it at 37 wks instead of taking chances at getting worse as time goes on. Any advice?! I voiced my concern and wishes very clearly and she said she will try to talk to mfm about it.
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Re: Why not 37?!?

Postby caryn » Fri Aug 03, 2012 11:26 pm

Our Experts say: This may be resolved tomorrow at 37 weeks gestation when a diagnosis of mild gestational hypertension-preeclampsia is best served by delivery, not carrying the pregnancy further (ACOG recommendations from its Task Force on Hypertensive Complications of Pregnancy).

I'd print out that link and ask! The trial in question is HYPITAT and as I understand it the consensus shows that induction at 37 weeks is medically indicated for women with gestational hypertension alone - and you've got proteinuria on top of that.
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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Re: Why not 37?!?

Postby Ecrc84 » Sat Aug 04, 2012 08:12 am

I mentioned the HYPITAT to her.... she was clueless saying she has never heard of it. Unfortunately I only have smartphone and am on bedrest so I can't print anything off to show her. I am just frustrated because I how how this disease goes, and I do not want to get to the point of being severe like I was with my son.
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Re: Why not 37?!?

Postby amberstrika » Mon Aug 06, 2012 09:44 pm

This isn't the most ethical thing to do, but you could always do what I did in your shoes with my second pregnancy. I was supposed to have a scheduled section at 37 weeks, when a random High Risk at the hospital for no reason what so ever decided that I should wait until 39. Ummm.. I had severe HELLP and preeclampsia with my first at 36 weeks and it almost ended very badly. With my second, by the time I hit 37 weeks my protein in my urine was in the 2000's!!! and my BP was around 170/100. So yeah.. something was definitely wrong. After the high risk told my OB about waiting, I put my foot down and went straight to L&D at my hospital complaining of a severe head ache and seeing extreme flashing lights (none of which was true). The next day my OB delivered my baby. I wasn't going to sit around and wait for it to get worse. The specialist didn't know a thing about my history. My daughter was perfectly healthy and weighed in at 7 lbs 6oz. She was great from day 1. No problems breathing or with jaundice. I have no idea what was with the specialist deciding I should wait, but I wasn't having any of it. Hope this helps!
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Re: Why not 37?!?

Postby tree » Mon Aug 06, 2012 10:46 pm

I would ask her to look up the HYPITAT study and the newest ACOG guidelines and tell you how she thinks they apply in your case. From a safe internet distance, it seems like a no-brainer to deliver you at 37 weeks (as a non-doctor). However, the experts are highly trained and highly knowledgable about your case. They aren't always right, but they may know something that we don't. That said, they had better know about the HYPITAT study. I would be nervous dealing with a doc who didn't know about it. You could also ask for a consult with a different MFM. It is okay to ask your doc to help you interpret or filter something you learned about online or from a friend. That has become a large part of their job, and this is a reasonable thing to ask about.
I understand that desperate times call for desperate measures, but I would not be comfortable lying about my symptoms. Things are bad enough for delivery already. Challenging your doctor is really hard, but it could be very important for your health and more effective. I would try reminding her just how bad things got last time. You would have to be nuts not to worry about that happening again. You said your labs were varying - are they generally trending in a bad direction? That could be a strong argument in favor of delivery.

Hang in there!
Daughter born April 2009 at 35 weeks due to Class 1 HELLP
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Re: Why not 37?!?

Postby amberstrika » Tue Aug 07, 2012 03:53 am

It's true about lying being a veeeeery sketchy, unethical thing to do. It was a very bad thing to do, but the right choice for me. As many of us know, there are TONS of occasions in which we are not taken seriously and things take a turn for the worse. I believe with all my heart that I avoided HELLP a second time by checking myself in to the hospital. They would never have gone ahead and given me a c-section the next if my lab work had not come back as being dangerous. However, without me saying that I was having text book symptoms no one seemed to be willing to make the final call. I did what I felt was best for myself and my baby. After the fact, my OB agreed. My favorite OB, the one who did the section, but NOT the one who decided to push it back, looked over my chart and was upset that the decision had been made by her colleague to push me back. With having had severe Preeclampsia, HELLP, pulmonary edema, pneumonia all at once with my first baby, in addition to the over 2000 level protein readings I currently had, coupled with BP that was quite high, there was no reason that I should have ever been sent home with instructions to wait it out.

I suppose my personal advice would be to not lie, but make sure you do whatever you need to do to make sure your symptoms and health are taken very seriously. If you don't feel comfortable waiting, you do what you need to do to be taken seriously. There are women here on the boards who have been neglected and ended up having eclamptic seizures are organ failure that could have been prevented. Doing what I did my baby was safely delivered, I was immediately given a mag drip and monitored closely. The difference between this last pregnancy's outcome and my first was night and day. This time I didn't have to miss my baby's first month of life spending it in intensive care.
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Re: Why not 37?!?

Postby blythe » Wed Aug 08, 2012 10:26 pm

How are you today? Have you gotten any more clarification about why not deliver you at 37 weeks - or a second or third opinion?

In your shoes I'd talk with your doctor again about your symptoms and concerns and history, and get your doctor to look at that Expert quote that Caryn linked and the HYPITAT study. Here is a link to our medical board, top doctors and researchers who specialize in hypertensive pregnancies, and who contribute to our "Ask the Experts"
http://www.preeclampsia.org/about-us/me ... sory-board

Just an extra comment from me as admin: I understand doing what you think is necessary to advocate for your health and your baby's health, but I'll stress being honest. Your docs need the most accurate information to give you the best care. Inaccurate information could get you the results you want, but could also lead to incorrect treatments. Also, if you doctors think you aren't being honest with them they might discount anything else that you tell them - which could also negatively impact your care. I'll be very clear that I'm glad for anything that gets a good outcome for mom and baby, and I'm not second-guessing anyone's choices, but I'd really caution against anything other than honesty going forward. Good luck and let us know how you are!
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
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Re: Why not 37?!?

Postby Ecrc84 » Sat Aug 11, 2012 07:34 am

My Dr consulted the 3 mfm specislists she referred me too. They all decided waiting to 38 weeks is best, they don't feel as though the same severity will happen again with me.... so, i have 10 days to go. Still doing two nst a week and weekly bloodwork and 24 hr urines. She said if anything shows up wacky on my results Thurs then I will be admitted that day. So... heres hoping the next ten days are uneventful!
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Re: Why not 37?!?

Postby sam10 » Sat Aug 11, 2012 07:59 am

Keeping my fingers crossed for an uneventful home-stretch. Will be thinking of you.
~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


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/
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