BP elevated and doing 24 HR... advice please?

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BP elevated and doing 24 HR... advice please?

Postby danaecgross » Thu Sep 06, 2012 07:14 am

So I am officially 34 weeks today! Hooray!

I had an appt yesterday with an ultrasound to check his position and growth. Unlike my last pregnancy (where my LO measured 14 days behind upon delivery), this baby is measuring 11 days ahead! I'm glad he's growing and can't believe he is already bigger than my last baby was at birth.

At my initial appt at 6 weeks, my BP was 100/60 and yesterday it was 136/92. They had me lay down and retook my BP while laying down.... yeah, I know, it's not accurate! Of course it was lower at 122/76. They said "oh much better!" and was going to send me on my way without a 24 hour urine! My in office dipstick was negative, but in my last pregnancy, I ended up with polyuria and actually produced over 6 liters so my samples were always too dilute for a dip to pick up protein. I requested a 24 hour urine anyway especially since I delivered at 35 weeks last pregnancy. I think they are annoyed with my persistence but I'm over caring what they think. The nurse even asked me if I was trying to have a repeat preterm delivery! Hmmmmm, of course not lady. Not on purpose!

So now that I am sitting here doing a 24 hour urine. It has me wondering what outcomes I can expect with abnormal results. I almost feel like a 24 hour urine is pointless, other than to recognize that there IS/ISN'T protein. I don't believe it is high enough for delivery, but I DO think there is SOME protein, maybe even over the diagnostic 300mg. So if it DOES come back with protein over the diagnostic criteria, what can I expect from my doctor? How far along in my pregnancy would they let me go? Do Drs give steroid shots for all preeclamptics before 35 weeks (I had steroid shots last time at 31 weeks)? My BP isn't incredibly high consistently, and baby is obviously doing fairly well with growth. I'm usually hyper vigilant with my care and always want to know what the labs say (other than go by symptoms) yet right now I feel like it doesn't matter because if I was sick or it was bad, I would have more symptoms. Does that make sense? The only thing about my last pregnancy is that I was spilling protein before my BP got really high. In fact, I think the highest BP reading I had then was 135/85 and that was only on a couple of occasions. Even when I spilled over 650mgs, my BP was 115/75. I feel educated about preeclampsia, but not on how to deal with it and the drs!

So, I guess I am wondering what to expect if my protein DOES come back elevated, even if only slightly. I turn my 24 hour urine in on Friday morning and I believe they are going to take blood also. My next appt is Wednesday and I think they'll discuss my results then. I'd like to be prepared for that appt on how to discuss the results and what to do if they are in fact abnormal. THANKS!
Danae
DD born 06/13/10 at 35 weeks, 4lbs 13oz, IUGR & Preeclampsia
PREGNANT AGAIN! EDD 10/18/12
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Re: BP elevated and doing 24 HR... advice please?

Postby angieb » Thu Sep 06, 2012 10:34 am

Most doctors don't do steroids after 32-33 weeks or so. You can always ask, but a lot don't do them after that as they are not thought to be as effective, later.

Are you having NST's or BPP's at all? If your protein comes back high, maybe even if it doesn't, I would ask to do those to monitor the baby since your blood pressure is pretty high for you. I also don't think it would be a bad idea to keep an eye on your blood pressure at home. If it's consistently high, call them.
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Re: BP elevated and doing 24 HR... advice please?

Postby caryn » Thu Sep 06, 2012 08:19 pm

The good news: elevated proteinuria isn't a delivery indicator. It is an indication that you're preeclamptic if it's coupled to two readings of either of 140/90 at least 6 hours apart. They won't deliver just for proteinuria - it just means your kidneys are being temporarily damaged by the chemicals released by the placenta. But the damage is supposed to be entirely reversible so they don't really worry about it. Delivery decisions are usually triggered by symptoms like uncontrollable sustained hypertension, fetal indicators of stress like heartrate dips, reports of a bad headache and visual disturbances coupled to hyperreflexia, bad labs...

If your proteinuria goes up before hypertension sets in, that's *usually* because of a little underlying kidney damage - and as I understand things, that's often ascribed to a childhood illness where you had a very high fever. (This is actually one reason vaccines for childhood viruses like measles enhance public health!) Preeclampsia doesn't generally cause lasting kidney damage itself - once your body mops up the chemicals causing the problem, it repairs the damage to the endothelium.

For an anecdote: I hit +17,000 mg/24h in my pregnancy with Oscar, when the diagnostic line is 300mg/24h. We didn't deliver for crazy high proteinuria, but did deliver a few days later when he started having decels.
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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