early Pre-E signs - What to demand of Dr?

[jadwaits]

Today I am 24w5d pregnant with identical twin girls. (Finally after 6 years of infertility, 4 rounds of IVF and 3 losses, one at 21 weeks.)

During the last week, my feet and legs have gotten very swollen, I've gained 6 lbs in 6 days, and my blood pressure was reading a bit high (136/86). My urine didn't show any protein in it. My dr said this is likely early symptoms of Pre-E, which I'm not yet diagnosed with, and put me on home bedrest.

I go back to see him on Friday and wanted to know what to ask for.

I'm not sure what the 24h urine testing is that I keep reading about. While at the drs this week, they tested from me just peeing in a cup just once. Should I ask for the 24 hour test?

Should I ask for a platelet count? Should I buy a home BP monitor? What else?

I'm also now concerned about the health of my babies. One was measuring quite small on Tues. I didn't think much of it since there seems to be a large margin of error each week in the measurements (I already see an MFM once a week to monitor for twin to twin transfusion, which I don't seem to have). But after looking around this site, I see the IUGR can result from Pre-E. What monitoring of the babies should be done?

Is any of this under my control? Can I be doing anything to help with the symptoms and/or development of Pre-E?

Thanks for any advice you can give. I've already been on edge this whole pregnancy because of the 21 week loss of my son. I had a surgery at 11 weeks to clamp my cervix shut and have had to worry about all of the issues that twins sharing a placenta can cause. I wasn't expecting this new concern.

[Raposa]

At this point, the placentas have already formed, so any treatment is going to be to minimize the effect of symptoms while trying to go as long as possible to enable your babies to thrive. There's not a lot that pre-e really responds to, unfortunately. Rest can help some people to avoid blood pressure spikes and make things easier on your kidneys, but it won't stop the progression, just make it easier for your body to weather things for a while.

When you do a 24 hour urine, the doctor sends a jug home with you. You start in the morning and all the pee for 24 hours goes in the jug. Then you drop it off with the doctor. They might also take some blood when you drop the jug off so they can compare protein numbers between the urine and the bloodwork.

[mom29]

It sounds like your doctor is already watching you closely.

When you see the MFM are you weighed and is your blood pressure checked or are you jut going for ultrasounds?

Does the hospital you are going to deliver at have a nicu? If not, would you switch over to the MFM for delivery?

If your hospital does not have a nicu, I'd take a look at the nicu's available to you in your area and see if the one you prefer is where the MFM practices. I did not anticipate needing to deliver early during my last pregnancy and was taken by surprise at having to deliver at 33 weeks due to pre-e. AFTER I delivered, I found out another hospital in my area has private rooms for each baby in nicu and parents are welcome to stay 24/7 with their babies. That would have been so helpful! I pondered what I would do if we had another baby and after much thought decided I'd stick with the MFM at the hospital with the ward style nicu. If you really really like and trust your MFM that might mean more to you than a more family friendly nicu. Maybe you will get the best of both worlds.

Personally, I'd get a monitor to keep an eye on my bp at home.