Should I push for delivery?

[astrangelaw]

I have a history of pre-e with all three of my prior pregnancies. (2003 - delivered at 39 weeks, 2004 - delivered at 37 weeks, and 2005 - delivered at 36 weeks)

This pregnancy has gone fairly smoothly. I had a miscarriage prior to this pregnancy, May 2012. We are due March 15, 2013 (according to LMP and first ultrasound). I started having labile pressures around 28 weeks, and now, at almost 37 weeks, I am having rather good pressures because I have been on modified bed rest due to becoming extremely ill with that horrible stomach virus going around. I have not tested positive on a urine dipstick, and my 24 hour urine came back 180 last Monday. The doctor said my creatinine level was a tad high, but not alarming especially considering the illness I've had. He wants me to go to 39 weeks, and everything that I have read is once I hit 37 weeks, delivery is best - considering my history and my labile pressures.

I want the best for my baby and my health as well. Waiting until 39 weeks makes me a bit uncomfortable with my history, but I don't want to overreact. I was so much younger, and chasing three kids, I never understood the severity and seriousness of pre-eclampsia and HELLP. What do you ladies think?

[astrangelaw]

bump - anyone?

[alviarin]

Hi and welcome to the forums. I can definitely relate to your concerns, I also have a history of preeclampsia close to term.

During my third pregnancy last year I started out with chronic hypertension, and my OB said that she was comfortable waiting to induce at 38 weeks as long as everything stayed the same. However to plan for delivery at 37 weeks if pre-e struck again (ie my proteinura came up). My MFM recommended induction at 37-38 weeks based on my history of pre-e.

You could ask your doc about the HYPITAT study ("Hypertension and Pre-eclampsia Intervention Trial At Term") which found an improvement in maternal outcomes with induction at 37 weeks for hypertension or preeclampsia without a difference in fetal outcomes. And see what their opinion of the study results are.

You could also ask about a repeat 24 hour urine test this week/weekend to see if your protein levels are trending up. The tests are fairly cheap and a repeat might give you some (temporary) peace of mind or it might give more weight to delivering sooner. Did you happen to have a baseline 24 hour urine done in early pregnancy or before pregnancy to compare last weeks results to?

Are you monitoring your pressures at home? How often are your appointments now?

Also please take a look at our Signs and Symptoms page if you haven't already, and please don't hesitate to call your doc or head in to L&D if anything feels off.

[alexis]

I'm also a chronic, and my OB's plan was to wait for 39 as long as my pressures stayed below 140/90 (I was medicated). If my pressure rose above that point, regardless of whether it was superimposed PE or not, and I was past 37 weeks, we would deliver.

There doesn't seem to be consistent guidance on what to do in this situation. Some OBs routinely deliver at 37. Others, like mine, only deliver before 39 weeks with immediate concern (my OB was familiar with HYPITAT, and felt it applied... if my BP went up). However, my pressures weren't labile--they were consistent, though rising a bit towards the end.

[astrangelaw]

Well, when I went in my pressures were in 90s (bottom number) and didn't come down even after laying on left side. Still no protein. He's bringing me back Monday. I did find out he has to jump through some hoops with hospital policy to deliver me before 39, so I think he just needs one more appointment of HBP to justify delivery. He's keeping a close eye on me and knows my history. I feel much better after this last appointment. Thanks all!