Concerned about dx/monitoring

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Concerned about dx/monitoring

Postby binkin » Tue Apr 23, 2013 11:21 am

Hi there! I am new to this forum though I have read some of the previous threads. I know someone who posts here who suggested this might be a good place to ask some questions I have.

I am pregnant for the first time. 3 weeks ago now, my BP was high at a midwife visit; I believe it was 130/94 or thereabouts, even when they rechecked it. They ordered lab work that looked fine (platelets, uric acid, protein:creatinine ratio). I was sent to triage, where they monitored my BP, which looked fine there. I was reclining that entire time, though.

2 weeks ago, my BP was still elevated at the office visit, and they ordered more labs and a 24 hour urine. The labs were fine again, but the urine collection showed 328 and they admitted me overnight. They had me redo the 24 hour urine and monitred my BP, again with me lying down or reclined the whole time. My BP when reclining is in the 110-120/70-80 range, which is apparently unconcerning. The second urine collection came back with 220, so they said I am in the clear and do not have pre-e. They diagnosed PIH.

Last week, BP was again elevated at the midwife. 130/93 IIRC. In office dip was clear. I am concerned about monitoring. Currently I do 2x/week NSTs and BP checks. I asked at what point we would be concerned, since I have reservations about redoing the urine catch and getting a 'good' number and going with that. They said, BP of like 140/95 or greater, headaches WORSE than what I have, vision disturbances, etc.

So, the NSTs look fine.
BP is high at home if I do anything at all (like microwave a mug of water and walk back to the couch), but goes down if I lie down. I am not on bed rest.
I have a consult with MFM tomorrow and I'd like to know what I should ask. I am not feeling a great deal of confidence in the lack of diagnosis right now. I have no more lab work scheduled at present. I thought of calling this morning as I have had a bad headache since last night; BP checked while NOT Resting was 122/97 but then after rest it has gone down to 114/83. I feel like every time I call or ask I get brushed off, and I can't decide whether I should push harder for labs again or just trust that the midwives are making the right calls. I feel almost like we are 'faking' good numbers by retesting urine and by taking BP while reclining when I am in the hospital, whereas that is not what I do at home.

Any advice?
binkin
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Re: Concerned about dx/monitoring

Postby sam10 » Tue Apr 23, 2013 01:59 pm

Hello and welcome. I am glad that your bloodwork and urine is being re-checked. The thing with PE is that it can change suddenly. It does not mean that if you are in the clear now with bloodwork and urine, it will be so tomorrow. So re-checking is key. It can change very quickly.
It happens to some of us that with rest BP is better than when moving around, which is why for some bedrest can be beneficial. I am also glad that you are going to see an MFM. The questions I'd ask is how your monitoring will look like for the remainder of your pregnancy, if you will be put on BP medications, if you should take your BP at home and how often, what your call-in BP numbers are (at what point do you need to call the doc), who will be monitoring you (midwife, ob or MFM or only MFM), at what point you'd be hospitalized,if you need to go on bedrest, what additional checks will be done, how many NSTs, at what point they'd deliver). You can also ask about the HYPITAT study (here is a link to an older post about this : viewtopic.php?f=12&t=45571&p=353670&hilit=hypitat#p353670)

Here is also a link to the signs and symptoms. Please make sure to call your doc and/or be seen if you experience any of these:
http://www.preeclampsia.org/signs-and-symptoms

Let us know how it goes :-)
~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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Re: Concerned about dx/monitoring

Postby angieb » Wed Apr 24, 2013 09:17 am

Welcome!

For what it's worth, my MFM's call in rules for me were:
-blood pressure at/over 140/90 (my bp is normally around 110/60-70's)
-bad headache that won't go away with tylenol
-upper right quadrant pain (pain around your ribcage/bra strap/shoulder blade/etc.)
-gain 5 lbs or more in a day or something like that (indication of severe swelling)

I would tell you to absolutely call in about any bad headaches that don't go away with tylenol.

Protein in the urine of over 300 mg plus 2 readings of 140/90 or higher is considered diagnostic for pre-e, officially, although in the 200's is not super alarmingly high, women can spill it in the thousands and not deliver yet, but still, I would want them watching closely. Someone could have a 24 hr of 500 mg then 200 then 100 then 900...it doesn't necessarily progress up or down, but when you are spilling protein it is a sign your kidneys may be getting stressed a bit. They definitely should be watching it, I would personally request weekly or maybe every 2 wks unless symptoms suddenly get much worse. They don't usually deliver urgently for only spilling protein or protein levels, but it does give part of the picture on how your body is doing. And in-office tests stink at measuring protein, I had a clear dip test, not even a trace of protein, and went home and did a 24 hour urine that came back at 700 mg of protein.

Hopefully the MFM will give you more clear answers. Sam10 already gave you great advice. I would absolutely request a call in bp number, weekly-ish labs, and 2x NST's, PLUS make sure they do a check on the baby's growth (ask for a growth u/s if you haven't had one recently), because preeclampsia can often be associated with growth restriction.

Good luck! Let us know how the MFM apptmt goes and if you have any more questions.
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/
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Re: Concerned about dx/monitoring

Postby binkin » Wed Apr 24, 2013 10:31 pm

Thank you; some good advice here.

I ended up calling and going in to triage yesterday, and MFM admitted me. I am doing another 24 hour urine collection now, and unsure if I will be in the hospital now until delivery or if I'll get to go home. I feel I at least have a better idea of what they're watching for, and bloodwork still looked good last night. My BP stays down if I am in bed, so I am hopeful about that.

I do think they intend to induce at 37 weeks, and I'm fine with that based on the evidence in favor of doing so. I will try to update!

Thank you again.
binkin
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Re: Concerned about dx/monitoring

Postby MomTimesThree » Thu Apr 25, 2013 07:48 am

While I'm sorry your admitted, sometimes its the best safest place to be. I hope you're able (if safe) to go home and either way have a plan in place you feel comfortable with.

Keep posted when you can!
Lauren
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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