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Can anyone point me to standard protocol for expectant mgmt

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Can anyone point me to standard protocol for expectant mgmt

Postby kaxy » Fri Sep 13, 2013 12:55 am

by kaxy (98 Posts), Fri Sep 13, 2013 12:55 am

I'm trying to find the recommendations/studies/etc. to see what the standard recommendation is for moms in my situation:

- preeclampsia at term with prior 2 births
- high blood pressure now at 36w with third child (had some 160s systolic and 103s diastolic, but not at the same time before going on labetelol)
- trace protein at last dipstick
- BP is currently in safe range with oral labetelol (120s-130s/70s-85s)

I had my second steroid injection today for the baby's lungs. Even though my BP is 'fine' now thanks to labetelol, what do we do with this? I'm clearly on the pre-e track, as far as I can tell.

Do we just try to get to 37w and induce, even if my BP is lower than 140/90 with meds? Or do we try to go longer?

I have a NST and appointment with my OB Monday morning. Just would like some perspective so I can have a more-informed discussion then. Thanks!
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
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Re: Can anyone point me to standard protocol for expectant m

Postby princess purr » Fri Sep 13, 2013 03:54 pm

by princess purr (1092 Posts), Fri Sep 13, 2013 03:54 pm

My doctor is doing my csection at 36 weeks in hopes to avoid PE all together. Are they having you do a 24 hour urine collection? I would think they would pull the plug at 37 weeks and induce, but every doctor is different.
Val (34) & Carlos (32)
Married: April 29th 2011
Veronica Rosina, 11/25/2004-11/27/2004
Born at 26.5 weeks (1 lb 4oz, 14 inches) because of severe preeclampsia (doc says I was on my way to HELLP but not there yet)
Nicholas Robert, 11/22/2013 7 lb 7oz 19.5 inches, born at 36 weeks (due to previous classical c-section) PE FREE!!!!!!
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Re: Can anyone point me to standard protocol for expectant m

Postby kaxy » Fri Sep 13, 2013 04:27 pm

by kaxy (98 Posts), Fri Sep 13, 2013 04:27 pm

I had bloodwork on the 11th/12th (it was the middle of the night) and they did some sort of ratio thing? Creatine ratio, is that it? I dunno. All my labs came back 'normal' at that time.

So my OB said we didn't need to do a 24 hour urine yet (she said this later in the day on the 12th) but maybe I'll do one next week? I'm not sure.

I guess I'll find out more on Monday.
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
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Posts: 98
Joined: Tue Jun 28, 2011 03:56 am

Re: Can anyone point me to standard protocol for expectant m

Postby princess purr » Fri Sep 13, 2013 04:32 pm

by princess purr (1092 Posts), Fri Sep 13, 2013 04:32 pm

With your history I don't see any point in you going past 37 weeks, especially if you are getting the shots for lung development.
Val (34) & Carlos (32)
Married: April 29th 2011
Veronica Rosina, 11/25/2004-11/27/2004
Born at 26.5 weeks (1 lb 4oz, 14 inches) because of severe preeclampsia (doc says I was on my way to HELLP but not there yet)
Nicholas Robert, 11/22/2013 7 lb 7oz 19.5 inches, born at 36 weeks (due to previous classical c-section) PE FREE!!!!!!
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Re: Can anyone point me to standard protocol for expectant m

Postby kaxy » Fri Sep 13, 2013 04:41 pm

by kaxy (98 Posts), Fri Sep 13, 2013 04:41 pm

I feel the same way. It's clear that this is in motion now, and it's a bummer that this is earlier than my other kids. I am comforted that I'm already 36w today and measuring right on, and that I should in theory be able to make it another week.

Guess I ought to pack a bag or something! :)
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
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Posts: 98
Joined: Tue Jun 28, 2011 03:56 am

Re: Can anyone point me to standard protocol for expectant m

Postby sam10 » Fri Sep 13, 2013 07:07 pm

by sam10 (1437 Posts), Fri Sep 13, 2013 07:07 pm

In my second pregnancy my BP started to rise (just a few spikes) around 34 weeks (protein was slightly up before), but I was never put on BP meds. My docs said if it got too high (threshold was 160/100 twice in 6 hours), they would deliver. And that's how it happened. BP got crazy pp and then I started the crazy dance of switching BP meds and dosages.
So, I would hope your doctor would not wait around too long at this point, since you are quite far along. I would ask what their game plan was. I am not sure there is a standard protocol for PE management, but let me dig up the Hypitat study for you.

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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Re: Can anyone point me to standard protocol for expectant m

Postby sam10 » Fri Sep 13, 2013 08:06 pm

by sam10 (1437 Posts), Fri Sep 13, 2013 08:06 pm

Here is the info on the HYPITAT study, which recommends delivery at 37 wiht even elevated pressures. Here is some related info.

similar post viewtopic.php?f=12&t=45037&p=350333&hilit=standard+treatment+for+PE&sid=bb6c30358838525ee45d38bdc26331f2#p350333

Check out Caryn's answer in this thread: viewtopic.php?f=12&t=45557&p=353603&hilit=hypitat&sid=8fe91cbac14b6db774ca61579a24440d#p353603

Here is the link to the study: http://www.ncbi.nlm.nih.gov/pubmed/19656558

I am a bit surprised that you are not doing a 24-hour urine collection, as it is still the standard for diagnosing PE.
~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/
sam10
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Posts: 1437
Joined: Sat Feb 20, 2010 12:04 am
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Re: Can anyone point me to standard protocol for expectant m

Postby kaxy » Fri Sep 13, 2013 09:01 pm

by kaxy (98 Posts), Fri Sep 13, 2013 09:01 pm

Thank you for those links! That's what I was trying to find. I knew I had seen similar things (or those things) before but I couldn't locate them.

I was a little surprised about not doing the 24 hour urine, too. When I asked, my OB said the creatine ratio done earlier that day was fine. I'll ask about it again on Monday.

Even if my BP is ok, it's only ok on meds so that's still technically hypertension right? Especially with the lung steroids now in place, and that I'm reasonably far along, and my history, I really can't think of a reason to stay pregnant past 37w. Hopefully my OB agrees, and hopefully my body will be favorable for induction.
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
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Posts: 98
Joined: Tue Jun 28, 2011 03:56 am

Re: Can anyone point me to standard protocol for expectant m

Postby sam10 » Fri Sep 13, 2013 09:08 pm

by sam10 (1437 Posts), Fri Sep 13, 2013 09:08 pm

You can always refer to the HYPITAT study if your doc pushes you to remain pregnant beyond 37 weeks. And yes, the medication is controlling your BP, but without it it would be too high. So, even if you don't have any protein in your urine, you have elevated pressures (PIH). For this alone you can refer to the HYPITAT study. And yes, please ask for a 24-hour urine collection. It does not cost much and you have the pleasure of collecting it, so not sure why your doc is hesitating to send you home with a jug.
~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/
sam10
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Posts: 1437
Joined: Sat Feb 20, 2010 12:04 am
Location: Boston, MA

Re: Can anyone point me to standard protocol for expectant m

Postby kaxy » Mon Sep 16, 2013 10:49 am

by kaxy (98 Posts), Mon Sep 16, 2013 10:49 am

Thought I'd update here --

Had a NST and appointment today. All is well on the NST and my BP was fine at the office (thanks to labetelol no doubt). Trace of protein still.

I go back on Thursday (36w6d) for a NST, ultrasound and appointment. I guess there's a chance my OB will want me to just stay pregnant rather than get going on the induction, it will depend on how those tests Thursday are going and how I'm doing. I totally spaced the HYPITAT study today but I will print it and bring it with me on Thursday.

I think she wants the baby to just keep growing and developing...but that can start to slow down now so I dunno. Hopefully I'll just go into labor Friday anyway.

Are there moms on here who are on BP meds and also stay pregnant past 37w?
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
Registered User
 
Posts: 98
Joined: Tue Jun 28, 2011 03:56 am

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