Wife just diagnosed with PE, what to do?

[tooleyg]

Last night our midwife took a high BP reading (180/114) on my wife, and she spilled protein in her urine. She has some swelling of her hands and feet, but no dizziness or seeing spots like you would expect from that high of a BP. We are 35 weeks along in our first pregnancy and up until now everything was going great. We see the midwife again on Friday (3 days later) to verify the high BP reading, and get some lab tests if it’s still high.

We were hoping to have a natural birth at home, but it looks like things have changed. From what I have found on the web it sounds like most doctors would like to induce sooner rather than later.

If the tests on Friday confirm PE, what steps can my wife and I take to reduce the effects, and help her deliver naturally? Any advice would be appreciated. Thank you.

[fiona]

Hello and welcome,

are you certain her BP was 180/114? A diagnosis of pe is made by two BP readings of 140/90 (or higher) taken 6 hours apart plus 300mg of protein or higher in a 24 hour urine test.

My expectations (from experience, not medical training) would have been to send your wife into L&D immediately. 180/114 is an incredibly high reading (my OB wanted me in hospital if I hit 160/106) and many doctors would deliver - especially so close to term.

Personally, I wouldn't wait until Friday - I would take her in now. Preeclampsia can develop extremely fast - in a matter of hours - and a BP at that level scares me.

The only cure for pe is delivery - lucklily your wife is at a very good place should that be necessary, but I am afraid the birth experience is unlikely to be the one you were both hoping for. What's important now is that your wife and baby are safe - preeclampsia is not a wait and see kind of disease. I wouldn't rest easy until her BP was taken again.

[laura]

Tooley,
I am so sorry but I have to agree with Fiona. If that pressure is accurate, it puts her at a greatly increased risk of having a seizure, stroke, or other serious nervous system event. Many, many, many doctors have not only admitted women with pressures lower than your wife's, they've given them anticonvulsants to prevent them from developing eclampsia.

You know, I'm really worried about your wife's blood pressure, so I'm going to send your post to one of our medical board doctors so you can get another opinion, so stay tuned, ok?

Hang in there. This stuff can be scary, but you guys can do this!

[catherine]

I really have to agree with Fiona, I went to the hospital at 35 weeks and 4 days with some symptoms of right upper quadrant pain and a big headache. My BP in L&D triage was 176/116. I delivered my baby 6 hours later and then went on to experience several very unpleasant complications associated with severe preeclampsia. Your wife's BP ALONE is at a very high level (the definiton of severe preeclampsia includes proteinuria with BPs at 160/110 or higher). I think you need to give serious consideration to going into L&D and having her current condition quantitatively evaluated. It would be very important to know if her BP is in that range right now, how much protein is she spilling (usually have to do a collection and then assay), whether or not the elevated blood pressures are negatively impacting her health or that of your baby. Usually, that might involve a blood draw for her to check her platelets and liver enzymes, and possibly an NST or BPP to check on the baby. None of these tests are too unpleasantly invasive and all could provide the assurance you need.

Happily, my daughter and I came away from my preeclampsia and HELLP experience unscarred. She had a little bit of a rough start and was in NICU for a couple of days, but after that she has done well, we even managed to establish an excellent nursing relationship that lasted 16-17 months.

Please don't wait until Friday. It can't do any damage to check your wife's condition today, and it might just save you from some problems down the line.

[ozierja]

One good thing is that 35 weeks is a good place to be if you do have to deliver!

[tooleyg]

Thank you for all of your responses. Her BP was tested again today and it is lower at 159/90. Still not in a good range. She has not experienced any of the effects typically associated with such a high BP, not to say nothing is wrong. We are montering the BP and other symptoms. The urine test and other BPs will be taken to confirm the PE.

Another question I have, is what would be expected with a 35 week baby? Would she need to be in the NICU for sometime? All tests up to this point suggest she is growing correctly and is healthy. How much development happens in the last 5 weeks?

[ozierja]

By now, mostly just growing and gaining weight is what is happening. This resource was great for me as to what to expect: http://www.pregnancyguideonline.com/
Of course everyone is different but in general, this is kind of how it goes week-by-week.

[deerhart]

most of the development done (according to the books) is weight gain and lungs.

My youngest was born at 36 weeks exactly. He spent 4 days in the special care until (3 on o2 24 hours off) and was released. He was on O2 because his lungs were in transition still (mature but still wet)He's had little to no problems since (hernia repair that was all).

If your child's lungs are mature, they are less likely to spend significant time in the NICU, baring other problems (low birth weight etc..). My son was 6lbs 12oz at 36 weeks (his big brother who I was sick with much longer was 5lbs 10oz, but had only grown an estimated 1lb the last 4 weeks I was pregnant which was 2-4 lbs too few)

[catherine]

I can answer this one as all of mine have been born at just about 35 weeks. If dealing with a healthy baby coming from a healthy mom you have a reasonable expectation of the baby doing really well. In the case of two of mine, they were "take homes". They had no reason not to be with me while in the hospital, although my youngest needed a little observation time for low blood sugar at delivery (born in the middle of the night after a long day not intended to involve birth). They were on the small side (5 lbs) which is the normal size for this gestation, and needed no support for breathing or eating. My middle child had a rougher start, probably directly caused by the preeclampsia, and consequently needed ventilator support and lung surfactant and some other medical interventions during her first few days of life. After that, she took off running. Developmentally you are pretty much right there. Sometimes there may be inital problems with eating, remembering to breath, and maintaining body temperature but they are usually rapidly resolved.

Umn, I hate to sound like a nag, but while the monitoring of BP may be reassuring to you, the liver enzymes and platelet count (which are very important) cannot be evaluated without the laboratory tests (blood draw). For that alone you should consider going to L&D, just her BP and the gestational age of the pregnancy will prompt these from the staff there. The information from this kind of test can have very important ramifications, not everyone "feels" the pain associated with incipient liver failure, and lowered platelets could put your wife at risk for hemorrage. I'm sure that your wife is very concerned about the baby and perhaps a little bit about "compromising" with respect to her delivery plans. I know I would be if I were in her situation, I just thought I had a little bit of food poisioning when I went to the hospital.... but sometimes the unexpected and unplanned for happens.

[youtan]

I just want to repeat what the others have said - after having gone through 2 scary pregnancies - I want to encourage you to please have her seen right away. 159/90 is still very high. In my case (and I was having no other problems, not even protein) - my OB sent me straight to the hospital - they drove me immediately, with a BP of 165/92 and also placed me on anti-seizure medication. Pre-e can become VERY serious, VERY fast - and its always best to play it safe! Friday is too far away to check labs.

You know, the first symptom of high BP and preeclampsia on our list is...nothing. So, only measurements like BP, protein, and what is sometimes terms PIH labs can determine the severity of this condition.

The best thing you can do now is to be as proactive as possible - make sure everything is checked and triple checked by the doctors!