Generally Concerned - looking for info

[anathor21]

Hello - just found this site this AM, interesting reading and I expect to be here a lot over the next few weeks at least...

Background:
First daughter was induced at term due to PIH onset at about 38 weeks, ended up c-section and everyone went home happy (minor drama only)
Second daughter was deliverd at 31 weeks due to fetal stress as a result of PIH/PE that came on in a matter of about a week (at least the BP/protein spilling only showed up for a week) - at slightly under 2.5lbs she was quite a scare for a while - not going to bore folks with too many details, but everyone is doing well now.

Now:
We're approximately 28 weeks into pregnancy #3 with a boy on the way (whew! only have two bathrooms...). Things are going well - the comparison in "stats" (BP/Weight gain) between this pregnancy and #2 are very interesting as they seem to be very much in line. (Slight drift upwards, but not dramatic or enough to be classified as PIH)

So now the questions (knew I'd get to this eventually) that I'm trying to find info on.

1) What is known about liklihood of PIH/PE in the third pregnancy after two prior experiences with it? Can anyone point me to some good research on this (I'm an engineer by training so I like numbers :) ).

2) What, if any, value is there to comparing stats between pregnancies? i.e. can the slight increases in BP that seem to mirror prior experience be considered significant?

3) When #2 was born several nurses made statements along the line of "wow, #1 had PE very late? it's unusual to have it come on earlier in next pregnancy" - is this just some sort of nurses urban myth or is there anything to this? Naturally with the two data points I have a hard time not drawing unplesant conclusions.

I'm interested in hearing from folks in the know - Frustrating that it seems so little is concrete about predicting/managing PIH/PE - getting the standard "we just have to watch closely and monitor" doesn't give the engineer in me much to hang my hat on. (Perhaps that's why I'm not a doctor).

I apologize if there is a faq/forum here with all the answers to these questions, I tried searching the forum and got database timeout error messages and my browsing didn't find much (a LOT of posts in forums is good, but makes a bit of a haystack for me to search)

Thanks in advance.

(minor updates to clarify current and historical status and add sig on 7/15)

[kdreher]

I can't provide answers to all of your questions - I do want to offer my welcome and support and encourage you to stick around as you will find a lot of info out. A few others will chime in shortly, I know...we are here to help. Is your wife being seen by a perinatologist at all? Don't think in terms of what the nurses say. I had eclampsia and HELLP set in at 26 wks with my first pregnancy - very sudden - and here I am 10 yrs later trying to get pregnant. Peri has said about 5-10% chance of getting HELLP again and up to 30% chance of some form of PE. I have no underlying factors and really it is a guessing game.I will be watched by OB and peri. I really don't think we can compare one pregnancy to the other as some women here are like me and have had a loss, but gone on to a PE free second pregnancy. The unknowns is what really bothers many of us because we can not find a common link. Feel free to post your questions anywhere...like I said welcome, I'm glad that you are interested in your wife's care and congrats on a baby boy on the way. Keep us posted.

[julie f]

Hi and welcome! I'm sorry though for your wife's troubles with this pregnancy. I am so happy to hear that your baby girls are doing so well after their rough starts.

I'll try and help with what I can!

1. As an engineer, I think you'll be sorely disappointed in the lack of solid numbers... [:0] Some women who are "supposed" to get it again don't. Somen women that it seems should do just fine end up right in the thick of it. Here is the best link I can give you, it's from our Ask the Experts Forum, it doesn't differentiate though between # of pregnancies: http://www.preeclampsia.org/forum/viewtopic.php?t=331&SearchTerms=sibai

2. From my personal experience only - in my 2nd pregnancy, I was on bp meds, so I'm not sure what my bp would have been at 26 weeks had I not been. I do know though that my bps started out a bit higher in the 2nd pregnancy and, I went into it already spilling protein. I truly think every pregnancy is so different. It could be that your wife's bps are high this time, but remain stable. It could be that she is spilling protein this time because of kidney damage sustained in the last pregnancy.

3. I had always heard this as well -- "Don't worry, if you get it again it will be later and less severe..." Unfortunately it does not seem that this is a fact. There was a great post about this by our Founder, Anne, a while back. I will see if I can dig it up. If you look though, at the link in #1, you'll see though that because your wife had PIH at term, her risk factors were lower than someone who had it earlier.

Has your wife been tested for an of the underlying disorders that can be associated with an increased risk of preeclampsia? (Blood clotting disorders, autoimmune disorders, etc.) Also, is she seeing a high-risk OB right now? How often is she being monitored? Is baby receiving extra monitoring too?

I wish I could be of more help. You are right, it is so frustrating that there are so many "what ifs" and unknowns...

Please keep us posted, I pray that yall are able to bring a full-term healthy little boy home. Congrats on the boy by the way!

[catherine]

Hi, welcome on in. Gordon who moderates this section should be along with some very practical advice and major insight for you fairly soon.

Yeah, the search issues are tricky here, I suspect it's because the postings have expanded exponentially in the last year or so.

Quicky responses to your questions:

1)http://www.preeclampsia.org/forum/viewtopic.php?t=331 Best answers from MFMs and specialists who have made research and treatment of hypertension in pregnancy their focus.

2) Yes, if basically you're describing hypertensive issues in all prior pregnancies. That might point to some underlying condition that might predispose your wife to these issues. Examples of this include chronic hypertension, a thrombophilia, an auto-immune disease. Sometimes if these factors are recognized it can influence the treatment, for example, women with chronic hypertension are more likely to be managed with BP meds than women who don't. This is because studies show that while the hypertensives receive a benefit in terms of longer gestation, neonatal health etc., the data doesn't support this for women who aren't. I think that it's not unreasonable to anticipate that you might have some issues in this pregnancy and the whole watching and monitoring thing is really the best, if most infuriating, answer.

If you start rooting around right in this forum you'll find this

http://www.preeclampsia.org/forum/viewtopic.php?t=7683 started by a fellow dad. His wife had a history of progressive PIH issues over the course of several pregnancies and is an interesting (if occasionally infuriating and scary) insight into how a family manages their way to the finishline complete with healthy baby and mom.

[rachel a]

Just wanted to add my welcome and ask:

Is your wife being treated with antihypertensive medications?

I understand what you mean by "watch close and monitor". It felt so absurd to me that the doctors would simply hook me up to IVs and machines and just watch. However, this is the course of action--

I too am wondering about an underlying disorder, such as an autoimmune disorder, chronic hypertension, or thrombophilia. Did your wife ever have tests to check for these? Any preconception consultations?

I will be thinking about you and your wife and praying for a safe delivery for mom and baby boy.

Please update soon.

[laura]

Hi Anathor,
I just wanted to say hi and say that I'm with the girls- repeat preeclampsia, increasingly severe preeclampsia often tends to indicate an underlying disorder that is probably triggering things.

I had my first after severe preeclampsia at 35 weeks, and then developed hypertension around 24 weeks with my second; it became clear that I have underlying chronic hypertension and aging and the stress of pregnancy was uncovering it.

Best wishes to you guys and good luck!

[anathor21]

Thanks for all the references and info - will take time tonight to review more closely. From a quick scan it seems I have given an incorrect impression about how things are going now with #3 - we are currently NOT in the PIH category, rather BP is quite good, but it is slightly up from beginning (i.e. now reading approx 130/80 vs pre-pregnancy of 115/70ish - not sure of exact pre-preg reading as I'm not looking at written record... ). So, it's up SLIGHTLY, but not yet enough to be of "real" concern except that it seems to be mimicking last time... (with #2 we were doing great until week 30 where it only took a week from first "better start watching BP" reading to necessary delivery)

Just wanted to clarify so later posts won't cause additional confusion.

[akemt]

In general, a rise in baseline BP of 30/15 points is cause for concern, though no longer diagnostic.

Also, it may help you to look back through your records and see when the rise began. There is something we call a "second trimester dip" that may help you gain further insight.

---

To quote "Chesley's Hypertensive Disorders in Pregnancy":
In general, mean arterial pressure declines in the first trimester, reaching a nadir between 16 to 20 weeks' gestation with a return to control values near term. Diastolic pressures decline to a greater extent than systolic pressures, the average mean change being about 10mm Hg. (pg 70)

---

If her BP's rose durring this time period, that can be an indicator to watch closely (yah, I know, you hate hearing that!). And the National Institute of Health's Working Group Report on Hypertension in Pregnancy stated that the drop tends to be even more pronounced in those with chronic or gestational hypertension. (Full transcripts can be found here: http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_preg.htm )

As you are aware, there is little to nothing that is concrete with PIH/preeclampsia.

I would think that expecting (and preparing for) PIH to show again and an early delivery is a good idea. If that does not end up being the case -you can be pleasantly suprised.

My own experience isn't much to go by. I feel like a bit of a fluke, honestly (but most of us probably do!). I had PIH in my first pregnancy, diagnosed around 29 weeks. In my second pregnancy, I followed a similar course, but my labile BP's and rise from baseline were noticed much earlier at around 20 weeks gestation with the addition of pitting edema, tachycardia, and some proteinuria, etc. How much of that was due to the fact that I was watching closely this time or whether it really came on earlier, I don't know. My body did a sort of stand-still.

GOTTA GO, Sorry! I'll try to finish later.

[gordon k]

Hello and welcome to the dad's forum. Glad that you found us.

From what I learned from my wife's experience (and again, I'm not a doctor), it seems to be (A) hard to predict if one will get preeclampsia (although there are high-risk symptoms to look out for, in your wife's case, previous PIH) and (B) when will it occur.

My wife should've gotten preeclampsia and delivered early, but didn't: she was on anti-hypertensive meds (atenolol), and was also tested for anything else that could've been wrong with her (underlying disorders, which in her case was essential/primary hypertension). She has a very proactive doctor who, in my humble opinion, kept my wife's preeclampsia "at bay."

Having a perinatologist that you and your wife trust, and who you can ask any questions, is so important. One of the frustrating things: you can't predict if and when preeclampsia is going to happen. But being familiar with its signs & symptoms, which I'm sure you are, http://www.preeclampsia.org/symptoms.asp (I KNOW that it's a frustrating statement that you hate, but unfortunately with this disease, it's the best we can do), helping your wife watch out for them, and having 24/7 access to her doc via a nurse or L&D are important.

Best of luck to you, please feel free to e-mail me kefferfamily@comcast.net if you like. Please keep us posted...

[anathor21]

So many posts to reply to... Thanks everyone, can't quite respond to every comment, but believe me I have read all and all links too. I'll start from the top though...

kstevens - We don't currently have a perinatologist, although we did discuss it with our OB pre-pregnancy as an option if needed.

In gerneral we are fortunate in many ways, one of which being that we have great confidence in our OB (unlike the experience that hfwarner3 had!). With that said, perhaps someone can fill me in if there is anything in particular that a perinatologist could add at this point?

pelote77 -
re: Don't worry, if you get it again... - the thing that got me the most was that we delivered Isabel at a hospital that has an excellent reputation for both research as well as care and I kept noticing that folks expressed surprise - I figured they woudl have "seen it all." Perhaps they were trying to appeal to the need to feel individual and not appear indifferent to things... it does leave me wondering what I was missing though, heh.

Regarding testing, although I don't know exactly all the tests that have been done, we did go through some additional testing after Isabel once we suggested to our OB that we were not done...

Our OB is not a "high risk" OB, but as I mentioned above she has stated a willingness to refer us as needed (and I believe our relationship is good enough that if we expressed concern she would do so if at all medically justified). We are currently in a 2 week appt cycle and I check her bp daily now and sometimes more if she is feeling odd, notices more swelling, etc.. (So far fairly steady, btw)
No active extra monitoring for #3 yet - but we are not yet showing difinitive signs of trouble (however we have had postitive US's - perfectly in-line growth). This is actually something I have wondered about though since Isabel was so light at birth (her length was close to 'normal for age') I do wonder how long she was in trouble (i.e. did she lose that much weight in the last week? the day our OB sent us to the hospital I remember a comment that 'the baby's belly is smaller than expected' from the US tech.

Catherine -
thanks for the links - I really appreciate your taking the time to dig them up. Good reading - took a rather long time to read all 13 pages of hfwarner3's experience, couldn't stop reading though, what a nightmare!

Rachel -
No, not currently on any medications - (see prior post) she is not really "high" yet. With Isabel it went from this "slow drift" to a spike at 30 weeks with protein spilling about 4 days after the BP rise. Perhaps I should write up my "Isabel story" somewhere to reference so I don't repeat it in bits and pieces.. heh.

Akemet -
Thanks for the specific info related to bp trending. In the interest of accuracy I will get a copy of the offical records for all three of our pregnancies and see how they look when graphed (heh, maybe it won't change a thing, but I can feel like I have done something, right?)
We are preparing mentally and logistically for early delivery (was hard with one child at home, will be different with two of them) and are preparing the girls for mommy to be away in case she is hospitalized - the seperation being the most traumatic part for the girls. We have our plans/backup plans. Will hope for the best... every week that goes by we are happier (will likely have to celebrate crossing 31 weeks).

Gordon K -
You are I believe the third to mention having a perinatologist on the team... so I'll have to reiterate my question from above - at what point is it appropriate/necessary to bring in the peri? Although the ultra-conservative side of me wants to have every specialist in the world look at us "just in case" this doesn't seem to really be a good use of time and may just result in more anxiety. What would a perinatologist likely do at this point that would result in a different course of treatment?

Thanks again to all who responded and I hope I have answered all questions/comments as necessary. I appreciate the information and general support.