When do doctors start doing urine tests?

This section is for discussions with other women who have probably been through the same signs/symptoms that you may be experiencing. Please note, we cannot offer medical advice and encourage members to discuss their concerns with their doctors. New members, come on in and introduce yourself!
rachel a
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Re : When do doctors start doing urine tests?

Postby rachel a » Tue Jul 26, 2005 04:12 pm

Julie,

You're very welcome!! I hope you can find what you're looking for!

kjones
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Re : When do doctors start doing urine tests?

Postby kjones » Tue Jul 26, 2005 10:50 am

Welcome!! It is strange that they did'nt keep up with your urine more than that. Anytime they do a urine on you, the dip automatically consist of reading for protein. Unless it is just to test for positive pregnancy. About you question as to when PE hits, if it hits in the next pregnancy? Mine hit around 20 weeks again, you just never know, but you surely will know the warning signs, and symptoms should they arise again. The other ones have done great with there post here. We are here for you. Godd Luck, & Best Wishes!!

alittlepregnant
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Re : When do doctors start doing urine tests?

Postby alittlepregnant » Tue Jul 26, 2005 10:20 am

quote:Originally posted by Rachel Adamson
...you mentioned that your bp started out pretty low so when it started to rise it wasn't concerning. Around here, we're sure to tell folks that -

"an increase of 30 mm Hg systolic [top number] or 15 mm Hg diastolic [bottom number] blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg." http://64.19.174.210/symptoms.asp#hyper

So, in reference to your question...you may have been presenting with bp issues, just not something that would jump out to someone not familiar with your baseline bp.

Verrrry interesting. Thank you!

rachel a
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Re : When do doctors start doing urine tests?

Postby rachel a » Mon Jul 25, 2005 11:37 pm

Julie,

Laura and Catherine have done an excellent job responding to your most recent post, but I just wanted to point out one (okay, a couple) thing(s)...you mentioned that your bp started out pretty low so when it started to rise it wasn't concerning. Around here, we're sure to tell folks that -

"an increase of 30 mm Hg systolic [top number] or 15 mm Hg diastolic [bottom number] blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg." http://64.19.174.210/symptoms.asp#hyper

So, in reference to your question...you may have been presenting with bp issues, just not something that would jump out to someone not familiar with your baseline bp.

Oh yes, one more statement that you mentioned...theory is that if you've had PE in a first pregnancy that IF you do get it AGAIN in a subsequent pregnancy that it will *likely* be later and less severe...well, that's just a theory and from most evidence presented it's based solely on the fact that A) the mom is aware of the signs/symptoms and B) she is considered high-risk and being watched more vigilantly. There is no scientific data stating that this is the case however. This is why it is so important to consider a pre-conception consultation with a peri/MFM.

I am so completely blown away by the fact that your OB did not do routine dipsticks. That's mind boggling, sadly though, it's not unheard of.

We're here for you and look forward to hearing more from you!

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catherine
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Re : When do doctors start doing urine tests?

Postby catherine » Mon Jul 25, 2005 04:27 pm

Julie, I think that the best thinking is that HELLP is a freakish varient of preeclampsia. I was like you, hit out of the blue when I got sick. I had no warning signs at all and managed to go from 0-60 in about 3 hours.... ie: fine and pigging out on fried chicken at 8 pm and doubled over in L&D triage by 11 pm. At that point I had the protein and the whacky BP and the bad liver enzyme/platelet/hemolysis stuff all happening. I was being seen (by sheer coincidence) by an MFM and had a normal check up barely a week before. I know that everything looked good... my baby's heartrate had been doing something funky so I'd been quite carefully overhauled to rule out stuff at that point. I know that there was nothing to indicate any warning signs (unless the baby heartrate thing was associated, it may have been ... too long and boring to recount here) of what was galloping towards me. I did have a high AFP/triple screen thing at 16 weeks and anecdotally, that may possibly signal that there might be something awry with the maternal/fetal connection, if it is not being caused by baby specific issues (eg. chromosomal abnormalities or neural tube defects). The rest of the time I was just perfect, normal BP, no protein, no anything except swollen ankles.... and if you don't have that in Arkansas in high summer.... well you have no circulation to begin with!!

I guess what might be a critically important issue for you to address (and I'm no doctor so bear this in mind) is the possibility that things might go a little awry at implantation that ultimately lead to preeclampsia a long way further down the road. Sometimes it may be a specfic pregnancy event (ie. that unique combo of egg, lining, phase of the moon, consumption of cheese dip whatever), that will never precisely occur that way again. This is what I ascribe my experience to. On the other hand, sometimes funky little "micro-events", like a blood-clotting system slightly out of whack might just undermine the quality of the formation of the maternal/placental connection. Under the latter conditions, it might not be unreasonable to anticipate that those same conditions might interfere with the perfect establishment of a future pregnancy.

laura
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Re : When do doctors start doing urine tests?

Postby laura » Mon Jul 25, 2005 02:47 pm

HELLP is a subtype of preeclampsia- in general all preeclampsia is caused by faulty placenta wiring. The vessels attaching the placenta to the uterus don't grow properly. Eventually, the fetus demands more bloodflow than these faulty vessels can manage and the disease process of preeclampsia begins- probably the most important aspect of that disease process is vasospasm, the vessels start clenching open and shut and this can damage the liver and blood parts (as in HELLP) and the kidneys (as in "garden variety" preeclampsia). The vasospasm is the common factor, but how it manifests can be different for each woman. HELLP is preeclampsia, but if the kidneys aren't affected, you won't spill protein.

HELLP stands for
Hemolysis- the destruction of red blood cells by the vasospasm
EL Elevated liver enzymes- the liver is damaged by the disease process of preeclampsia
LP- Low platelets- the vasospasm breaks the platelets.

It may manifest differently, but the disease process is caused by (some think) the same things. Some women, like Erin (deerhart) had evidence of severe disease- complete with Central Nervous System disturbance, yet she never showed any evidence of kidney damage. Hope this clears things up a bit!

alittlepregnant
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Re : When do doctors start doing urine tests?

Postby alittlepregnant » Mon Jul 25, 2005 02:13 pm

Thanks, all, for the useful information. I didn't even know there were perinatologists who specialize in hypertensive disorders!

No, I didn't pee in a cup at every visit -- in fact, if I recall correctly, I only did it at the first, when they were verifying that I was actually pregnant (a goofy formality, since I'd already had about umpteen ultrasounds at my reproductive endocrinologist's).

What I wish I knew is when pre-eclampsia set in. My understanding is that if I get it in a second pregnancy, it's likely to happen later. Am I correct about this, do you know? But without knowing whether it set in only immediately prior to the crisis, or whether it was actually lurking earlier, it's harder for me to put the whole experience in perspective.

My blood pressure throughout my pregnancy increased, but since I started low, no one was ever particularly alarmed. Since high blood pressure is kind of the hallmark of preeclampsia, that suggests that I didn't have it much prior to the HELLP crisis, but I sure wish I knew the urine story to help complete the picture.

I guess the bottom line is this: Did I have pre-eclampsia -- if you can have HELLP without it! -- and, if so, when did it set in? That as much as anything will influence my decision about trying to have another baby.

I can't believe I'm even considering it after last time, but then I guess I like to live dangerously!

Thanks so much for the information and your good wishes.

youtan
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Re : When do doctors start doing urine tests?

Postby youtan » Mon Jul 25, 2005 01:45 pm

You've gotten excellent responses so far. I'm so glad that you've found us. I know that I was completely in the dark after my HELLP experience. But, having shared with these ladies - I've learned so much and feel much better about things today.

Yep - a perinatologist should be able to thoroughly digest and discuss your HELLP experience with you. It will help to have as much detail as you'd like - and let it sit in your mind some. The doc should also give you some numbers for the likely chance of reoccurance of HELLP and/or PE. These are based on history, any underlying conditions (which they should check for), and other possible risks. The statistics can be scary and sometimes it can feel like a gamble to try another pregnancy.

Laura and Catherine, for me I had all the numbers broken down by my peri. Somewhere I have a 8-12 pg sloppy handout that my peri gave me to read and digest. Its filled with 3% for this risk, 10% more for that, etc, etc and definitions for all kinds of stages of preE, HELLP and eclampsia. But, statistics are just numbers - we never know how our own story will turn out.

Would like to wish you all the best in making this decision. Check out the posts in HELLP Syndrome Survivors. Love to chat with you more!!

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catherine
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Re : When do doctors start doing urine tests?

Postby catherine » Mon Jul 25, 2005 12:46 am

Laura, you think my aging brain can hang on to data like that????

Seriously though, I'm a fan of Sabai's data that argues for a flat 5% reoccurance risk for HELLP, independent of the estimates for reoccuring preeclampsia which run increasingly higher depending on how early in pregnancy you became ill. Because I have a reputation for my Cleopatra/Pollyanna tendancies, I will mention that others have made estimates as high as 25% risk of reoccurance. I think that the numbers are all "whack" as many women choose not to get pregnant again and that surely influences the number collection KWIM?

Sooooo Julie, I speak as the voice of total neutrality here [;)]... I had a picture perfect pregnancy (unplanned) after my ugly brush with HELLP, and decided to call the baby making quits at that point. I strongly suspect that for folks like ourselves, generalized numbers are of little or no value because the REAL question is "am I GOING to get IT again and WHEN?" The person most likely to give you the best answer, taking into account your previous history, your current health and any underlying predispositions that might raise your risks higher than the average person (eg. chronic hypertension, thrombophilias, auto-immune disease etc.) would be a perinatologist who specializes in hypertensive issues in pregnancy. Seeking out one of these folk is enormously valuable, because not only do they really know what they are talking about, but they can also give you insight into issues of appropriate care (including whether or not you should be peeing on the protein sticks every time you pass a bathroom). In my case I'm so bonded to my guys at the office that I'm still going there..... what a waste of expertise... an MFM who specializes in critical care obstetrics doing an annual exam on a woman whose tubes are ancient history!

Welcome to the PF... we chew over this stuff all the time so feel free to keep asking questions.... as you think more about this stuff... you'll have more, and more...

rachel a
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Re : When do doctors start doing urine tests?

Postby rachel a » Mon Jul 25, 2005 12:21 am

Julie,

Most OBs do urine tests (dipsticks) at each visit to check for protein, along with routine blood pressure checks and weigh-in. Did you not "pee" into a cup during your routine office visits?

If this is the case, I am aware of a woman on the forum whose OB practice was no longer "routinely" checking urine for protein--I don't think she ever told us why the practice decided to go that route.

You are correct in your understanding that HELLP can come on suddenly. Very suddenly and without prior warning--such as protein in the urine.

You are aware that there are two tests performed to check for protein -- #1 - the casual in-office dipstick (not 100% accurate) and #2 - the 24hr urine, which entails urinating into a big orange jug for 24 hours.

I would recommend thoroughly reviewing your medical records and being sure to share them with an MFM or Peri (whichever you choose to utilize).

I am so very sorry for your horrible experience and so very happy that you have a healthy son. I wish you the best in your decision to TTC.

We look forward to more posts from you in the future.


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