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Induction for mild preeclampsia?

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Induction for mild preeclampsia?

Postby lisacole » Mon Feb 15, 2010 12:07 am

I'm 35 weeks pregnant and have mild preeclampsia. I was diagnosed about 3 weeks ago. Since then, I've been going in for nonstress tests twice a week and so far everything has been fine. My blood pressure is usually around 140/90 but occasionally my diastolic is over 100. Usually when a nurse takes my bp at the nst it's somewhere around 120/80.

My dr said for mild preeclampsia he induces at 37 to 38 weeks. Is this standard procedure? I know that only delivery of the baby will make the pre-e go away, it's just that I worry that my body won't be ready to give birth in 2 or 3 more weeks.
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Re : Induction for mild preeclampsia?

Postby veronica44 » Mon Feb 15, 2010 12:19 am

It is standard practice to induce at 38 weeks or so, even with mild PE. It is a condition which can progress very rapidly, and so delivery is done as soon as it is relatively safe for the baby to do so. A study was published not too long ago which showed that outcomes for mother and baby, even with mild PE or PIH alone, were better if induction was done a couple of weeks early.

I had mild PE and was induced at 38 weeks exactly. My daughter and I both did great. I'm glad induction at 38 weeks was chosen for us. By the time I checked into L&D for induction I was getting new PE symptoms like hyperreflexia and face swelling.

Pitocin was used to induce, and my labor went quickly and without complications. I was already at 2 cm dilation to begin with though so that might have helped. I did have to get an epidural due to the intense pain, I suspect the Pitocin played a factor.

Also, I did not have success breastfeeding as my daughter had a weak sucking reflex at the beginning and my supply never got established. IF you want to breastfeed and IF you have this issue due to early induction, I'd recommend supplementing with a lactation aid instead of with bottles, and finding an LC you can work with to help. That is the only thing about the early delivery I regret and wish I had done differently.

All in all, I'd have gotten induced at 38 weeks again if faced with the same situation. Best of luck to you!
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Re : Induction for mild preeclampsia?

Postby cucocab » Mon Feb 15, 2010 12:24 am

I was also induced at 38 weeks with mild pre e with my first pregnancy. Everything went well, we used pitocin and it did nothing to progress me (24 hrs) so they broke my water. I delivered in 1 1/2 from that time went from a 5cm to a 10 in the time it took them to roll me to my side for a different position and back (about 5 min). The delivery went great, my boy was/is as healthy as can be! I also had time for an epidural. Good luck!
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Re : Induction for mild preeclampsia?

Postby caryn » Mon Feb 15, 2010 01:56 pm

Yes, a new big study has shown that induction for mild PE at 37 weeks doesn't compromise the baby but improves the mother's outcomes above expectant management. The longer the pregnancy goes, the sicker the mother gets; induction lowers risk of severe hypertension, pulmonary edema, PPH, etc.

Here's a link to the [url="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60736-4/abstract"]abstract[/url] from the Lancet and here's one to the [url="http://www.studies-obsgyn.nl/home/page.asp?page_id=357"]trial page[/url].
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Re : Induction for mild preeclampsia?

Postby l412angel » Mon Feb 15, 2010 08:32 pm

My question would be that if it is considered ok to induce at 37 weeks...can one request to be induced at 37 weeks even if everything is ok if they have a major history of severe pe/hellp?
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Re : Induction for mild preeclampsia?

Postby duhitstaken » Mon Feb 15, 2010 11:12 pm

According to my dr if there is nothing wrong, and you are pregnant with only 1 baby, the earliest you can be induced just because you want to be is 39 weeks. However, induction at 37 is just fine and you ARE considered full term, but some women's bodies aren't ready at that time to deliver and that is why they don't induce "just because." They can make your body ready to be delivered though. I was induced for mild pe at 36 weeks and 6 days...as soon as I was diagnosed I was told I am going to deliver because it is safer for me and the baby to get her out.
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Re : Induction for mild preeclampsia?

Postby caryn » Tue Feb 16, 2010 00:12 am

Odds are that a woman with a history of severe early PE like you, Laura, will be seeing an increase in her blood pressure by term, and gestational hypertensives were included in that study. If your bp were 100/60 and the baby was flying through NSTs and you were 38 weeks, I don't think many doctors would be willing to induce. But if your pressures are up, this study says that it's safer to do so.

We hear a lot about inductions for convenience, but I'm not sure how many of those are because of mild obstetric indicators that the mother may not even realize she has. If you want to be done being pregnant and ask for an induction, and the doc sees that your pressures are trending up by 40/20 over your baseline and agrees to an induction, do you necessarily realize *why* an induction is medically indicated and that you'e not just getting one because you've asked for it? I don't know -- never having been in that situation! -- but I find myself wondering how many inductions are for reasons like that, rather than "convenience".
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Re : Induction for mild preeclampsia?

Postby mellybute » Tue Feb 16, 2010 09:27 am

I went in on 8/1/09, the day I turned 37 weeks with (per my medical records) Mild Pre-eclampsia. My bp was hovering around 145-150/95ish, all labs were good at this point, and no protein. This was the first time in my pregnancy that I had elevated blood pressure. I was having contractions though which they didn't like since I was scheduled for a c-section the next week. No natural delivery, no need for contractions :-)

The on call doc decided since I was 37 weeks to keep me and do my section the next a.m. Well, everything got way worse after delivery, but atleast baby was healthy and well. Post Partum PE just took it's ugly little toll on me :-)
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Re : Induction for mild preeclampsia?

Postby glimmer » Tue Feb 16, 2010 09:31 am

Hi. I was in the same situation as you and was resisting to be induced.
The study Caryn cites is - to my understanding - scientifically sound and
states that it is better for the mother to be induced after 37 weeks.
Actually there were less Ceasarians in women that were induced for preeclampsia
at 37 weeks or more than in those who waited longer.
It also sais that there were no adverse outcomes for the infants although that was not their focus. (They looked at mortality and NICU times, I believe, but not e.g. at breastfeeding issues or others.) Since I had had severe preeclampsia in a previous pregnancy I
agreed to be induced at 38 weeks. It took a long time to induce me, but then the labor was easy and straightforward. In labor my preeclampsia became severe again.
Now, I am going to be the devil's advocate and want to be very clear that this is against medical advice. But if I were pregnant again, I would wait longer before agreeing to be induced. To me it seemed that my daughter did need a bit more time before coming out and - in my case - it seemed both times labor itself that kicked me into the severe (and ugly) range. But - I would have only done so if there would have been close monitoring of me and the baby, so that we could have acted fast. It would have been playing with the fire, no doubt and I would not recommend it.




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Re : Induction for mild preeclampsia?

Postby lisacole » Tue Feb 16, 2010 03:20 pm

Thanks everyone for your input. From reading your replies and the studies posted it does seem that induction is most likely to lead to a good outcome. I'm 35w5d, I can't believe I'm going to have a baby in 2 weeks! I have a dr appointment in a week so I'll know then when induction will happen.
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