Alternative diagnosis

[blythe]

I assume pitocin can raise your bp just like labor can raise your bp (and the preeclampsia biology Caryn describes is both fascinating and a scary reminder of why labor and the first 24 hours after birth are especially dangerous) - but I'm concerned about your statement "And that can actually lead to many of the same things preeclampsia causes."
That doesn't seem accurate to not-a-doc me. Here's a study that lists complications of preeclampsia, I'm not aware that hypertension from effort (I'm thinking hard exercise or weight lifting as a comparison?) has any similar bad outcomes:
http://www.ncbi.nlm.nih.gov/pubmed/17983486
CONCLUSIONS: (1) The morbidity of severe complications from high to low are: placental abruption, DIC, induced cardiopathy, renal failure, cerebro vascular accident and HELLP syndrome. (2) The main causes of mortality for gravida and puerperant are: cerebro vascular accident, HELLP syndrome, DIC and induced cardiopathy. (3) The major complications harmful to perinatal newborns are in the order of: placental abruption, HELLP syndrome, DIC, renal failure, cerebro vascular accident and induced cardiopathy.

My understanding is that the blood pressure increases and the other complications of preeclampsia are symptoms of the underlying pregnancy dysfunction.

I can "hear" you still trying to wrap your mind around all this, you're doing good, keep reading! If you can find more specifics about why pitocin would be similar to preeclampsia I'm more than happy to learn more! Oh - and I can't find it right now, but I'm sure there's some other Expert responses about the 30/15 increase, and I'm pretty sure there's one about pre-hypertensives and hitting the 140/90... have fun in the Ask the Experts archives and let us know what you find! Also, keep in mind that the 140/90 is a *research definition* - women can and do get sick at lower pressures, with and without protein, with and without bad labs. The research definitions are very important for research, but in practice, doctors have to be more flexible! Our Experts say over and over that "doctors treat people, not diseases".

[caryn]

Labor itself causes spectacular changes in pressures, because hypoxic placentas produce more soluble flt, which pokes little holes in your vasculature, which freaks out your kidneys, which send out vasoconstrictors because obviously something is wrong because all of the fluid is leaking out into your interstitial spaces between your cells instead of coming to visit them, so your blood has the wrong ratios of stuff, which triggers release of said vasoconstrictors. And placentas get hypoxic - short of oxygen - because you're contracting. So there's really no way to not be contracting and still have a baby except Caesarean, which... yeah.

Preeclampsia is just a runaway train. There really aren't a heck of a lot of "good" options, except the ones where everyone lives!

[aajatwins]

Did you know the pitocin can cause your bp to increase dramatically even without preeclampsia/eclampsia/PIH? And that can actually lead to many of the same things preeclampsia causes.

I know all about it now I was never diagnosed with any hypertensive issues in that pregnancy, so I knew nothing about what pitocin could do then. I'm sure being hit with pitocin was not in my best interest at that time, but I had been having "the" headache for two days before that and had vision changes the night before - so I was already well on my way to poor situation. However, during my VBAC, the pitocin did nothing to my BP. (Actually, the epidural lowered it enough that they gave me something to raise it back up - talk about feeling like I needed to freak out.)

[alviarin]

UKs 2005 PRECOG guidelines have some reccomendations for new-onset proteinura (even w/o hypertenstion:)
http://www.preeclampsia.org/images/pdf/ ... elines.pdf

[StrongMom]

W
How does this work for pre-hypertensives then, (120-130/80-89) range? They can only increase 1 point in some cases? I was just hoping to find some more information on whether or not this had been totally ruled out as part of the diagnostic criteria and how they handle someone with very low bp to start as well (90/60) who now has bps in the 120/80s range and is spilling protein- but isn't considered preeclamptic because she hasn't reached 140/90? (This is coming from another message board I follow)

Hopefully she is being watched closely by her doctors. And she know the signs and symptoms of pre-eclampsia. http://www.preeclampsia.org/health-info ... d-symptoms

If you go to our Care Providers page you will find links to some more technical guidelines, like ACOG Practice Guideline for Diagnosing and Managing Pre-eclampsia and Eclampsia: http://www.preeclampsia.org/care-providers

Although it is out-dated (though not inaccurate) the NIH working group report on High Blood Pressure in Pregnancy states:

"In the past it has been recommended that an increment of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes.14,15 Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyper- uricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present."
http://www.nhlbi.nih.gov/guidelines/archives/hbp_preg/

They are working on some diagnostic tests to ID women at risk earlier -before they are symptomatic- but they are still in research stages.

Thank you!!! This is exactly what I was looking for.

I am very worried for this women, especially since she is spilling protein and has headaches. I have urged her to see an OB. However, her midwife wasn't concerned because her bp wasn't 140/90. Then a 'medical professional' jumped on the thread and also told her not to worry since the recommendation to worry about numbers increasing 30/15 points above baseline were outdated. She jumped on this not wanting to believe that anything was really wrong. Hopefully, she will seek help before anything goes dramatically wrong.

[alviarin]

W
How does this work for pre-hypertensives then, (120-130/80-89) range? They can only increase 1 point in some cases? I was just hoping to find some more information on whether or not this had been totally ruled out as part of the diagnostic criteria and how they handle someone with very low bp to start as well (90/60) who now has bps in the 120/80s range and is spilling protein- but isn't considered preeclamptic because she hasn't reached 140/90? (This is coming from another message board I follow)

Hopefully she is being watched closely by her doctors. And she know the signs and symptoms of pre-eclampsia. http://www.preeclampsia.org/health-info ... d-symptoms

If you go to our Care Providers page you will find links to some more technical guidelines, like ACOG Practice Guideline for Diagnosing and Managing Pre-eclampsia and Eclampsia: http://www.preeclampsia.org/care-providers

Although it is out-dated (though not inaccurate) the NIH working group report on High Blood Pressure in Pregnancy states:

"In the past it has been recommended that an increment of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes.14,15 Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyper- uricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present."
http://www.nhlbi.nih.gov/guidelines/archives/hbp_preg/

They are working on some diagnostic tests to ID women at risk earlier -before they are symptomatic- but they are still in research stages.

[StrongMom]

Did you know the pitocin can cause your bp to increase dramatically even without preeclampsia/eclampsia/PIH? And that can actually lead to many of the same things preeclampsia causes.

[aajatwins]

I had only creeping BPs during my twin pregnancy. At the beginning of induction, I was 135/85 (baseline 90/60) and when I spiked out at 150/105, I seized. I never spilled a bit of protein, so I have no idea where I fall in PIH/PE categories other than eclampsia.

On the other hand, my cousin's wife has chronic HTN and so has had PE with all 3 pregnancies. other than bedrest and BP meds, she has "normal" pregnancies and delivers full-term babies with no issues.

PE is just a crazy thing.

[angieb]

I had HELLP syndrome with my blood pressure never getting to or above 140/90.

[StrongMom]

Which makes sense to me.... could not believe not having a significant increase in your baseline even if it doesn't reach the magical 140/90 *has been proven* to not be preeclampsia/eclampsia. Obviously the the more traditional diagnosis would make sense for the majority of the population. This was coming from someone who is a medical professional who works in L&D.

How does this work for pre-hypertensives then, (120-130/80-89) range? They can only increase 1 point in some cases? I was just hoping to find some more information on whether or not this had been totally ruled out as part of the diagnostic criteria and how they handle someone with very low bp to start as well (90/60) who now has bps in the 120/80s range and is spilling protein- but isn't considered preeclamptic because she hasn't reached 140/90? (This is coming from another message board I follow)