Unfortunately I don't think there is a "normal" plan yet, recommendations vary a bit from doc to doc as you have seen. However it seems like more doctors are reccomending delivery at 37 weeks in part due results of the HYPITAT study. Also it will be interesting to see what new guidelines might come out of ACOG's Hypertension in Pregnancy Task Force: http://www.preeclampsia.org/forum/viewt ... 19&t=44954
My personal experience with labile BPs and OB recommendations:
1) My first OB scheduled an induction at 38 weeks since my pressures wouldn't get better and might get worse. He was right, since day of induction I developed rapidly worsening pre-eclampsia and narrowly avoided an emergency-c section.
2) During my second pregnancy, when my pressures started acting up again, my MFM said it meant I was heading for
pre-e again, chronic hypertension later in life, or both. Unfortunately it was both! We induced for
mild pre-e at 37 weeks and my pressures spiked after delivery and I was eventually diagnosed with chronic hypertension.
3) During this pregnancy, on BP meds now for
chronic hypertension, my MFM is recommending delivery at 37-38 weeks. My OB is hoping we can get to 38 weeks, but of course if pre-e rears it's ugly head again we'll deliver sooner. We ran a baseline 24 hour urine in early pregnancy, and if anything changes symptom or pressure-wise we'll run another one.
Bloodwork will tend to pick up criteria for
severe pre-e or HELLP syndrome, but it won't pick up milder cases of pre-e. And protein dipsticks can be slightly off sometimes. So a 24 hour urine test is still considered the "gold" standard for
diagnosis of pre-e.
What does the MFM reccomend in terms of monitoring and setting a delivery date? They tend to see more patients with hypertension and preeclampsia.
I hope this helps, keep the questions coming.