Gestational Hypertension - No Induction Option?

[Anonymous]

2nd time mom with two recent blood pressure readings, 37w was over 140/90, 38w was over 160/90, which is borderline severe. All previous readings normal, normal first pregnancy, and no white coat syndrome. Bloodwork is fine so it's just gestational hypertension. OB doesn't seem concerned and is taking a "wait and see" approach. I've read everywhere that I should be induced by now. Wonder if hospitals are overwhelmed and they don't think I'm in need of an induction? If it matters, delivering at one of the INOVA hospitals.

[Anonymous]

You need an induction. If you were at my hospital (RN) in DC, the doctors and midwives would recommend you stay for an induction. Good luck. Also, tell you doctor that you are concerned this may develop into preeclampsia and you want to avoid this.

[Anonymous]

OP here: Anyone been in the same position where their OB acted like it wasn't an issue and continued with business as usual? Is this OB blatantly ignoring ACOG guidelines? I'm with one of the big practices in the area, Capital Women's Care.

My next appointment is not for another week at 39w. Seems like a long time to have to wait.

[Anonymous]

At WHC center, I was induced at 38w 4 days for blood pressure readings right around 140/90. Even though my bloodwork was fine, I wasn't really given an option. You could go to Labor and Delivery and say your BP readings are 160/90 and you are concerned.

[Anonymous]

Nope. When my pressure was that high at 38 weeks, I convinced them to let me go home for 24 hours to pack and finish up some stuff, but they only let me do it with promises to take my blood pressure twice while I was home, and come back if it got higher.

I was admitted the next day and induced.

[Anonymous]

Anonymous wrote:At WHC center, I was induced at 38w 4 days for blood pressure readings right around 140/90. Even though my bloodwork was fine, I wasn't really given an option. You could go to Labor and Delivery and say your BP readings are 160/90 and you are concerned.

OP, do you have a blood pressure machine at home that you can monitor on? If you don't take this PP's suggestion of going to L&D (which I was also going to suggest as an option), then at the very least keep monitoring at home. If it remains at 160/90 at home, you could try to call the after hours line & hope that it's not your specific OB on call. If it gets higher or you get symptoms of preelampsia, then go straight to L&D and expect not to leave there until you've had your baby.

[Anonymous]

OP: You are correct to question this. I work with heart disease patients and have found that many OBs do not focus on pregnancy complications. If you do some current research we are learning that women who have complications in their pregnancy, to include low birthweight babies, have a greater chance of early onset heart disease. That may have to do with your life moving forward but it is a significant thing to know
Do you have an at home blood pressure monitor? I like the Omron. I would chart my blood pressure. Ask questions and advocate for yourself.
Because you don’t want to have a stroke!

[Anonymous]

I recommend seeing an MFM. They are much more experienced in looking at BP and making the call to induce.

For what it’s worth though, my experience with the MFM was they were actually more willing to wait and see than my OB, but that was based on my particular numbers. ( My OB freaked out and wanted to induce at 37 weeks for mildly elevated BP)

140/90 if I recall was not cause for induction. If you are regularly getting that 160 number though, almost any OB would induce.

Best advice I can give is start taking your BP 3x/day and logging it on a piece of paper. You should do 1 hr after waking, just before lunch, and in the evening around 8 pm. The trend of the many data points is the best way for the doctor to determine the course of action.

In your case if that 160 was not a fluke, I’d be persistent in getting another opinion. Preeclampsia develops so quickly.

[Anonymous]

Forgot to add: for my OB, 160 was the number at which she made you go to L&D for immediate evaluation and bloodwork.

[Anonymous]

Anonymous wrote:OP here: Anyone been in the same position where their OB acted like it wasn't an issue and continued with business as usual? Is this OB blatantly ignoring ACOG guidelines? I'm with one of the big practices in the area, Capital Women's Care.

My next appointment is not for another week at 39w. Seems like a long time to have to wait.

I did not have hypertension but I did have a diagnosis where I should have been induced by 37 weeks. I am a physician (not OBGYN) and read the current clinical practice guidelines myself. My docs also a CWC practice said it wasn’t necessary. At my 38 week appointment, my OB and Maternal-Fetal Medicine doctor were insistent it was not necessary. My labs were fine and the ultrasounds and NSTs were reassuring. I refused to leave until I had an induction scheduled. Went to the hospital that night and left with a healthy child. Pretty sure they labeled me as a hysterical first time mom but I didn’t care. With my next pregnancy, I ended up mostly seeing other OBs in the practice. Not because I was upset, my schedule had changed and therefore the docs I saw changed. Towards the end of my next pregnancy, I ended up seeing my main OB from my first pregnancy. She apologized to me and told me I was correct. Another mother with my same diagnosis did not end up leaving the hospital with her baby. No specifics were given but reading between the lines, I deduced that that mother was either not induced until way past 37 weeks or was not induced at all. My diagnosis came with a high risk of still birth past 37 weeks.

Never be afraid to advocate for your child.

[Anonymous]

This is shocking to me. Definitely monitor BP at home. Walking into L&D isn't a bad idea, but short of that, maybe call your office back? At the very least you have the right to speak to your OB further about this.

[Anonymous]

print out the ACOG recommendation and tell them you want to be induced. or just go to the ER and tell them you feel like your BP is high.

[Anonymous]

This seems out of step with the guidelines. I was scheduled for a 38w induction with these kind of readings at 36w. Then they found protein in the urine so got bumped up to emergency 37w induction.

[Anonymous]

^^ PP: I had midwives (CNM at a hospital) so they were pretty anti-intervention and they STILL scheduled induction --that should tell you something!

[Anonymous]

I would wait until the office closes, and then call the CWC on-duty doctor number and leave a message that you don't feel well/your blood pressure is high/you took a reading at home and it's higher/whatever excuse and tell them you want to go to Sibley for monitoring, and then just show up at L&D. Once you're at Sibley, they probably won't let you leave with blood pressure readings that high.

Preeclampsia can come on really quickly so I don't think you're being paranoid.