Pre-E questions....anyone have experience?

[jindc]

I haven't posted for a while...
I'm 36+ weeks pregnant and at my last appointment, my OB mentioned that she thinks I'm going to develop pre-e/high BP and therefore need to consider the reality that I could have to be induced.

The issue is this: I have had ONE occurance of high BP my entire pregnancy (it was taken after I walked from my bus stop to the office in the August heat, and when she took it again towards the end of the appointment, it was back to normal). Additionally, I went once for NST monitoring at the hospital where I had my BP checked the entire 4 hours I was there, and it was only on the higher (not pre-e high) end when I first got hooked up and was nervous.

Secondly, I have never had excess protein in my urine (or glucose). I don't think I have excessive swelling - my feet and hands have JUST this past week started to get a little bigger (can get my wedding ring on and off sometimes, but have just decided to keep it off). I don't have chest pain, excessive headaches, etc. The only horrible part of my pregnancy (other than the baby is bigger now and walking isn't much fun!) is that I have had reflux/heartburtn the entire 2nd and 3rd tri- it's caused me to throw up a number of time, which I know some of you have said can actually be a sign of pre-e.

I have a BP monitor at home (wrist one) and haven't had a high reading.

I'm worried - not that I'll get pre-e....I'm not a fool, I know how serious it is and trust me - if ever a patient wanted to know if something were an issue, it would be me (I didn't try to cheat the GD test, which I had to take in the first and second tri). I'm very realistic about the fact that between a monday and a tuesday, pre-e can pop up and from a tuesday and a wednesday, it can skyrocket to HELLP.

However, I think my doctor is just assuming these things are going to happen to me because of my weight. I get it - I'm overweight. I talked to her about this at my first appointment (losing a lot of weight, then gaining back a bunch during fertility treatment and curbing a lot of my hardcore physical activity like kickboxing and step while pregnant, but I gain weight fast when I'm not as active). I get the impression she is dooming me to induction because of a misconception about weight and pregnancy vs doing what is best based on legitimate health concerns.

Does anyone have experience with this? I know pre-e can develop at the end of pregnancy and there really is nothing you can do about it. But if I don't have signs, other than I've gained more weight than she wanted me to, what actions should I be taking? Should I ask for more monitoring before we go the route of just assuming I need an induction? Anyone with a similar situation make it to going in to labor naturally? I'm OK with extra monitoring before and during labor/delivery, but I don't want to enter the post-induction slippery slope of interventions (I have planned for a natural birth).

[Anonymous]

Do a 24 hr urine collection.

[Anonymous]

Well, I've been induced twice for high bp/pre-e and had two natural births. So induction isn't that bad.

If they're concerned about HELLP, which can present with normal bp, the blood test is very easy. You can volunteer for a 24-hour urine catch, but unless they're picking up something at your appointment, I wouldn't bother. It's a bit of a pain.

But I really don't understand where your doctor is coming from. Your blood pressure is 120/80, your protein is -. You have a teeny bit of swelling. As long as both you and your doctor are monitoring these things, it sounds like so far your pregnancy is fine. A doctor isn't (or at least shouldn't) induce you for high bp/pre-e when you don't have high bp or pre-e.

[Anonymous]

I guess I'm confused as to why she is assuming you'll develop pre-E. Are you obese, or just slightly overweight? In my experience, pre-E has little to do with weight (of course it can be a contributing factor, but the women I know who've developed it haven't been overweight for the most part). And you don't have GD I assume? No protein, no high BP? Something seems weird to me - don't get her assumption.

FWIW I'm 33+ weeks with my second. I did develop high-ish BP at the end of my first pregnancy but made it to term (no protein etc). This time I've had ok BP but still have a bit to go. Doc hasn't mentioned any potential concerns with PE. I'm not small, either - 200 lbs at 33 weeks.

[Anonymous]

I was induced for pre-e at 38 weeks. My BP had been going up and down and I was quite swollen. Not overweight, not sure how that factors in.

I will say two things. First, ask her to agree that you will only be induced if the real signs appear, such as protein or constantly elevated BP. That may very well be her plan already. Second, I'm afraid I now have the sense that they knew I was headed toward pre-e and they were right. I think over time OBs just get a sense of when it is coming based on how you look and other less tangible factors.

If you think she is just trying to induce you because she wants to induce an overweight patient, remember that you have the final say.

Induction with pre-e wasn't so horrible for me either. I had pitocin but not epidural and it was fairly fast. Best of luck to you for a good labor and healthy mom and baby.

[jindc]

I do not have GD and I'm overweight. I've gained 34lbs and after losing 75lbs before pregnancy, I have every faith that I can get back to where I was even if takes longer than before I had a kid.

I took the "hypertension blood panel) in August - everything was fine. Should I take this again? I ask because it's apparently a fasting blood test and they never told me this, so I had to come back a different day for it since I had eaten breakfast.

Also, isn't there a difference between high-ish BP and pre-e?

I guess I am just looking for options to bring with me to the next appointment. I'm seeing a different doctor, so the perspective will be good. Is it worth saying that since she is so concerned, why don't I come in more often for BP/urine checks? I tried this before, but no one would take my BP without an appointment and I didn't think it was worth a doctor's appointment when a nurse can do the BP/urine testing....

To be clear I'm not trying to AVOID dealing with pre-e if I develop it - I'm trying to avoid being convinced of something that isn't a real health issue. If it IS a real health issue, I'll definitely deal with it the best way possible!

[jindc]

what do they look for if pre-e isn't based on protein in urine or the blood panel? Just slightly elevated BP? Even if it's below 140/90?

isn't pre-e swelling pretty dramatic? how do you know the difference between mild pregnancy foot/hand swelling and pre-e? I thought pre-e swelling was more all over (legs and face not just feet and hands?)

[Anonymous]

Did you ask her why she thought you'd get it?
Are you extremely overweight for your height, or just marginally?

[Anonymous]

10:31 here: high bp and pre-e can be two different things. High bp alone is risky for baby, and they may/will induce for that, once you've gotten to 37 weeks. For pre-e, they will try to hold off until 37 weeks, but after that will probably induce, if you have it.

For my first, my bp went up at 36 weeks and I had DC at 37 weeks. For my second, my bp went up at 30 weeks and I had protein at 33 weeks. DC was born at 34 weeks, and my doctors and I wonder if I would have developed pre-e with my first if I hadn't been induced. We'll never know, though.

[jindc]

Anonymous wrote:Did you ask her why she thought you'd get it?
Are you extremely overweight for your height, or just marginally?

I'm not sure why she thinks it - she thought I'd get GD, too, because of weight and my sugar was fine (102!) so I took GS test in first and second trimester. I feel like if I could have taken it in my 3rd, she'd have wanted that.

I'm overweight - not obese. I don't really know how to quantify if I'm "extremely", I'm heavier than I'm happy at, but it isn't the main cause of pre-e or GD. My coworkers wife had severe pre-e with both pregnancies and she's a tiny little thing.

It makes me happy to hear people have been induced and had natural delivery.

I'm also worried about the avoidable early delivery of a child. I feel like if he's delivered early when it might not be medically necessary, it's not the best for him.

[Anonymous]

jindc wrote:what do they look for if pre-e isn't based on protein in urine or the blood panel? Just slightly elevated BP? Even if it's below 140/90?

isn't pre-e swelling pretty dramatic? how do you know the difference between mild pregnancy foot/hand swelling and pre-e? I thought pre-e swelling was more all over (legs and face not just feet and hands?)

J here with my unfortunate experience with pre-e to add to the discussion

Diagnostically, pre-e requires the following:

-Two separate readings of 140/90 or higher for BP on two occasions at least six hours apart.
-Elevated protein in the urine (generally above 300 on the 24 hour urine collection)

I find it very odd that your doctors are wanting to push a pre-e diagnosis - I had many elevated bp readings before my doctors were talking induction. In the end they had me stay at the hospital to do a 24 hour urine and to get recorded bps to finalize the diagnosis. Even after that because the readings were generally under 160 and the urine showed only mild protein elevation, they still wanted to hold off on induction for as long as possible. It was only when the BPs veered into the severe category that they moved to induce (above 160/100 - highest was 189/something and 150/110). I would absolutely not agree to an induction if these diagnostic criteria had not been met.

Pre-e blood work requires no fasting - it is like four tests testing your kidney and liver function. I had these tests taken like 6 times over the course of 2 weeks to ensure that my pre-e was not worsening.

Pre-e symptoms can vary wildly. I had no real swelling until the very end and even then it was not very noticeable to me - I only could tell because I suddenly gained five pounds in a few days after only having gained 4 lbs the entire pregnancy.

The only pre-e symptom I ever had was a nagging slight headache that would not go away for about 2 weeks. My doctors, through the end, were never sure if this was actually related to the pre-e or just a symptom of a pulled muscle in the neck or something.

Anyway good luck - your doctors sound a bit nutty to be honest. I would push back hard to get an official pre-e diagnosis before inducing.

[jindc]

re: fasting...the blood lab told me that some of the tests requested required fasting - there were like 18 tests in one blood draw!

maybe when I go in for my appointment Thursday I should ask for the blood panel done again?

[Anonymous]

Google the HYPITAT trial. After 38 weeks outcomes are better if you induce for even mild high blood pressure. The key is getting to 38 weeks for fetal development.

It sounds like you are downplaying your blood pressures. How do your current BPs relate to prepregnancy? Generally your BP in your third tri should be lower than your baseline prepregnancy. If it is higher than prepregnancy (even if not over 140/90) that could be worrying. Also, any spike in BP is worrying - even if the cause is anxiety or exertion. A high spike when anxious indicates that you are having trouble regulating it.

My story: BPs crept up in 3rd tri close (but never over) 140/90. After one really high spike in the midwives office at 39 weeks they sent me to be induced, even though it came down fairly quickly. No protein although they said I started to get some during labor. Delivery was fast and natural, healthy baby!

[jindc]

I have no idea what my normal BP is because I don't have a primary care doctor so haven't had an actual check up in a long time (I know, it's not good....but it is what it is and I couldn't find a PCP that took insurance once the one I used to see went "members only").

I'm not trying to downplay anything, I'm trying to avoid a doctor forcing me into a medical procedure that might not be necessary because of possibilities.

Like I said, I'm not one to downplay any of these very serious pregnancy issues - my mom had a stillbirth at 8 months for her first pregnancy, so I'm perhaps "tainted" in how conservative I am in pregnancy. I worry about everything.

[jindc]

also, how does monitoring your BP during delivery work?

If I have to be induced, I'd like to avoid magnesium and all that (and I know the risk doesn't go away right after delivery).

are you just hooked up to monitors? catheters for your urine?

and what happens if you're not ready to deliver and you get induced? I worry about forcing my body to do something it's not ready to do.

Sorry about all these questions...I want to be prepared and it sounds like there's no sure fire way to understand if a patient has pre-e or not, so they just error on the side of inducing.