Induction for signs of pre-eclampsia at 37.5 weeks?

[Anonymous]

I am 37 weeks today and at my appt this morning my BP was slightly elevated and I am having increasing amounts of swelling in my legs. I had a three pound weight jump this week and have not been eating a lot (crowded stomach not allowing that!) and my doc attributed the weight gain to water. I have to start going in twice a week now to monitor for pre-eclampsia. So I am going in Monday and I am wondering at that point, if BP has gone up even more or there are other signs of pre-eclampsia, and they want to induce, is it worth fighting for bed rest or am I better off just letting them induce at 37.5 weeks? Pregnanct has been totally uneventful until this week and everything I know technically I am full term now but I feel like it would be better to get to 38 or 39 weeks if possible. Anyone had a similar situation?

[Anonymous]

I got induced at 37 weeks after I gained 7 lbs in one week, my BP was elevated, and my edema was disgustingly awful. My delivery was normala nd my baby came right home with me.

Don't fight it - have the baby and get yourself healthy. You're 37.5 weeks - I mean, seriously - you're at term. If you were like 31 weeks, I'd understand - but 37.5? I've had a preemie in the past so I know the risks of early delivery and NICU stays, but at 37.5, your chances of a healthy baby are great.

Your body is telling you it's not happy or healthy and the ONLY cure for PE is delivery. I know a family that lost the mom to PE which degenerated into HELLP and DIC - she hemorrhaged at the birth and never recovered. Why mess around with it?

Good luck and best wishes for a healthy mom and baby!

[Anonymous]

Anonymous wrote:I got induced at 37 weeks after I gained 7 lbs in one week, my BP was elevated, and my edema was disgustingly awful. My delivery was normala nd my baby came right home with me.

Don't fight it - have the baby and get yourself healthy. You're 37.5 weeks - I mean, seriously - you're at term. If you were like 31 weeks, I'd understand - but 37.5? I've had a preemie in the past so I know the risks of early delivery and NICU stays, but at 37.5, your chances of a healthy baby are great.

Your body is telling you it's not happy or healthy and the ONLY cure for PE is delivery. I know a family that lost the mom to PE which degenerated into HELLP and DIC - she hemorrhaged at the birth and never recovered. Why mess around with it?

Good luck and best wishes for a healthy mom and baby!

OP here. Thanks for this story. Do you know if you were dilated at all before induction. I am not.

[Anonymous]

I had a very similar situation around 37 weeks, and I did the opposite of the PP. My midwife and I discussed the options and decided that my BP was only slightly elevated (bottom number was 93), I had gained 3 lbs in one week as well, and I was not testing positive for protein in my urine. We agreed to continue testing me 2x per week, and I bought a blood pressure cuff to monitor my BP at home. It never went more than slightly elevated, my weight gain didn't spike again, and I never tested positive for protein in my urine. Under these circumstances, my midwife and I determined that it was best to wait until the baby came on its own, unless something took a turn. It never did. And baby came at 40W5D. My recommendation is to see how it goes and if your symptoms don't worsen, then I wouldn't induce.

[Anonymous]

11:46 here. PP is right - the BP numbers may well dictate your course of events. I had elevated BPs for a week before I was induced and both the systolic and diastolic were too high. Had a BP cuff, taking my BP hourly, had a nurse coming to my house to check on me, etc. My OB sent me to Sibley for monitoring three times during week 36 based on my BP numbers. I never had any more than trace protein in my urine.

I was 3 cm dilated and 90 % effaced when I was induced at 37w, 1d. Actually, I didn't even end up getting "induced" - all they did was break my water and baby was born in under 2 hours.

I don't want to sound like a reactionary or the voice of doom, but PE is a very serious thing and should not be taken lightly. Really talk it through with your doctor and decide what's safest. Your OB wouldn't tell you to deliver (and as I understand it, hasn't yet) unless he or she thinks that is safest for you.

[Anonymous]

I'm pretty sure bed rest isn't typically imposed after the 36 week mark.

[Anonymous]

OP here. I should mention, my BP was only 120 over 80, which as I understand it is normal for most people but it is definitely up from where I've been (110 over 70 recently and even lower in the second trimester) so elevated for me and there was the weight jump and somewhat significant swelling. It doesn't seem like there is much reason to be concerned right now but I am just trying to plan ahead in case things do go downhill. I totally trust my doctors though so I guess I just go with the flow.

[Anonymous]

High blood pressure and/or swelling simply does NOT equal pre-eclampsia. Both of these can be very normal variations towards the end of pregnancy. Yes, they *can* be warning signs of pre-e, and of course full blown pre-e is indeed quite dangerous. However, it would be very reasonable to just watch and wait at this point. Also, if you are interested, there are ways to bring down your bp such as acupuncture, herbs/homeopathy, simple stress-reduction efforts, massage, and 20-30 minutes of walking daily. Walking (followed by elevating your legs) will also help to reduce the lower extremity swelling. On the other hand, if you are someone that is planning on a medicalized birth, or are open to induction or cesarean, then getting induced now would probably be just fine (maybe wait until 38 weeks to give baby a few more days to grow.) Good luck with whatever you decide.

[Anonymous]

I faced a similar situation at the end of my pregnancy but like a PP, my midwife felt it best to take a wait and see approach. My symptoms resolved and nothing dangerous developed. I was glad I waited and my baby was born at 41 weeks 5 days.

When I was in your situation, I remember reading that even babies born at 37 weeks can have health issues that wouldn't exist if they'd stayed in longer. So for me I really wanted to wait it out unless there was an obvious danger to me or my baby. Here's one article I remember reading.
http://www.usatoday.com/news/health/2005-10-09-babies-birth_x.htm

Also I think it's important to be aware that an induction (especially with an unfavorable cervix) could increase your chance of a cesarean. That was another reason I really wanted to wait as long as possible.

good luck to you!

[Anonymous]

I was induced for PE at 38 weeks but I had clear protein in my urine and my blood pressure had been steadily rising for weeks. It was higher than OPs. I was also massively swollen.

I was induced, put on a magnesium sulfate IV, and able to deliver from start to finish in about 20 hours. (It was my first and I didn't have an epi.) I was not a great candidate for induction because the baby was high and I was 50% effaced but not really dilated. My doula told me that when a woman has PE, an induction is more likely to work because the body is in a sense rejecting the baby. I have not discussed this with my OB but the induction worked quite well for me.

Good luck either way, OP.

[Anonymous]

I had high blood pressure starting at 37 weeks (130 / 80) and they had me in to monitor it twice a week. I also had swelling, but no weight gain or protein in urine. I fought induction for 2.5 weeks and finally when BP was 150 / 80 and it was right before that last blizzard did they convince me it was the safest thing to do.

I was 3cm and 50% effaced that morning and just needed 2 tablets of cytotec before I went into full labor myself. Not as bad an experience as i thought it'd be.

120/80 doesnt seem that high - just something they should monitor, if you ask me.

I'm glad I listened, though, because my DD was 9 lbs, 10oz!! So I'm glad I didnt wait any longer But that's not saying you should get induced at this point - just had a big baby

[Anonymous]

OP I've been induced for PE twice. With DC1, I was diagnosed with PE at 28 weeks and made it to 33 weeks on BP meds and bedrest. I had high BP, protein in urine and started to develop HELLP (liver enzymes and clotting ability tanked). With DC2 I made it to 40 weeks but my BP spiked up to 160/100 so I was induced. My BP spiked to 220/110 during delivery. For both kids I had a vaginal delivery and no epi though strict natural birth advocate would probably say it was unatural since I was on Magnesium Sulfate for the first and IV BP meds during delivery for my second. My BP is normally 90-100/60-70.

BP rise from PE is not the same as general hypertension and does NOT respond to walking and other homeopathetic remedies, even specific BP meds have a limited effect. This is awful and dangerous advice from a PP. In PE, the baby is not receiving enough oxygen and the placenta sends out a substance that attempts to increase the blood flow to the fetus. This causes high blood pressure and damages your blood vessels which causes the edema, and affects organs such as your kidneys (hence spilling protein) and liver. The last thing you would want to if you do have PE is to exercise and divert more blood from the fetus pushing the cascade effect.

In PE your BP usually becomes labile first. It spiked up and then comes down. As PE progesses it doesn't come down.

The clinical diagnosis of mild PE is two in office readings of 140/90 and protein (300+) in your urine. PIH is two readings of 140/90 without the protein. Severe PE or severe PIH is a reading for 160/100. PIH can be just as dangerous as PE and clinicians/researchers now view these as progessions of the same disease. The general standard of care is to induce for mild after 37 weeks and after 34 weeks for severe PE though depending on your other symptoms can be much sooner. You can develop PE up to six weeks post partum.
Some patients present non-textbook patterns so there are new recommendations to closely monitor patients who reach 120/80 or present a greater than 30 pt increase from their normal non-pregnant BP in the third trimester.

If at one of your next office visits you have a reading of 140/90 they will probably have you lay on your left side for a few minutes and take your BP again. If it reads 140/90 you will probably be sent to labor and delivery to induce. You could request to be monitored in L&D and run the blood panels and be released if it comes down. With my second I hit 140/90 twice around 36 and 38 weeks so my MFM sent me to L&D but my BP came down each time so I was able to go home.

The office protein strips are not very accurate and the only real way to measure is with a 24 urine collection (PITA). At 37.5 weeks they probably would not have you do this.

You could get a home BP monitor and check yourself once or twice a day and after delivery. If your BP goes up at home and does come down after laying on your left side for a few minutes, you have visual problems (floaters, lights, sudden blurryness), upper left abdominal pain, or a horrible headach call your doctor immediately and don't feel silly about going to L&D immediately. PE can move fast in some cases leading to stroke, seizures, abruption, or reverse flow.

[Anonymous]

Anonymous wrote:OP I've been induced for PE twice. With DC1, I was diagnosed with PE at 28 weeks and made it to 33 weeks on BP meds and bedrest. I had high BP, protein in urine and started to develop HELLP (liver enzymes and clotting ability tanked). With DC2 I made it to 40 weeks but my BP spiked up to 160/100 so I was induced. My BP spiked to 220/110 during delivery. For both kids I had a vaginal delivery and no epi though strict natural birth advocate would probably say it was unatural since I was on Magnesium Sulfate for the first and IV BP meds during delivery for my second. My BP is normally 90-100/60-70.

BP rise from PE is not the same as general hypertension and does NOT respond to walking and other homeopathetic remedies, even specific BP meds have a limited effect. This is awful and dangerous advice from a PP. In PE, the baby is not receiving enough oxygen and the placenta sends out a substance that attempts to increase the blood flow to the fetus. This causes high blood pressure and damages your blood vessels which causes the edema, and affects organs such as your kidneys (hence spilling protein) and liver. The last thing you would want to if you do have PE is to exercise and divert more blood from the fetus pushing the cascade effect.

In PE your BP usually becomes labile first. It spiked up and then comes down. As PE progesses it doesn't come down.

The clinical diagnosis of mild PE is two in office readings of 140/90 and protein (300+) in your urine. PIH is two readings of 140/90 without the protein. Severe PE or severe PIH is a reading for 160/100. PIH can be just as dangerous as PE and clinicians/researchers now view these as progessions of the same disease. The general standard of care is to induce for mild after 37 weeks and after 34 weeks for severe PE though depending on your other symptoms can be much sooner. You can develop PE up to six weeks post partum.
Some patients present non-textbook patterns so there are new recommendations to closely monitor patients who reach 120/80 or present a greater than 30 pt increase from their normal non-pregnant BP in the third trimester.

If at one of your next office visits you have a reading of 140/90 they will probably have you lay on your left side for a few minutes and take your BP again. If it reads 140/90 you will probably be sent to labor and delivery to induce. You could request to be monitored in L&D and run the blood panels and be released if it comes down. With my second I hit 140/90 twice around 36 and 38 weeks so my MFM sent me to L&D but my BP came down each time so I was able to go home.

The office protein strips are not very accurate and the only real way to measure is with a 24 urine collection (PITA). At 37.5 weeks they probably would not have you do this.

You could get a home BP monitor and check yourself once or twice a day and after delivery. If your BP goes up at home and does come down after laying on your left side for a few minutes, you have visual problems (floaters, lights, sudden blurryness), upper left abdominal pain, or a horrible headach call your doctor immediately and don't feel silly about going to L&D immediately. PE can move fast in some cases leading to stroke, seizures, abruption, or reverse flow.

Stop being such a whack job. The point is that she doesn't have any clear signals indicating PE. Therefore, working with her body to lower her BP is definitely not "awful and dangerous" advice. Many many midwives - extremely competent maternity care providers - recommend these exact things. And, they have great success with them. Just because YOUR personal experience was full blown eclampsia, doesn't mean that everyone with a slightly elevated bp and some swelling in their legs is going to keel over from pre-e.

[Anonymous]

Please, please, please listen to your doctor - my sister developed PIH at 28 weeks, PE at 30, which rapidly deteriorated into HELLP syndrome. They induced at 30 weeks 2 days - no one knew if my sister and/or the baby would survive. We had a happy ending, both my sister and my niece (now 3 & 1/2) are doing great, but please don't take any risks.

[Anonymous]

"Stop being such a whack job. The point is that she doesn't have any clear signals indicating PE. Therefore, working with her body to lower her BP is definitely not "awful and dangerous" advice. Many many midwives - extremely competent maternity care providers - recommend these exact things. And, they have great success with them. Just because YOUR personal experience was full blown eclampsia, doesn't mean that everyone with a slightly elevated bp and some swelling in their legs is going to keel over from pre-e. "

You are a whack job. I have researched this extensively and I am active in PE support groups. Ignorance about this disease can have tragic outcomes and I know women who suffered horrible loses from listening to uninformed mid wives. There are many wonderful midwives out there and having PE does not mean you can not have a mid wife as long as an MFM is consulting or a doula. Telling a woman that she can work with her body to reverse PE is dead wrong and dangerous.