Pre-E questions....anyone have experience?
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Anonymous
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OP, I think you should go read the HYPITAT study (available for free here: http://obgyn.med.umich.edu/sites/obgyn.med.umich.edu/files/Hypitat.pdf), because it doesn't say anything remotely close to what the PP said it did. The women in the study all had SUSTAINED readings of >95 diastolic, which you have not had, so you would not even have qualified to take part in it. There is a study currently being conducted about the merits of treating mild hypertension in pregnancy, but it won't be completed until the spring and the results won't be published until sometime after that.
I just researched this issue because my systolic BP is slightly elevated at 32 weeks, and what I found is that the primary concern about mildly elevated BP in late pregnancy is that it could turn into preeclampsia. You are obviously being monitored for that. Beyond that, there isn't much they're going to do for you because they generally don't consider giving meds until BP is sustained 160/110 (some docs probably do, but standard of care is not to intervene until BP gets very high, because meds can bring it down too much and that can be bad for the baby). According to the studies I read, the risks to baby from hypertension that is *NOT* preeclampsia only kick in at high levels -- mild hypertension does not increase negative outcomes for baby in the absence of preeclampsia. There is more concern about negative cardiovascular effects for mom but given that you are already nearing the end I don't think that's a concern for you. It sounds to me like you are a victim of size discrimination by your doctor and I would be very concerned about delivering with this practice. They are clearly setting you up for induction for reasons that are not based on actual evidence of a medical indication for such. Two random high blood pressure readings in the presence of otherwise normal ones and the absence of any clinical indications of preeclampsia is just a tempest in a teapot. It's good to be vigilant just in case you were to develop pre-e, but telling you they think that you will get it is totally unethical and out of line IMO. |
Anonymous
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Friend of JinDC here from separate thread.
First, J is not obese, and if you saw her you'd be like SERIOUSLY?! to the doc for the chubby shaming. I was just thinking of celebrities that plumped up a bit for description and I'd say somewhere between medium and heaviest Kelly Clarkson, at worst. So, maybe not at her fighting weight (which I know you'll get back to, J!) but NOT some serious heavyweight by any means. Also, she's definitely NOT downplaying the blood pressure based on what I know of her! So, J, I'm sorry, I don't mean to dump a load of crunch on you, but I'd push back hard on this. Not saying push back as in refuse, there's no way I could know enough to advise you on that. But, push back until you are comfortable with the reasoning behind the decisions and part of those decisions. I know you know some of my personal story, but here it is again: I've now been with two different medical practices through two different pregnancies and my blood pressure has always done the spikey thing toward the end. In both cases, no protein and no swelling, but the spikes are always concerning to me. With my first pregnancy I started out very slim and gained about 40 lbs. Yes, 40! Maybe even a bit more since I wasn't completely sure of my prepreg weight. With this pregnancy, I started off a good 15 lbs heavier than I was before my first pregnancy, and I have so far gained a scant 20 lbs at 35 weeks, which I am told is absolutely fine, but feels low. As it turns out, I'll probably end up weighing about the same at the end of this pregnancy as I did with my first, though I've gained much less weight to get here. The reason I'm sharing this is that I do think that weight gain / loss is a crapshoot (to some extent). Oh, also, my BP spikes are identical this pregnancy to last pregnancy (20 lbs 35 weeks, fairly faithful to the GW midwives diet and active vs. 40+ lbs first pregnancy, still somewhat active, but probably not as intentionally so if that makes any sense). With my first, when my BP was spiking, my OB asked me to come in 2x a week toward the end to monitor, and he said if it ever was high and didn't come right down, I'd go to hospital for monitoring. After a few times crossing town for the BP checks, I shared that this was a huge stressor for me, so he allowed me to have my best friend (a nurse) monitor my BP at home. My BP was always way lower at home, and her cuff was carefully calibrated. This time around, my midwives are likewise noticing spikes in my BP and their approach is that I come in, sit down (feet on floor and supported!) and put my left arm on the table and make sure it is supported. Take a few minutes to relax and calm down, then they take my BP. They also said the same thing as my first OB, if my OB reads high, then they'd simply ask me to sit still and relax to try and bring it down, and if it didn't come down, I'd go to hospital for monitoring. So far this has really worked wonders. But, if someone was up my ass the whole time about my weight gain, or worse, REALLY stressing me out over my BP, I'm sure it would be through the roof! Instead, my midwives have suggested that I come in, get comfortable, and think about something very peaceful, like a pleasant scene, or a person I have great empathy for. It helps so much. Also, the few times my readings are 140/90 or so (notably, after I got the scary ultrasound news and was beside myself, and another time when I was nearly in a fender bender trying to park and running late), they want to reread them in five minutes. When they've been 132/80's, they don't even bother and say that's just fine for me, even remarked that my BP "is behaving today." In the meantime, your doctor has been gunning for you about your weight since day one. Pre-E is no joke, as we know from our other Oct mom friends. I'd take it very seriously and I know you do. At the same time, your doctor really seems like a classic fat-shamer who almost wants you to have a problem to prove her right. (Am I crossing a line? I'm sorry if so, but that just seems really possible to me). (Further ironic because honestly I do not think you are particularly "fat"). Do you feel it is too late to change doctors? The reason I say this is, if you do NEED to be induced, or develop Pre-E, the last thing you need is to have lingering doubts over the necessity of it all, and you don't want to go into these things not trusting your doctor to be unbiased. To me, that is coming through loud and clear in your message, and even if you LOVE this doc otherwise, it's an issue that isn't likely to go away unless you talk it out, (respectfully above all else, of course!) or find a new doctor who sees you as a person and not a disaster waiting to happen. My advice: write down ALL of your questions, worries, and concerns. Take them to the different doctor you're seeing this week to discuss. Whether or not you discuss the inherent stress of your doctor constantly doubting your health despite evidence that you are healthy, and ignoring the difference between pregnancy induced hypertension (which is sometimes a problem, and often is NOT), white coat syndrome, and Pre-E. These all have different symptoms and diagnosis, and nothing you've shared indicates you meet the threshhold for any of them, except white coat syndrome. After all, pregnancy induced hypertension is not a blood pressure in the 130/90 range. It's higher, and has to be a repeat reading 2 hours apart, right? Anyway, yes, as you know, being "overweight" increases your risk of high blood pressure in life, generally, and likewise you have a higher chance of developing gestational hypertension. But this is not always the case, and even if you have that, it does not always lead to Pre-E. More advice: don't get ahead of yourself with magnesium and don't borrow worries. Find out what conditions your docs would prescribe it under. I'd be asking questions like this: why would the assumption be that this is Pre-E even without any other symptoms? Under what scenario would I be induced based on my symptoms as they are, or what changes could possibly take place that would make you favor inducing? Would I ever be induced based on worries about Pre-E if my blood pressure stays the same, or is this only if it increases? Would you induce based on blood pressure alone or would we do other monitoring first, like 24 hour protein collection or non stress test / biophysical profile to check on baby? Do you "believe" in white coat syndrome? Is it possible that the doctor asking me about my BP and weight all of the time, and the fact that it's triggering a "fight or flight" feeling when my BP is checked, is having an effect on my readings? Can I be seated and have my arm supported when you take my BP? If my BP did continue to climb, when would magnesium be necessary? I have heard a lot about magnesium and am fearful of the side-effects, is there anything I can do to reduce my chances of needing it? When would you consider prescribing magnesium? If I'm given magnesium, would that require separating me from baby? Anyway, sorry if any of this is overkill, or if I'm letting my own bias influence a personal issue of yours, and let me make clear again that I don't mean to suggest I have any idea what is medically necessary in your case. I ONLY know that you need to ask questions and get answers until you are personally comfortable and confident in your doctor's reasoning for diagnosis and any treatment. That is your right as a patient and it's called informed consent. You can't consent if you are not fully informed and bullying does not count for informing. xo Pumpkin |
Anonymous
I had pre-e, 3 times, the last time it was considered severe pre-e, but I had little to no swelling. My blood pressure was going up consistently and I had reached the maximum dose of labetalol (2400 mg/day) So typically there is a lot of swelling, in my case there was not. But my blood pressure was consistently above 150/110, my reflexes were off, and I was seeing spots and had a headache. I only had magnesium during my last delivery (not fun!), 2 of the 3 deliveries were before 37 weeks, but all 3 times I started dilating and had contractions the day of the diagnosis. (I knew all 3 times that they would be born that day, it was a gut feeling) My BP was checked every 15 mins, sometimes more than that. I did a total of 6 24 hour urine tests during my last pregnancy. Needless to say, I got my tubes tied. 
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Anonymous
| I remember your doctor also being so sure that you would have GD just based on your weight, right? It sounds like she is just super sensitive/anticipatory when it comes to overweight women. Maybe she just errs too much on the side of caution for whatever reason. I have no experience with pre-e or HELLP but I HAVE been induced before and even if you have to go through an induction, they're really not *that* bad! I was a FTM and my induction resulted in a labor that was 12 hours, start to finish, with only 14 minutes of pushing and no tearing or episiotomy. Healthy 6 lb 12 oz baby. So, even if she does try to schedule an induction, try to remain positive that it can still be a totally fine birth experience! |
jindc
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Hi all - thanks for the info - I'll definitely read the study when I get home (I can't get it to load here).
And thanks, Pumpkin - I know you know I'm not trying to make light of this! Your questions are really helpful - I'll put them in my notebook. I am seeing another doctor, which might be helpful because it'll be another set of eyes. I've also asked for an additional blood/urine test either prior to or at my next appointment. I've never had another doctor say anything about my BP (before pregnancy), nor did they say anything when I went to the monitoring a few weeks ago. le sigh |
Anonymous
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13:51 again. Sounds like you have a great friend, OP! I just wanted to add that I also have white coat. It started during my first pregnancy when I got the first above-normal blood pressure reading I had ever had. During my second pregnancy, I would occasionally get a reading as high as 160/100 in the doctor's office (and then 120/70 later that day at home), because I found getting my blood pressure taken so threatening. White coat is absolutely real. Does having it mean that you are at higher risk than someone who doesn't get white coat for developing chronic hypertension later in life? I have no doubt that that's the case. But if you get normal readings at home, you don't have hypertension yet and there's no reason to treat you as if you do. Everyone's blood pressure is labile, e.g. goes up and down during the day based on your activity level, food intake, state of mind, etc. What docs want to know about is your resting BP because that is what it is most of the time. The midwives approach your friend described is the right one because it is most likely to give an accurate picture of what your blood pressure is like a majority of the time.
I didn't want to say above that I think you should find a new care provider, because I know that is hard at the very end, but I thought it too. One of my children's births was a disaster because I had a care provider who I did not trust and I have regrets about it to this day. |
jindc
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thanks for this - it makes me feel a bit better. Yes, I've taken two GD tests, passed both with flying colors. I'm also not a fan of the "what should I eat to pass my GD test" questions because if I HAVE an issue, I want to KNOW so it can be managed for the healthiest pregnancy possible. Maybe I've read too much about inductions and epidurals for my own good lol |
Anonymous
The point of inducing for high BPs is to avoid preeclampsia and the inherent danger of elevated BPs alone. You are really minimizing. And the spikes are always a concern - the common practice of having you lie on your left side, "relax", whatever, actually produce false readings. OP may not yet meet the definition of hypertension in the HYPITAT study but that is obviously the standard of care her OB has in mind, so she should know about it, especially if her BP starts to increase. If you really distrust your doc that much you should change practices. |
Anonymous
Yeah, I think you are probably a little too fixated on inductions and epidurals. Inductions actually go better for preeclampsia and high BPs than the general population. My induction was fine - epidural was fine - it was all fine. Of course you should make sure you are comfortable with your care, but don't catastrophize. |
Anonymous
Geez, your doc let you go home when you had a BP reading that high? My midwife sent me straight to the hospital with a reading not even that high and I was induced that night. And these were the wisdom MW so not intervention pushers. |
jindc
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hm I've never been told to lie on my left side and relax - I take it on the dr's office bed thingy every time.
What is considered high if 140/90 isn't the standard some of you are using here? I think last time I went my BP was 131/73. also, can't change practices at 36 weeks. Any doctor on call will deliver me, though - it's GW. |
Anonymous
131/73 is actually relatively high. At that BP my docs were having me rest periodically on my left side during the day and eventually bedders when it got around 135/80-something. Especially if it is on an upward trend, your doc is correct to keep an eye on it. |
Anonymous
Can you please provide some cites (or reread what you're referring to, since it does NOT match your description of it) to go along with your fear-mongering? OP does not meet the threshold even for pregnancy hypertension, let alone Pre-E. So while it's good to be prepared and monitor for anything that is happening, there's absolutely no reason for her doctor to be talking induction over an isolated couple of readings in the 130/80 zone! Here are some cites that directly contradict you: Mild high blood pressure in pregnancy usually only requires close monitoring. If you have high blood pressure that is rapidly increasing or has reached moderately high levels, you may be treated with blood pressure medicine. Severe high blood pressure (higher than 160 mm Hg systolic or 110 mm Hg diastolic) can result in poor fetal growth (intrauterine growth restriction) and is likely to be treated with an antihypertensive medicine. source: http://www.webmd.com/baby/tc/preeclampsia-and-high-blood-pressure-during-pregnancy-treatment-overview "Your midwife will diagnose high blood pressure if: Your blood pressure shows a reading of 140/90 or higher for two readings, four hours apart. Your blood pressure shows a one-off reading of the bottom number (diastolic) of 110 or more. The diastolic reading is more important in giving information about your health. So if this figure alone is high, it's enough to mean you have high blood pressure.....gestational hypertension isn't usually a problem, although you will be referred to hospital for specialist care. http://www.babycentre.co.uk/a554818/blood-pressure-in-pregnancy#ixzz2gP7hXlU1" source: http://www.babycentre.co.uk/a554818/blood-pressure-in-pregnancy#ixzz2gP7ZaJqw If PIH is mild, it can be treated at home. If you have been diagnosed with PIH and your doctor recommends home treatment, you will need to maintain a quiet, restful environment with limited activity or bed rest on your left side. It is important that you follow the diet and fluid intake guidelines from your health care provider and maintain your scheduled appointments. Your perception of fetal movement every three hours is also important. Any changes need to be reported to your health care provider immediately. If PIH becomes worse, you will need to be admitted to the hospital where you can be closely monitored. Your health care provider will work with you to maintain the health of you and your baby. In severe cases, the baby may have to be delivered. High blood pressure is treated with medication, and magnesium is given through an IV to prevent seizures. source: cleveland clinic http://my.clevelandclinic.org/healthy_living/pregnancy/hic_pregnancy-induced_hypertension.aspx |
jindc
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but it's not any higher than it had been previously, which is why I'm wondering if there isn't an upward trend, why it is a sudden discussion of induction. It's regularly been, as I can remember, in the 120s-low 130s, and when I got a higher reading she said that the lower number was what was important and if it got to 90 that would be a concern. If it had regularly been in this range, why wasn't it brought up before so I could have extra monitoring or whatnot? I'm just confused, I guess. It wasn't really explained to me why it automatically meant we should discuss induction at my next appointment, etc. |
Anonymous
Gestational hypertension is diagnosed when blood pressure readings are higher than 140/90 mm Hg in a woman who had normal blood pressure prior to 20 weeks and has no proteinuria (excess protein in the urine). Please provide cites if you're going to dish out medical advice. http://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID=90&ContentID=P02484 |