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

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[Post New]10/08/2013 17:37
quote
Anonymous
Anonymous wrote:OP, 130s/80s is really not a big deal. This is the conclusion I came to when I checked out the literature. See, e.g., these links:

http://www.ncbi.nlm.nih.gov/pubmed/17253478

http://www.hindawi.com/journals/jp/2012/105918/ (this is the full article, see in particular sections 8, 9 & 10)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746761/

http://www.ncbi.nlm.nih.gov/pubmed/19250798

http://ncbi.nlm.nih.gov/pubmed/15842284

In all of these, *mild* gestational hypertension is defined as 140/90 and above. The conclusion in the literature is that mildly elevated BP in the absence of proteinuria and/or other symptoms of preeclampsia/HELLP does not pose a risk to the fetus, and in fact that treatment is riskier than expectant management (and does not affect the risk of developing preeclampsia in any event). If your doctor wants to induce at 40 weeks, it is simply because she doesn't think there is any benefit to the baby staying in past your due date, not because you *need* an induction for very slightly elevated BP. Hopefully you will go into labor on your own and this will all be moot, but I personally would not consent to an induction (particularly not as a FTM since they are far less likely to be successful) in the absence of a specific clinical indication that one is medically necessary, i.e. signs that preeclampsia is developing. Good luck!


+ a big, heartfelt 1. I'd push her on this. Why would she be uncomfortable letting you go past 40 weeks with "very mild hypertension?" My doctor has a very different approach and my BP numbers are about the same as yours. My first birth went to 41 weeks, and no plans to induce at 40 weeks with this one for similar numbers and he says the evidence does not support it. So, I'd just question, unless you don't mind the induction.
[Post New]10/09/2013 10:32
quote
jindc
Member Offline
thanks - I think if it gets to that point, I'll ask for a second opinion from another OB if I can.
I do mind an induction for the sake of induction - I know how it works if your body is not at all ready for it. I'm on 1CM dialated and just over 50% effaced so if I got drugs now for induction, I'd be screwed.
I appreciate caution, for sure, but I'm not sure I view this as caution or doubt that an overweight woman with mildly elevated BP (which might be normal!) can have a perfectly healthy pregnancy and delivery. I want to hope it's extreme caution.
I'm going in for a growth scan today, and I go back Monday. I'm going to transition to half days at work, so to me that gives my doctor the option to have me come in for extra monitoring (BP/urine checks) for piece of mind.

That said, the thought - now - of going to 41 weeks....UGH! lol
[Post New]10/10/2013 13:01
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Anonymous
What did the growth scan show?
[Post New]10/10/2013 13:26
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jindc
Member Offline
thanks for asking - he's clearly NOT measuring small.
Estimate from scan was 8lbs 2oz currently (obviously give or take the 10% in either direction). 38 weeks pregnant.

When she was measuring the head, my husband said, "is it normal sized?" and the sonographer said, "actually measuring a little big". Grrrreat.

But - no small baby here, that we can tell. Not sure what the next step is. I go back Monday. I've been reading up on inductions vs Bishop Score so I have the info I need.

I am going to start working half days next week, which might help my overall circulation/BP. If the weather clears up, I'll make an effort to walk in the afternoon once I'm home and fed so as to try to help move "bishop score" points along.
[Post New]10/10/2013 16:15
quote
Anonymous
Anonymous wrote:OP, 130s/80s is really not a big deal. This is the conclusion I came to when I checked out the literature. See, e.g., these links:

http://www.ncbi.nlm.nih.gov/pubmed/17253478

http://www.hindawi.com/journals/jp/2012/105918/ (this is the full article, see in particular sections 8, 9 & 10)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746761/

http://www.ncbi.nlm.nih.gov/pubmed/19250798

http://ncbi.nlm.nih.gov/pubmed/15842284

In all of these, *mild* gestational hypertension is defined as 140/90 and above. The conclusion in the literature is that mildly elevated BP in the absence of proteinuria and/or other symptoms of preeclampsia/HELLP does not pose a risk to the fetus, and in fact that treatment is riskier than expectant management (and does not affect the risk of developing preeclampsia in any event). If your doctor wants to induce at 40 weeks, it is simply because she doesn't think there is any benefit to the baby staying in past your due date, not because you *need* an induction for very slightly elevated BP. Hopefully you will go into labor on your own and this will all be moot, but I personally would not consent to an induction (particularly not as a FTM since they are far less likely to be successful) in the absence of a specific clinical indication that one is medically necessary, i.e. signs that preeclampsia is developing. Good luck!


OP listen to your doctor. The worry is that your BP is borderline hypertensive and could develop into pre eclampsia. There is plenty of evidence that induction after 37 weeks if your BP continues to creep up a bit further is the safest option. Induction may be over used, but it is also medically indicated sometimes. Of course you should get all the second opinions you need, but your OBs concerns are warranted and very much in line with the standard of care.
[Post New]10/10/2013 16:19
quote
Anonymous
jindc wrote:thanks for asking - he's clearly NOT measuring small.
Estimate from scan was 8lbs 2oz currently (obviously give or take the 10% in either direction). 38 weeks pregnant.

When she was measuring the head, my husband said, "is it normal sized?" and the sonographer said, "actually measuring a little big". Grrrreat.

But - no small baby here, that we can tell. Not sure what the next step is. I go back Monday. I've been reading up on inductions vs Bishop Score so I have the info I need.

I am going to start working half days next week, which might help my overall circulation/BP. If the weather clears up, I'll make an effort to walk in the afternoon once I'm home and fed so as to try to help move "bishop score" points along.


BTW, there is actually a study indicating that an unfavorable bishop score is actually more of an indication for induction for hypertension/pre eclampsia.
[Post New]10/10/2013 16:27
quote
jindc
Member Offline
OP here...yes, I know to take it seriously, but my doctor is also (obviously) not in a rush. I saw her Tuesday. I go back Monday. Part of the point of me working half days after this week is so that I'm available for increased screening if necessary. I know PRE-E develops quickly, as I've said a few times on this thread. But I also know that my doctor worries a lot.

Also, what does "unfavorable bishop score is actually more of an indication for induction" mean? indication of what? successful? Not successful? If you read the thread, my worry is being induced because of fears, not justifications, and that the induction will fail because I'm not close enough to being ready so labor doesn't start properly/stalls and I end up needing a C-Section.
[Post New]10/10/2013 17:00
quote
Anonymous
jindc wrote:OP here...yes, I know to take it seriously, but my doctor is also (obviously) not in a rush. I saw her Tuesday. I go back Monday. Part of the point of me working half days after this week is so that I'm available for increased screening if necessary. I know PRE-E develops quickly, as I've said a few times on this thread. But I also know that my doctor worries a lot.

Also, what does "unfavorable bishop score is actually more of an indication for induction" mean? indication of what? successful? Not successful? If you read the thread, my worry is being induced because of fears, not justifications, and that the induction will fail because I'm not close enough to being ready so labor doesn't start properly/stalls and I end up needing a C-Section.


I am sorry I can't link it here, but google "unfavorable cervix hypitat."

Keep in mind that your doctor does not think in terms of "justification" - she is thinking about risks, benefits, and the severity of those risks. So you should ask her to explain how she is weighing the risks of induction vs the risks of waiting.
[Post New]10/10/2013 17:28
quote
jindc
Member Offline
Thanks, I'll check it out.
I am sure on Monday we will talk excessively about our options.

Fwiw I do think I have been very proactive in assessing my risk factors - asking for the blood work and 24 hr urine collection. Starting Monday, I might see if coming in every few days will be more or less helpful.

I am not opposed to induction in general, but it is natural to fear failed induction. I think I need to structure the conversation to also include how they determine induction processes aren't working. Because an impatient doctor might have more to do with a csection outcome. And I might have to forego natural birth if induction is unbearable. But that's life, right?
[Post New]10/11/2013 10:47
quote
Anonymous
Anonymous wrote:
Anonymous wrote:OP, 130s/80s is really not a big deal. This is the conclusion I came to when I checked out the literature. See, e.g., these links:

http://www.ncbi.nlm.nih.gov/pubmed/17253478

http://www.hindawi.com/journals/jp/2012/105918/ (this is the full article, see in particular sections 8, 9 & 10)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746761/

http://www.ncbi.nlm.nih.gov/pubmed/19250798

http://ncbi.nlm.nih.gov/pubmed/15842284

In all of these, *mild* gestational hypertension is defined as 140/90 and above. The conclusion in the literature is that mildly elevated BP in the absence of proteinuria and/or other symptoms of preeclampsia/HELLP does not pose a risk to the fetus, and in fact that treatment is riskier than expectant management (and does not affect the risk of developing preeclampsia in any event). If your doctor wants to induce at 40 weeks, it is simply because she doesn't think there is any benefit to the baby staying in past your due date, not because you *need* an induction for very slightly elevated BP. Hopefully you will go into labor on your own and this will all be moot, but I personally would not consent to an induction (particularly not as a FTM since they are far less likely to be successful) in the absence of a specific clinical indication that one is medically necessary, i.e. signs that preeclampsia is developing. Good luck!


OP listen to your doctor. The worry is that your BP is borderline hypertensive and could develop into pre eclampsia. There is plenty of evidence that induction after 37 weeks if your BP continues to creep up a bit further is the safest option. Induction may be over used, but it is also medically indicated sometimes. Of course you should get all the second opinions you need, but your OBs concerns are warranted and very much in line with the standard of care.


Hyperconservative PP, just STOP trying to scare the OP. You are wrong. The literature does not support your opinion. That's why I posted the above links. If you are happy with having been induced unnecessarily, bully for you. Not all of us are okay with that. I have had three babies, had an occasional high blood pressure reading during all three pregnancies, and it was NOTHING. The studies say that about 45% of women who present BEFORE 36 weeks with elevated BP will go on to develop preeclampsia. You know what that means? 55% won't develop it. So the reasonable course is to continue to monitor for pre-e but otherwise just fucking relax.
[Post New]10/22/2013 14:55
quote
jindc
Member Offline
Op here
Today we just went ahead and scheduled an induction for next week. I am due Friday (the 25th) and my doctor and I weighed the options together and discussed the process.

She doesn't think blood pressure is much of an issue at this point but concluded that we might not know. The issue at this point might be size - he hasn't even dropped and she it could be a his big head just won't engage and the only way to find out is trial and error (lucky me).

So I am content and at this point just hope I can avoid a c section. I'll be beyond full term and he still has time to make an appearance on his own before induction. I am also comfortable with my input in the process - I can choose to wait out induction for a long time if I want, and try multiple cervidil attempts before using pitocin.

But still, sort of sad it looks like he won't come on his own. Trying to remain hopeful for a vaginal delivery but I do NOT feel pressured into a c section by my doctor at all. She said I could be there for three days being induced if I wanted (um, no thanks!).

So that's what's up with my blood pressure story. Will spend the weekend walking and maybe having sex. Which sounds horrible at this point! Thanks all for the experiences/advice/kind words
[Post New]10/22/2013 19:35
quote
Anonymous
Hi J- Turkey here from the old thread. I was thinking of you and this thread today and was trying to find it on my phone from the drs office. My bps - typically 117/80 - were 139/89 and 140/88 this morning and I started to really worry. No protein in my urine and ultimately after awhile it dropped down to 120/80. Phew. I have a regular OB appt this Thursday so I will be reading through this again tonight!

I hope your LO makes his debut very soon! Best wishes for an easy delivery and a healthy and happy mom and baby!
[Post New]10/22/2013 23:09
quote
Anonymous
You can have a natural delivery (i.e. - pain med free & vaginal) with an induction. I've done it 4 times. You need to have a doula/ a good team to help you cope with the pain toward the end.
[Post New]10/23/2013 07:20
quote
Anonymous
Anonymous wrote:You can have a natural delivery (i.e. - pain med free & vaginal) with an induction. I've done it 4 times. You need to have a doula/ a good team to help you cope with the pain toward the end.


This is true, but you should also make sure you're up and moving around. If baby is not dropping and not ready, I hate to say this, but it usually means with first time moms that baby is just not ready. Once you force things, you not only have to be moving around to reduce pain, but you also need to be moving around to open up your body and get baby into position. Can your OB tell which way baby is facing? Check out the website spinning babies over the weekend to look into moves and positions you can use during labor to help maximize good position before and during labor. A friend of mine was induced and the nurses told her she'd have to stay in bed all night once the cervadil is in. It sounds like your doctor is going to go to bat for you that you can do cervadil minus pitocin and see what happens with your cervix and if she means it, this is FANTASTIC. Get the cervadil going and that alone might put you into labor. If it does, and you feel antsy, by all means listen to your body and not some nurse telling you that you need to be in bed because the monitor is slipping, etc. Get up, walk around, get on hands and knees, do what your body is telling you to do. This will help you minimize the chances of surgical intervention becoming necessary by ensuring your body can open up for labor. Remember, you were designed to do this. Sure, sometimes things happen and thankfully surgery is there if you really need it, but MOST of the time, the body can do it.
[Post New]10/23/2013 07:35
quote
jindc
Member Offline
Op here - I don't have a doula ($$$) but my husband and I have done a lot of work on unmedicated labor including Susan Messina's class and a class about using yoga and massage in labor. He knows that I am going for unmedicated because of the moving around.
My doctor told me that once the Cervidil is in, I need to be in bed for an hour but after that can move around as I want - stairs, shower, whatever. I just can't leave the hospital. And she didn't make it seem like she was stretching policy - but that two rounds of Cervidil is everyone's option.

I have read a lot about how to get baby to move. I sit in the floor when we watch tv, go for walks, sit on the ball, etc. I obviously know that if he isn't ready, induction isn't ideal but I do respect that my provider has a reason to be concerned about blood pressure and size - even if ultrasounds are off, his head was (my husband has a big head!), which could be preventing him from engaging...in which case we won't know until we try.

It's definite not an ideal situation, but I respect weighing the risks and benefits. I'll be past 40 weeks and he will be fine. I have come to terms with the situation not being what I had prepared for. Since my doctor won't be there (she delivers a different day) I don't believe this has anything to do with her convenience but instead not wanting to wonder about my bp first, baby getting even bigger second.

I go back Monday for an NST and check, and will have a short discussion about what steps I should take at the hospital to avoid being sectioned. GW doesn't seem to push c-sections and I know my doctor wants me to avoid it.
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