| T O P I C R E V I E W |
| beetkvass |
Posted - 11/03/2009 : 1:58:42 PM
I am confused. I have noticed remarks about developing preeclampsia and the length of time having it, as long as 12 weeks even. When someone says they have preeclampsia what exactly is the definition? I read one thread where someone they never had a lot of protein in their urine but because their BP was so high they were still considered preeclamptic. Forgive me for not having all the links handy.
I assume that what I had before was not preeclampsia because my OB's never identified at such? I had severe edema, very high BP, horrible headaches and had to be hospitalized and then induced BUT I never had elevated protein that I was aware of.
However because I now have chronic hypertension I am at an increased risk for preeclampsia. Having had preeclampsia previously would be another risk factor...but is PIH a risk factor as well? I wish I had more of an idea what my "chances" are.
Do you not have preeclampsia till you meet all the criteria? And what exactly do people mean when they differentiate between having mild or severe preeclampsia in their sigs? Thanks! |
| 9 L A T E S T R E P L I E S (Newest First) |
| CountryMom27 |
Posted - 12/16/2009 : 2:43:37 PM
Like many here I had a variety of symptoms, different with each pregnancy. My first I had high BP quick onset at 39 weeks (150/85). Higher and increasing during labor, positive dip during labor, headaches & swelling. I was put on mag sulfate. My baseline non-pregnant BP is 90/60.
Second child, I had normal BP until 25 weeks when it hit 150/80. First urine test showed no protein, second 24 hr a week later showed protein of 800 which I believe would classify me as mild. Once on bedrest, my BPs would be fine until the moment I sat up even slightly and then they would shoot up - systolic & diastolic. My protein dropped too below 300 after bedrest. All of my NSTs and blood panels were good. But my episodes of climbing BP, my baseline BP, and my symptoms (visual disturbances, headaches, abdominal pain, swelling. ) worsened as my pregnancy progressed. I carried to term with both children.
I consider both cases to be mild PE b/c of my pressures and my low protein levels but based on how I felt, I'd say moderate. Not sure what the "official" diagnosis would be :-) |
| biokatie |
Posted - 12/13/2009 : 11:13:40 PM
When I was induced, due to 180/120 pressures, and + fetal lung maturity @ 36 weeks...the dr was teaching the residents that I was considered to be severe pre-e due to the presence of the high bp, headache, and hyperreflexia, no matter what the urine said, and that mag sulfate should be started. However, when they dipped the urine they did find a lot of protein. |
| Blythe |
Posted - 11/19/2009 : 8:13:08 PM
The Working Group Report defined severe PE on *one* extra symptom
http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_preg.htm
http://emedicine.medscape.com/article/796690-overview
Diagnostic criteria for severe preeclampsia include at least one of the following:
Systolic BP greater than 160 mm Hg or diastolic BP greater than 110 mm Hg on 2 occasions 6 hours apart with the patient at bed rest
Proteinuria greater than 5000 mg in a 24-hour collection or more than 3+ on 2 random urine samples collected at least 4 hours apart
Oliguria with less than 500 mL per 24 hours
Persistent maternal headache or visual disturbance
Pulmonary edema or cyanosis
Concerning abdominal pain
Impaired liver function test findings
Thrombocytopenia
Oligohydramnios, decreased fetal growth, or placental abruption
So you just need *one* severe marker to get the diagnosis.
Bianca, it sounds like NZ criteria are very similar to ours. The 30/15 was dropped from the diagnostic criteria in the Working Group Report, but most of our docs still recommend watching moms closely if bp increases like that. |
| nov_mum |
Posted - 11/19/2009 : 5:38:02 PM
The guidelines here are - if you bp increases by 30 systolic and 15 diastolic, plus protein in urine (protein/creatinine ratio) of 30mmols or more. Under 18 is normal, under 30 is tolerated in pregnancy and anything over is diagnostic. So, the bp depends on you booking bp. If you were 100/60 and then you had a bp of 130/75 that would be cause for concern and they would monitor for other signs. 24hrs urines are being phased out here. I did one through my entire hospital stay and experience with PE. The other sypmtoms of deraanged LFT's, RFT's, upper right quadrant/epigastric pain, visual disturbances and headaches.
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| missgamecock |
Posted - 11/05/2009 : 1:56:06 PM
Wierd because I was diagnosed with mild pe before Cate was born. Yet I had the neurological issues and my bp SHOT up the week I had her. My last ob appt is when it consistently 100 diastolic. However, after that appt, it was up to 160-170s/100-120 diastolic. So I guess I changed into severe too. My protein was low, but diagnotic. |
| jgrumet |
Posted - 11/05/2009 : 11:01:15 AM
my 24 hour urine came back extremely low and they blamed and protein from my extreme bleeding.
in the catheter my urine came back without even traces of protein.
after delivery I had trace amounts of protein in my urine and that was as high as it got.....
I definitely had HELLP, but I'm confused about if I technically had PE too. |
| my3tatertots |
Posted - 11/04/2009 : 4:45:07 PM
That's interesting about the definition of severe PE because I would have called my PE both times mild since I didn't have a ton of protein either time (2+ and 3+) at delivery and because my PE seemed to progress slowly with no other complications like HELLP. But my BPs were definitely 160/100 and higher so I guess I was severe both times after all. I asked my OB early on in this (my 3rd) pregnancy whether I was PE or PIH. He said it didn't really matter because the treatment plan was going to be the same either way. He's kind of laid back that way but not so much that he doesn't take my health and symptoms seriously. I see his point about it not mattering so much from his POV but for me, I want a definite diagnosis. I can say for sure that my 2nd pregnancy was PE according to the research definition. My 1st pregnancy was mostly likely PE too. Keeping my fingers crossed that the 3rd time is a charm. :-) |
| Caryn |
Posted - 11/04/2009 : 11:31:23 AM
Also, the research definition that Rachel's quoted -- two readings of either of 140/90 plus a 24-hour proteinuria of 300 mg -- is just that, a research definition. But pregnant women aren't always managed according to the research definition, because (as one of our Experts says) OBs treat women, not diseases, and there's no point in letting someone get a whole lot sicker in one way simply because she doesn't meet the research definition in another.
But our thinking about this syndrome is being revised on a daily basis. Scientists got their first really solid hit on causation in 2002, and since then the research literature has morphed daily.
They now think of preeclampsia as a disease that can present in a lot of different ways, depending on your underlying physiology and the genetic luck of the draw with any given placenta. The idea is that preeclampsia and HELLP syndrome and gestational hypertension are all variants of the underlying maternal-fetal conflict. All pregnancies involve negotiation between the mother's genes and the father's genes over how many maternal resources the baby can draw down through the placenta, to produce a thriving baby that's still small enough to fit through the pelvis. This negotiation is governed at the immune system level. Preeclampsia is likely a runaway immune response to the foreign organ of the placenta.
Some of our Experts have started referring to gestational hypertension with no proteinuria as "non-proteinuric preeclampsia".
The links in my .sig are a good place to start. I hope this helps! |
| rachelc |
Posted - 11/03/2009 : 5:25:49 PM
Let me start off by saying that I am not a medical professional. I am just someone who has been there, done that. My understanding is that preeclampsia is diagnosed with two bp readings of 140/90 or greater taken several hours apart and a 24 hour urine of 300 or greater. I think that often times people, including some medical professionals, use the terms preeclampsia and PIH interchangeably. Also, there are tests beside the 24 hour urine that indicate a woman is experiencing kidney problems in their pregnancy such as high uric acid or abnormal creatinine. It is possible that some practitioners would diagnose pe based on those tests.
Generally a pregnant woman is not diagnosed with preeclampsia until 20 weeks gestation. Development of symptoms similar to pih or preeclampsia before 20 weeks are generally attributed to another medical condition that the woman may have. The average time for diagnosis to delivery is two weeks. Some women deliver almost immediately after being diagnosed while others continue their pregnancy for many more weeks. The decision to deliver is based on a combination of factors including how the disease is affecting mother and baby as well as how far along the pregnancy is.
Diagnosis of severe preeclampsia requires that a preeclamptic woman have a bp reading of 160/100 and/or greater or a 24 hour urine protein of 5000mg or greater. I personally fell into the category of severe pe because my bp met the criteria even though my highest 24 hour urine was only 333 mg/dl. I did also have high uric acid.
The only way that you can know for sure whether you had PIH or PE is to get a copy of your medical records. You might be surprised by what your doctor didn't tell you. I did not know that I had HELLP syndrome with my first pregnancy until 9 years after the fact. I requested my medical records and it was written in my chart.
It is likely that your pregnancy unmasked your tendency for chronic hypertension. I too developed chronic hypertension after one of my pregnancies. Chronic hypertensives have a 25% chance of developing superimposed pe. I do not know if having pih increases those risks even more. If you are considering another pregnancy, I would highly recommend that you have a preconception consultation with a high risk specialist. He can go over your medical records with you and help you determine the best course of action for you. Some women discover that they had an underlying disorder that contributed to their pe. If your doctor feels that you may fit into this category he can recommend testing for that.
I hope that I answered most of your questions. We are all here to support each other so if you have more questions feel free to ask! |
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