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beetkvass
Starting Member
US
35 Posts |
 Posted - 11/03/2009 : 1:58:42 PM
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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! |
Marcella
David Benjamin 05/00
William Isaac 05/01
Fintan Anthony 06/04
Eudora Irene LeClerc 10/16
Emmeline Caroline Marie 02/23
Little one due 07/05/10 |
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rachelc
Advanced Member
USA
538 Posts |
Posted - 11/03/2009 : 5:25:49 PM
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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! |
Rachel Proud Mom of 3 Girls!
Courtney 3 lb. 13 oz born 9/12/99 33 weeks due to Severe PE
Sierra 6 lb. 8 oz. born 8/1/04 36 weeks due to PE
Haley 5 lb. 7 oz. born 5/8/07 33 weeks due to Severe PE |
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Caryn
Ask the Experienced Moderator
USA
7654 Posts |
Posted - 11/04/2009 : 11:31:23 AM
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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! |
Science is getting us closer to finding a cause, and even a cure. The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
Caryn, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE |
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my3tatertots
New Member
US
50 Posts |
Posted - 11/04/2009 : 4:45:07 PM
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| 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. :-) |
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jgrumet
Junior Member
473 Posts |
Posted - 11/05/2009 : 11:01:15 AM
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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. |
Jamie (22)
Brian (26)
Aram 6/22/2008 born 33 weeks 5 days- HELLP class II
Adopting next baby 2010! |
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missgamecock
Senior Member
USA
6058 Posts |
Posted - 11/05/2009 : 1:56:06 PM
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| 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. |
Sabrina, mom of Kirsten Scout DOB 3/27/99, 5lbs, 1oz., 36 weeks 0 days, severe PE, & Sara Grace DOB 6/28/05, 6lbs 1oz., Severe PIH, 35 weeks 5 days. #3 Peyton, lost at 13 weeks 3 days on 2/21/08
4th - Lost at 5 weeks 4/30/08.
DD #3, Caitlyn Elyse (Catie), a Rainbow Baby, DOB 1/16/09, 5lbs 7 ozs, 36 weeks, Diagnosed w/ chronic HTN, RT Uterine Artery Notching, and mild PE.
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nov_mum
Starting Member
NZ
7 Posts |
Posted - 11/19/2009 : 5:38:02 PM
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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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Blythe
Ask the Experienced Moderator
USA
2081 Posts |
Posted - 11/19/2009 : 8:13:08 PM
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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. |
Heather - mom to
DS #1 - 7/18/03, 37 weeks - Mild PE, 5lbs, 8oz, 4 days in NICU
DS #2 - 8/11/06, 36 1/2 weeks, 6lbs, 14oz!!! Induced for diagnostic BP. No NICU!
DD #3 - 9/10/09, high bp at 33 1/2 weeks, induced at 37 weeks, 5 pounds, 12 ounces - healthy girl!
"Thank God for the internet - otherwise my children would be raised in a med school library" |
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Explain what defines having preeclampsia better?
