UPDATE Confused, help?

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caryn
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Re : UPDATE Confused, help?

Postby caryn » Thu Jul 15, 638923 11:00 am

That's not quite right, as I understand things -- proteinuria is just one measure of severity, and not a terribly useful one. Regular checks are great, especially if they're running labs and NSTs, but high pressures are dangerous in and of themselves, which is why the NIH Working Group Report talks about medicating women with sustained pressures above around /100.

Are you doing kick counts at home? Do you have any of the other symptoms? Is your doc consulting with a MFM?

ashesashie
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Re : UPDATE Confused, help?

Postby ashesashie » Sat Jul 03, 638923 2:47 pm

Thank you ladies. Caryn thank you for the medical studies, that gives me a better idea. I appreciate everybody's input, I really trust your judgment. I will let you know when I hear back from the Dr.

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caryn
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Re : UPDATE Confused, help?

Postby caryn » Sat Jul 03, 638923 2:39 pm

Oh, and keep us posted as you're able -- I think you're quite right to be worried, and I wouldn't be surprised if the next time we hear from you you're in the hospital or have a new baby. :)

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l412angel
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Re : UPDATE Confused, help?

Postby l412angel » Sat Jul 03, 638923 2:35 pm

I would request Labs to be redone...maybe demand they be redone...can never be too careful!

I know you want to give baby more time, but you need to be healthy as well, baby will need you!

I would o to L&D...your pressures are scary!

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caryn
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Re : UPDATE Confused, help?

Postby caryn » Sat Jul 03, 638923 2:35 pm

Really severe hypertension like you're reporting (that 172/117 scares me) is usually something they monitor very, very closely -- and/or treat with meds or IV mag sulfate -- regardless of gestational age.

I didn't remember this from your previous posts, but you're diagnostic for protein -- you only have to be above 300 once -- so you're a severe PE patient. You just need 300 mg of proteinuria and one reading above 160/100. Severe PE patients are "considered" for induction at 34 weeks according to the NIH Working Group Report, and are often monitored in a tertiary hospital and watched day-to-day. Here's a link and a quote:

Hospitalization for the duration of pregnancy is indicated for preterm onset of severe gestational hypertension or preeclampsia. The decision to prolong the pregnancy in these women is determined day by day. The women should receive intensive maternal and fetal surveillance, usually at a tertiary care facility. Laboratory studies are performed at frequent intervals and include serial determinations of platelet count, serum liver enzyme levels, renal function, and urinary protein. Assiduous attention is given for worsening hypertension; evidence of central nervous system involvement that includes severe headache, disorientation, or visual symptoms; and hepatic involvement indicated by epigastric pain and tenderness.

It also says that Antihypertensive therapy is indicated when blood pressure is dangerously high or rises suddenly in women with preeclampsia, especially intrapartum. Antihypertensive agents can be withheld as long as maternal pressure is only mildly elevated. Some experts would treat persistent diastolic levels of 105 mm Hg or higher. Others would withhold treatment until diastolic blood pressure levels reach 110 mm Hg. In adolescents whose diastolic pressures were recently below 75 mm Hg, treating persistent levels of 100 mm Hg or higher may be considered. So I'd ask about meds, and if there's a point at which they'd admit you for closer monitoring.

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Re : UPDATE Confused, help?

Postby sam10 » Sat Jul 03, 638923 1:20 pm

I'd ask for labs to be repeated tomorrow when you go see your doctor. Unfortunately, things can turn for the worse quickly,especially if you don't feel right.(that's how I felt, just really off).

In any case, I'd call in with your BP numbers, because they are very high.

Let us know what they have to say.

ashesashie
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Re : UPDATE Confused, help?

Postby ashesashie » Sat Jul 03, 638923 1:07 pm

Lab work hasn't been done in about a month, but it was fine then. 24 hour urine before this one was was 568, and I don't know the exact number for the most recent one the nurse that called just said it was "much better."

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Re : UPDATE Confused, help?

Postby sam10 » Sat Jul 03, 638923 1:00 pm

Since I am not a doctor and cannot answer your last question. The way I understand it though, spilling protein should not be the only indicator. I think it would be important to also get your BP under control. Has any lab work (platelet count, liver enzymes) been done recently? Was that ok?
What have the doctors diagnosed you with?

ashesashie
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Re : UPDATE Confused, help?

Postby ashesashie » Sat Jul 03, 638923 12:58 pm

So does that mean you would expect them to push back induction to 37 instead of the 36 that she has been talking about? Don't get me wrong, I want my baby to have more time, but I don't feel right, and the bps getting so high are starting to scare me.

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caryn
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Re : UPDATE Confused, help?

Postby caryn » Sat Jul 03, 638923 12:50 pm

The HYPITAT study found that maternal outcomes improved with induction at 37 weeks, when compared with expectant management (i.e. waiting until you go into labor spontaneously), in all women with hypertension above 140/90.

Protein's required at the moment for a diagnosis of preeclampsia, but some of our Experts have begun referring to hypertension and low protein numbers as "non-proteinuric preeclampsia", because we know, now, that the problem's the placenta, and protein is just a marker and not a terribly useful one really.


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