Expectant dad needs info about preeclampsia

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somtamfetcher
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Re : Expectant dad needs info about preeclampsia

Postby somtamfetcher » Mon Feb 27, 638930 7:11 am

Wow! Thank you everyone for all the helpful information.

I was able to get a little more information from one of the nurses tonight. Some of them are more patient and helpful than others.

First, the proteinuria count on the dipstick the night she was admitted was +4, not +2. Someone lied to me earlier. That is what triggered the emergency. They immediately gave her dexamethasone and put her on magnesium sulfate for 48 hours. They have since stopped the magnesium sulfate.

Her protein count after they ran the 24 hour urine test was 4700! The initial blood tests they ran showed no symptoms of HELLP. There is another blood test scheduled for 6 am tomorrow morning where they will check again. They will do another 24 hour protein check on Sunday.

The nurse said normally they like to try for 35 weeks, but in this instance she thought 32 weeks would be a more realistic goal. Her opinion was that if the protein count did not dramatically increase and the babies kept growing, then 35 weeks may still be possible, but it would be best to prepare for earlier.

Please note, this was one of the senior nurses, not one of the doctors who told me all of this. I think I have only managed to speak to the doctors twice since this thing began. I think she took pity on me because I looked so stressed.

It sounds like this problem is not going to go away, and that it really is a serious situation. I guess somewhere in the back of my mind I hoped this would clear up. Her blood pressure didn't seem so bad to me. They are not worried about her blood pressure, but only about the protein count and her dilated cervix.

I guess at this point all I can do is wait and see. Have any of you suffered any serious complications from extremely high proteinuria counts? How long is the recovery for the surrogate going to be? She is my sister in law, so I feel very responsible for her health as well. I simply can't let anything happen to her.




rachelc
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Re : Expectant dad needs info about preeclampsia

Postby rachelc » Mon Feb 27, 638930 4:28 am

I am sorry that you are having to go through this. I know you have a lot of questions.

Here are some questions that you can ask
1. Ask them to do a 24 hour urine test and labs to check kidney and liver function. This will give the best picture of the mothers health.
2. Ask them to check her reflexes. Hyperactive reflexes are a sign that her central nervous system is being affected by the PE. Headache is also a sign but, that could also be from the mag.
2. Are they doing any additional tests on the babies like ultrasounds that check for specific health markers like amniotic fluid level, the functionality of the placenta, fetal movement, etc. There is a test called a biophysical profile that measures all of these things. It's basically an ultrasound where the tech is looking for those specific things.
3. Why the mag? It doesn't seem like her bp is significantly high Why not bp meds instead? Is she also in preterm labor? The mag can be used for that purpose as well.
4. Has the surrogate been given steroid shots to develop the babies lungs? I would request that.

The reason you haven't gotten any clear answers about when the babies will come is because there aren't any. The decision is a delicate balance of the safety of woman and babies. She could suddenly becomes extremely sick and have to deliver even if the babies seem to be doing fine. Or one or both of the babies could show signs of distress and need delivery. Here are some things that could warrant immediate delivery. Surrogates bp begins to rise and can't be controlled. Surrogate shows signs of HELLP Syndrome, a sort of ugly step-sister to PE that affects the liver and red blood cells. Surrogate is spilling a large amount of protein, 5000 mg/dl is considered severe pe and can cause permanent damage to the kidneys. One or both babies show signs of distress like erratic or low heart rate. There is not enough amniotic fluid. The babies do not pass the specialized ultrasound test I mentioned above. The babies are not growing or show signs of intra-uterine growth restriction (IUGR).

I can't give you any information about possible developmental issues for 29 weekers. I had two 33 weekers that did extremely well and show no signs of developmental delay. My hope for you is that babies and surrogate can hold out until 32 weeks. This seemed to be a big milestone to my doctors because there are fetal developments that occur around 32 weeks.

Please feel free to ask questions as they come to you. We want to help in any way that we can. Good luck!

aggie95mom
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Re : Expectant dad needs info about preeclampsia

Postby aggie95mom » Sun Feb 26, 638930 10:40 pm

I just wanted to add something about the '+2' reading ... that's usually from a urine dipstick test. The readings, I think, usually are none, trace, +1, +2, +3 and maybe something greater. It's just a snapshot, though, that can be highly influenced by how well hydrated or not the mother is. According to my MFM, the only way to truly measure the protein level is to do a 24 hour urine collection. This is where you'll get a reading that corresponds to the actual mg of protein in the urine. You might want to ask for this if it hasn't been done.

I second Trish's suggestion to ask about the steroid shots. I don't know how Thailand medical procedures are for preemies, but you might also want to ask if they administer surfactant to preemies born before a certain gestational age. It's common in the U.S. for babies, usually before 30 weeks though my son's hospital said they have administered up to 32/33 weeks when needed, but I don't know about other places. You can read about it, but it's the sticky substance that a full term infant's lungs automatically produce to keep the air sacs properly inflated. For preemies born early, this subanstance hasn't necessarily been produced yet so it can be synthetically given.

This is on the signs and symptoms page that Anne linked you to, but also make sure they are checking your surrogate's reflexes which are also graded ... usually called beats of clonus. I'm not knowledgable there because I never experienced this, but depending on how her reflexes respond gives an indication of whether or not there is central nervous system involvement, as well.

mommy2maddie
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Re : Expectant dad needs info about preeclampsia

Postby mommy2maddie » Sun Feb 26, 638930 8:40 pm

Those are very good weights for 29+4 and being twins! My daughter was born at 29+4, she is a little behind physically, for instance she didnt walk until 16 months but that is it. She did not have any problems in the NICU, but every child is different. I am not sure what +2 would be in miligrams, but when I delivered I had over 15,000 miligrams of protein in my urine. So I am sure the doctors are keeping an eye on her, they are probably trying to squeeze out some more days if they can. I was diagnosed with Preeclampsia at 28+6, I was put in the hospital at 29+1 and delivered at 29+4, but everyone is different. Sorry I couldnt help you more, I wish you the best of luck.

annes
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Re : Expectant dad needs info about preeclampsia

Postby annes » Sun Feb 26, 638930 8:27 pm

Here is a link to our signs and symptoms page, although your surrogate is in the hospital, the best place to be, this list may help you ask some questions and know what the docs should be looking for. http://www.preeclampsia.org/symptoms.asp
I would keep an eye on the headaches and the pain in her stomach, is it on the right side? For me that was a sign I totally missed, I just thought the baby was pushing my ribs. Magnesium sulfate is a normal course of action with pe, although it is unpleasant, it is often a lifesaver. Take care.

trish
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Re : Expectant dad needs info about preeclampsia

Postby trish » Sun Feb 26, 638930 8:20 pm

Welcome!! Sorry you've needed to find us but I'm glad you did! Like Jules said, the average time from diagnosis to delivery is 2 weeks - but that takes into account the people who need to be delivered within hours & those who go a month or more. Seems like they are taking good care of your surrogate & good they have done an u/s to check on your babies.

Have they done steroid shots to help mature the babies lungs? If not that is something I would ask about. There are so many factors that go into needing to deliver early it's hard to even say what would be "the" deciding factor. Have they done a 24 hour urine test or run blood work on your surrogate? Both will give a better idea of how she's doing.

Please keep us updated & feel free to ask more questions as they come up. :)

jules2
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Re : Expectant dad needs info about preeclampsia

Postby jules2 » Sun Feb 26, 638930 7:09 am

Congrats on the pregnancy and I am sorry it is ending up so stressful. I know something about Thailand, having worked there myself, and the language barrier must be making things even worse for you.

I understand your concerns, but the surrogate probably is in the safest place possible. They should be monitoring her blood pressure at least every 6 hours; more often if it starts to rise. Are they doing 24-hour protein collection? Is she taking anti-hypertensives? Her blood pressure does not seem to be substantially raised at the moment. As you seem to be aware, this disease can worsen very rapidly though in severe cases.

+2 is a significant amount of protein (sorry can't be more precise), but there are plenty of women here who were admitted with much higher levels (I was admitted with +3 at 25+5 weeks). Its high but not very high if you see what I mean.

On average, women can go for around 2 weeks after diagnosis before they have to deliver, but this is so highly variable I'm not sure it is all that helpful to know, sorry.

The abdominal pain is worrying, as are the headaches (look up HELLP symptoms if you haven't already), and I expect they might decide to deliver if her platelets fall, or liver enzymes raise, or there is evidence of haemolysis (red blood cells getting crushed). They should be taking blood for these tests regularly too. They might also deliver if her blood pressure starts to rise substantially. Most cultures / hospitals / doctors will have slightly different cut-points for this though.

I'm not an expert, but I think you are in a relatively good position with the longer-term outcomes for the babies, based on their GA and weights. Yes, there is definitely a chance of the problems you mention but the odds of severe disability are not high at this stage; the chances are they will have a positive future.

somtamfetcher
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Expectant dad needs info about preeclampsia

Postby somtamfetcher » Sat Feb 25, 638930 10:13 pm

Hello everyone,

I am an American currently living in Bangkok, Thailand. My wife and I have tried for almost a decade to have a child. We finally succeeded using her eggs, my sperm, and a gestational surrogate. I am 39 and my wife is 31. The surrogate is currently pregnant with twins, one boy and one girl, at 29 wks +4 days. Since this was an IVF, there is no question about the date.

The mother was admitted to the hospital with preeclampsia 5 days ago. Blood pressure is currently 140/90. As we are not wealthy and can not afford an expensive international hospital, we are restricted to the Thai hospitals where the doctors do not speak English very well. My Thai is OK for casual conversations, but I am having communications problems at this point. The usual response of "ask your doctor to explain" may not be helpful in this case.

I am hoping some of you on this forum can give me some specific questions that I can use to gain an understanding of what is going on. Specific questions that can be answered with yes/no or a number are generally fairly easy to convey. More general questions that require lengthy opinions are not so helpful due to my language difficulties. This isn't the ideal situation, but it is the one I have so I need to make the best of it.

I have been told her protein count is currently "+2". Now, from my research I think I can get a handle on the problem if a number is given in milligrams, but I have no idea what "+2" actually means. Can someone give me a formula that can convert this into the number of milligrams? Is "+2" serious? If not, what is considered serious? How quickly should this rise?

The mother is currently on magnesium sulfate and is confined to bed in the hospital. Her condition seems stable at the moment, but very stressful for all of us. Her blood pressure is not increasing for now. She is suffering from headaches, and has some pain in her upper abdomen. She often complains of extreme tightness in the upper region of her stomach.

Additionally, she is dialated to about 4 cm.

I understand this is a serious condition. I also understand there are levels of seriousness, all the way from "you need to be careful" up to "if you don't do something right this instant everyone is going to die." I believe we have caught this condition early. When we took her to the emergency room I thought we were being overly cautious. It was just a few simple pains which could have been anything. I was shocked when they admitted her and would not let her come home.

What I really want to know is two things. First, on average, how long can I expect this situation to go on. Second, what are the conditions that will cause the doctor to say that it's gone far enough and schedule the C section.

The doctor will not give me any kind of guess as to the length. I understand every case is different, but statistically there must be an average. I just need some kind of guideline.

I also don't really have a clear understanding of what they would look for to make the determination of when to end the pregnancy. The language barrier isn't helping in this case. I don't want to say that I don't trust the doctor, but sometimes in Thailand it is good to keep an eye on what they are doing. The liability rules over here are not the same as in the West, and a smart person doesn't blindly assume every medical professional applies the utmost care to every case. Gentle prodding can sometimes make the difference between success and a disaster.

As of 3 days ago, the babies were 1.2kg (2 lbs. 10 oz.) and 1.4kg (3 lbs. 1 oz.) Although this isn't directly a preeclampsia question, many of you who have suffered from this condition may have suggestions on what can be done about the long term effects of a premature birth. I think the probability of survival by both the children and the mother is very high right now, but I am concerned about learning disabilities and neuromuscular disorders that may develop. Does anyone have any information they can share here, or point me to a place that does?

I am hoping the accumulated experience on this forum may help me to get through this with my sanity intact. I am very worried about what might happen. My information stream from the doctor is limited. One thing about Thai culture is that if you don't ask exactly the right questions, you can't guarantee the answer you are going to get.

When I first arrived here over a decade ago, I tried to order a pizza from the delivery service. I asked the girl on the phone "do you speak English". She answered no. Later, my friend explained I asked the wrong question. I was supposed to ask "may I speak to someone who speaks English." Subtle difference. Information is not volunteered in this society if you don't phrase your question correctly.

If any of you can offer me specific questions that will help me to understand what is happening, I will very much appreciate the assistance. This problem is a little more important than ordering a pizza.








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