Severe Preeclampsia Question

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amandamm
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Re : Severe Preeclampsia Question

Postby amandamm » Thu Oct 14, 2010 12:36 am

I didn't have any other symptoms either. I had high bp, which I didn't know until I went to the doctor. and brisk refluxes, which I also found out at the doctor. I was on hospital bedrest for a week the first time.
I think it is important to keep the baby in for as long as possible, and I think your obs are just thinking a premature baby is better than a dead baby.

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caryn
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Re : Severe Preeclampsia Question

Postby caryn » Thu Oct 14, 2010 00:35 am

Ah, that's different -- your docs aren't sure what sort of care is best, then. Technically a "severe preeclampsia" diagnosis is a mild preeclampsia diagnosis plus some other thing -- severe headache, bad labs, proteinuria over 5000 mg, one reading of either of 160/100, etc. -- and severe PE is usually managed on a day-to-day basis in a tertiary center with fun things like constant fetal monitoring and mag sulfate drips.

It sounds like you've been hospitalized very early in that cascade -- I'm guessing one high reading -- and that your bp is responsive to meds. In which case one statistically defensible course of action is to continue with monitoring until there are either maternal or fetal indicators for delivery. It sounds like your care team doesn't agree on what those indicators ought to be.

Which is no fun for you!

Can you nail down all the members of your care team on what would count as a reason to move to induction? I'm pretty certain that there are a lot of disputes in the literature and at conferences about that. 34 weeks is where they "consider" severe PE patients for induction; 37 weeks is term and a number of docs will induce at 37 weeks for high blood pressure alone, on the grounds that newer studies have shown maternal benefit and no neonatal risk in a hypertensive population.

In your shoes, I'd want to know what they all agree would count as a reason for delivery, and why they're not clear about which things they're disagreeing about.

sarahrb
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Re : Severe Preeclampsia Question

Postby sarahrb » Wed Oct 13, 2010 07:10 pm

Thank you all for your replies.
My doctor this morning said that we are doing okay and he doesn't see why I couldn't make it until 37 weeks on bed rest and labatatol 300 twice per day. I have shown no other symptoms, my lab work comes back clear every other day, the baby is growing and is strong and my protein was 342, so 42 over where they would have liked to see it, which is still borderline. My doctors group has 5 doctors in practice and the most stressful thing for me so far has been pressure from some of them to induce immediately, where as the past two doctors over two days have said I am doing ok and don't need an immediate induction. Right now baby Jack is five days longer in my belly than when they first wanted to induce and tomorrow we will be at 35 weeks. I doubt I can last much longer with all the doubts and realities about what could happen, so we are day by day and I am in the hospital, so if something were to happen, am in the best possible place to be.
Thank you and I love hearing all your stories.

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Re : Severe Preeclampsia Question

Postby kara » Wed Oct 13, 2010 00:56 am

I was "well enough" to have stayed in the bed pregnant for a short time longer, however, it was determined that my baby was the one suffering the brunt of the disorder. Due to her small size, limited blood flow, and overall condition, we induced at 31 weeks. Fortunately I was well under the way to having her when I had a placental abruption, even though my condition was stable. She did wonderfully well at 31 weeks, though she did have some nicu stay. 34 weekers usually do very well, and 35 weekers often can go home with mom from the hospital.

There comes a point when keeping them inside is more harmful than having them born early, as was the case for my daughter. She is nearly 5 now and about as normal as 5 year olds are.

smilingangels
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Re : Severe Preeclampsia Question

Postby smilingangels » Tue Oct 12, 2010 10:41 pm

Im sorry that you are going through this but i agree with the others i would go ahead with being induced. Ill share my story with you

I started having problems at 26w with protein in my urine the MFM wanted me to go to his hospital then and remain there until i delivered. I refused so i just got admitted to my OBs hospital and remained there on bedrest for a week or so they got everything under control and i got released on strict bedrest. 2w later i went to my OB & MFM appt and my bp was high i forget what but it was up there. My ob made me stay there for about 45 minutes to see if it would come down, it didnt but he knew i was going for a level II US at the MFM not even an hour after i left his office so were doing the US everything looks great then the US tech runs out of the room talks to the doctor and comes in to tell me that i HAVE to get to the hospital right away and that i may deliver that night. I freaked out my DH was with me and we went straight there they started the steroid injections and hooked me up to Mag well i made it through that night and the next morning they came in and did another US ran out yet again the doc came in and told me i HAD to have an emergency c section within the hour ok i freaked im only 29w my husband was over an hour away and i was by myself not to mention going to have surgery well dh made it within minutes (he was speeding the whole time) well within minutes they delivered her she wasnt breathing so they had to put her on a vent i didnt get to see her but for a split second and they rushed her out. She weighed 2 pounds 7oz 14 1/2" long. She was on the vent for 15 hours and spent 6w in the NICU (over an hour from me) i wasnt allowed to see her until she was 3 days old because of the reactions to the mag it sent my heart into attacks and i couldnt hold my stats on my own. Im happy to say i have a happy and healthy almost 10 month old now although weighing only 12 pounds she completely healthy and has no long term effects.

So honestly although scary i have to agree that your at a pretty good place and although delivering early is scary its really important that you listen this stuff is agressive and happens fast.

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l412angel
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Re : Severe Preeclampsia Question

Postby l412angel » Tue Oct 12, 2010 08:48 pm

I agree with the others, if your doctors are saying to induce I would. Unfortunately they have seen what can happen. Many times BP meds can mask high BP and Preeclampsia. PE can also progress rapidly after delivery and progress into HELLP. Your doctors know your at a good point in your pregnancy and more than likely do not want to risk you getting sicker.

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mrss
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Re : Severe Preeclampsia Question

Postby mrss » Tue Oct 12, 2010 11:14 am

I've done this twice now. The first time I was able to limp along with home bedrest and later hospital monitoring until 37 weeks, but my pressures weren't crazy and I did not meet diagnostic levels for protein, although my platelets were low. This time the symptoms came on later, but they were worse and I ended up with an emergency c-section at 35w4d. I didn't throw significant amounts of protein until a few hours before delivery. It can change very rapidly and if you have multiple doctors suggesting you induce, it would be wise to seriously consider it.

beth0277
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Re : Severe Preeclampsia Question

Postby beth0277 » Tue Oct 12, 2010 10:04 am

If *I* were in your situation with my doctors telling me it is best to induce, I would do it. I agree with the others that you are in a good place at almost 35 weeks. In my experience, my PE symptoms went from non-existant to severe within a matter of 2 hours. Knowing how far along you are and how quickly this disease can progress, I may be inclined to take your doctors advice. Of course, only you can make this decision but your doctors have experience with women in your situation.

I hope everything works out well for you! Keep us updated. :)

alexa5
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Re : Severe Preeclampsia Question

Postby alexa5 » Tue Oct 12, 2010 09:35 am

I agree with the above....it can be sneakier than you think. Granted I did have PIH starting at 28 weeks, but no protein, until suddenly at 33 weeks. At the same time as the protein I started to have some other symptoms, but honestly I thought I felt fine. But I was induced by the end of the week based on my pressures mainly....my protein and labs weren't all that bad.

Caryn makes a good point...it might seem too early, but you are at a pretty safe point in your pregnancy, and it is better sooner rather than taking the risk of it starting to affect your baby or having to get an emergency c-section. I was glad to be able to deliver normally, and my son spend 3 weeks in the NICU but he was mainly a feeder and grower--he is 20 months now and he is higher in percentiles than many other kids his age :-)

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Re : Severe Preeclampsia Question

Postby aajatwins » Mon Oct 11, 2010 10:02 pm

From what I've read (here on the forums mostly), PE can be so unpredictable. My experience is similar to Caryn's. All my symptoms looked like normal pregnancy woes: headache, swelling, pain in my ribs (there were 2 sets of feet in there), and headache. I had no idea that seeing stars meant anything, but that was the night before I seized. Your body is giving you warning signs, your doctors are right to not want to ignore them.


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