(update ?)Dr will not order 24hour urine..(friend's issues)

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trish
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Re: (update ?)Dr will not order 24hour urine..(friend's issu

Postby trish » Sat Feb 25, 2012 09:18 pm

I have some shocking information: I have never done a 24 hour test. Never!! In 3, what my OB considered PE pregnancies, 2 of which were induced specifically for maternal indicators for PE she never ordered a 24 hour test. I have no idea why and even asked for them in my 3rd pregnancy. But, other than that "quirk" shall we say, she was very on top of things as far as other testing, monitoring and inducing me with my first the day I showed up to a regular appt with high BP and a pesky pain in my URQ (when I had NO idea what that even meant!) and inducing me with my 3rd at 36 weeks because of PE symptoms.

Keep on encouraging her to trust herself & go into to L&D if anything seems off or if her pressure stay high like they've been. I don't trust anyone who says NOT to monitor yourself!!
Trish: mama to my 3 PE Princesses:
Elizabeth 11/6/03 induced at 37 weeks for PE
Katie 4/13/05 induced at 38 weeks for PE
Allison 12/27/07 induced at 36 weeks for PE then PP PE & BP issues for over a year

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Re: (update ?)Dr will not order 24hour urine..(friend's issu

Postby laura » Sat Feb 25, 2012 05:29 pm

The other tactic your friend may wish to try is to ask them to document her requests in her medical record AND record that they declined. Then, make sure they do it. In my experience, providers who are inclined not to take you seriously often reconsider when looking at it through the lens of what it will look like postpartum from the record.
Mom to Allie (1998, severe PE)| Camille (2003, oligohydramnios )|the Dude (2007, chronic hypertension)
The Captain is my hero!

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Re: (update ?)Dr will not order 24hour urine..(friend's issu

Postby susheli » Sat Feb 25, 2012 04:48 pm

Angie,

I understand and share your concern - you are a good friend. I had a doctor like this in my second pregnancy. WOuld not take my home bps seriously, thought I was a worrier - it was awful. I knew I had to be proactive and when I switched doctors and hospitals, the new one took me seriously immediately. Turns out I was headed toward severe PE and delivered days after I switched. I still cannot bear thinking what might have happened had I stayed with the other doctor ...

Not to panic you or your friend, but to say that I feel strongly that you are right to help your friend trust her body, keep taking her pressures and bypass that doctor the next time she has a concern.

Please keep us updated!
Susannah

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Re: (update ?)Dr will not order 24hour urine..(friend's issu

Postby blythe » Sat Feb 25, 2012 02:02 pm

Search our archives and the ask the experts archives for 'white coat syndrome' or possibly 'stress' - I'm thinking of the info that our docs say about white coat meaning that the body's bp regulation is a bit 'broken'. That still puts her at higher risk of PE, and her 163/108 makes not-a-doc me really nervous. I was induced at lower bps with trace protein (no 24 hr) and on mag with my first. In her shoes I would definitely go to the hospital for a second opinion if her bp is up again. One thing she might do is ask her doc what bp numbers he *would* be worried about and want her to come in. In my third pregnancy my doc wanted me to come in for 150/100. Her doc apparently has reasons that he's comfortable with much higher numbers. But yes, non-medically speaking, in her shoes I would want a second opinion.

Sorry this is choppy, I'm still on my phone all weekend. Good luck to your friend, I hope we're nervous over nothing :).
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

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Re: (update ?)Dr will not order 24hour urine..(friend's issu

Postby angieb » Sat Feb 25, 2012 12:50 am

Talked to my friend again today---

My friend was sent home yesterday on bedrest due to high bp, but her Dr told her to stop taking her bp at home, because the dr thinks that anxiety/stress or possibly the pupps is making her blood pressure so high. I know that "white coat syndrome" can sometimes make someone have high blood pressure, but I've never heard of it happening at home too, or it being *that* high. My friend thinks her doctor thinks she's been a worrywart her whole pregnancy, but I feel like her blood pressure is high enough for legitimate concern here and it's unlikely stress/anxiety related.

I have told her to keep monitoring her blood pressure at home anyway and to just bypass her doctor and go in to the Women's Evaluation Unit at our main high risk/highest NICU hospital if her blood pressure is "up" again. Does that sound about right, "in our nonmedical" opinions ;) ? Or could it really be stress? (In which case I am definitely not helping!) (I am probably going to send her this post so her concerns are validated if that seems to be the case.)
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/

blythe
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Re: Dr refusing to order 24 hour urine...(friend's issues)

Postby blythe » Sat Feb 25, 2012 09:35 am

Just echoing Alviarin, The Hypitat study is the one that recommends induction at 37+ weeks for PIH *or* PE. It's a newer study out of the Netherlands just as most US hospitals are pushing for no elective inductions until 39+ weeks. Hypertension is *not* elective, it is a *medical* indication, but without protein it seems that many docs are still treating inductions for 'just' hypertension as elective.

For your friend though, if they did a 24 hour urine you're right that they might find that she's actually diagnostic.

Echoing Alviarin again, I would just encourage her to watch her signs and symptoms and monitor her blood pressure at home and go back in with *any* concerns. Could she get a second opinion or a MFM consult?

In the meantime you just get to wait and know the worst case possibilities :(. But one thing that helps me sleep at night while helping on these boards is that she's under a doctor's care and ultimately it's their call. I hope your friend and her baby stay stable.
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

alviarin
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Re: Dr refusing to order 24 hour urine...(friend's issues)

Postby alviarin » Sat Feb 25, 2012 00:19 am

I believe you are thinking of the HYPITAT study ("Hypertension and Pre-eclapmsia Intervention Trial At Term") which found an improvement in maternal outcomes with induction at 37 weeks for hypertension or preclampsia without a difference in fetal outcomes.

I can see why you would be worried about your friend. Even if it is *just* gestational hypertension 163/108 is in the severe hypertension range. During my second pregnancy my "go to L&D" numbers were pressures at/above 150/100 and I wasn't even diagnosed with pre-e yet, just labile BPs. And as you said, you can't rule out pre-e without a 24 hour urine collection. I was one of those ladies who dipped negative and "trace" even with diagnostic levels of proteinura.

If you haven't already maybe you can point your friend to our website, and make sure she knows the signs and symptoms of preeclampsia. Good luck!
Hypothyroid mom to
Connor (severe pre-e at 38 weeks)
Claire (dx'd with pre-e and induction at 37 weeks)
Annabelle (chronic HTN & GD, superimposed pre-e @34 weeks, induction @37 weeks)

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heather j
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Re: Dr refusing to order 24 hour urine...(friend's issues)

Postby heather j » Fri Feb 24, 2012 10:21 pm

The only reason, I would think, not to do a 24 hour at 37 weeks is because mama is being induced. I can't find the information (Blythe?), but IIRC, 37 weeks is the golden gestation to call it when you're dealing with gestational hypertension period. I'll shoot Heather and Caryn a message and see if they have the info. I've been where you are in regards to watching a friend go through this and it IS NOT FUN.
Heather (PAI-1 4G/4G) mama to:
Nicolas Edison (6/2004) 36 weeks, PE, HELLP, and placental abruption
Ella Amelia (3/2007) 37 weeks, lovenox, PE-free
Oliver Lyon (1/2011) 37 weeks, lovenox, PE-free
Milo Mason (2/2014) 39 weeks PE-free

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(update ?)Dr will not order 24hour urine..(friend's issues)

Postby angieb » Fri Feb 24, 2012 08:04 pm

I have a friend who has been monitoring her blood pressure since 20ish weeks due to a high number at an appointment with her general doc for illness. It's been mostly okay since then, fast forward to this week. She's 37 weeks with PUPPS and on Wednesday had a blood pressure of around 163/108. They monitored her, did bloodwork labs, and an in office dipstick test (twice maybe?), then sent her on her way (no 24 hour urine ordered, no follow up monitoring scheduled.) I told her to do kick counts, keep an eye on her blood pressure at home, and not to hesitate to go in or bug her doctor if she starts feeling off.

Today her blood pressure was "up" again. It was high enough today that they sent her in for monitoring again. I encouraged her to ask for a 24 hour urine if/before they sent her home, and explained why they are better tests than the dipsticks. Well, they sent her home, on bedrest now, and told her that her "labs were so good" (I think her labs from Wed.) that a 24 hour urine is unnecessary. (As a sidenote, I'd probably be dead now if I'd had that kind of care- my blood pressure was normal and labs went from normal to bad to horrible in 18 hrs )

Anyway, my question is, is there really a reason not to bother with a 24 hr urine in this case? Why wouldn't a dr order one? I don't get that.

Also, is the recommendation to only deliver at 37 wks for pre-e or is it for hypertension too? What was that study?

Any extra thoughts on this are appreciated.

(Update)
Talked to my friend again today---

My friend was sent home yesterday on bedrest due to high bp, but her Dr told her to stop taking her bp at home, because the dr thinks that anxiety/stress or possibly the pupps is making her blood pressure so high. I know that "white coat syndrome" can sometimes make someone have high blood pressure, but I've never heard of it happening at home too, or it being *that* high. My friend thinks her doctor thinks she's been a worrywart her whole pregnancy, but I feel like her blood pressure is high enough for legitimate concern here and it's unlikely stress/anxiety related. I have told her to keep monitoring her blood pressure at home anyway and to just bypass her doctor and go in to the Women's Evaluation Unit at our main high risk/highest NICU hospital if her blood pressure is "up" again. Does that sound about right, "in our nonmedical" opinions ;) ?
Last edited by angieb on Sat Feb 25, 2012 12:48 am, edited 4 times in total.
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/


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