Confused about pre-e risk assessment

[alviarin]

My first induction is kinda hazy, since I felt so bad with severe pre-e. I was on mag (magnesium sulfate) to help prevent seizures, but I declined an epidural. With hindsight I wish I had gone for an epidural, because if they had needed to wheel me away for an emergency c-section I would have had to be put totally under vs. just cranking up an epidural. And an emergency c-section was a definite possibility at the time. My pressures were also crazy high during labor, and an epidural can lower BP (in addition to reducing pain). They put something in to ripen my cervix the night before, and started the pitocin close to dawn. They maxed out the pitocin in early afternoon, and I had my son at 3:26 pm. He was 8lb 9oz born at 38 weeks gestation.

With my last two inductions, things went more smoothly since I wasn't as sick. I avoided magnesium sulfate since I didn't have any symptoms of severe pre-e or CNS (central nervous system) involvement, and I requested an epidural. My pressures were even normal during labor. They started the pitocin in the morning and I had both kiddos around lunch time. Both my 37 weekers did well, and didn't require any extra hospital time. Of course an epidural isn't totally risk-free, but I've had two with no ill effects. Also whether you get mag or not depends on the doc though, some are more cautious than others.

From talking to other mothers who have had both regular and induced labor, with an induction you don't get much of a break between contractions. So pain becomes more of an issue. But it is still doable without anesthesia or pain killers, though I definitely don't reccomend it!

[laney_p]

Yeah, the ACOG guidelines recommend not pushing a preeclampsia patient past 37 weeks, so that's really standard. It's basically taking the preventative step of halting the process early, to hopefully mitigate the train continuing to run down the track and cause worse complications.

Stick in there and let us know how you continue to do! <3

[IHNIWLTM]

Doesn't look like I will need meds as of right now for BP. Still waiting on results of most recent 24hr collection and blood test results, should have them tomorrow. MFM doc stated that regardless whether or not Pre-E or just PIH the protocol is to induce at 37 weeks at most 38 weeks. I am meeting with midwives tomorrow to see if they are setting a date and to find out what their protocol is for inductions.

Alvarin and others: were your inductions all done the same? Any questions I should ask?

[alviarin]

My understanding is that whether or not they start meds to reduce BP depends on how high your BP is running over your normal baseline. My doctors were ok with 140s/90s (with closer monitoring) but started to get more concerned at 160/100+.

I have had three inductions. I understand not wanting to be medicated more than necessary, but sometimes delivering sooner keeps you (and/or baby) from getting sicker and needing even more meds. You can always ask your doctor to explain the risks vs. benefits in more detail.

Yay for 34 weeks, and here's hoping that things stay stable until New Years! Please keep us posted as you are able.

[IHNIWLTM]

Just wanted to give an update, last 24hr urine collection was fine. I am now 34w4d, BP was high during office visit and had to get another NST done, that was fine, BP went down a little so I was able to go home. Still waiting on blood work and urine results. They are still thinking induction at 37 or 38 weeks, and now my concerns are with getting the induction, I had wanted to go unmedicated and am concerned that the induction wont work and I will end up with a c-section. Do doctors normally prescribe bp meds if your bp is high and you have no other problems? It would be great to at least get to 38 weeks but am really dreading the thought of having to be medically induced.

[sam10]

PE is very confusing! Nobody knows how it will progress and thus doctors will make day-to-day decisions! I am glad, however, that the MFM is keeping a close eye on you and your placenta!

Did you get the results from your 24-hour urine collection?

[IHNIWLTM]

Saw the MFM doc today. I am 29w5d. BP is fine, no protein in urine at my last midwife visit, everything seemed to be going fine however, the MFM doc today said that the placenta is maturing faster then it should and that she had some concerns about the umbilical artery and blood flow? and has asked me to take it slower and work from home if possible. She did a non-stress test in the office and everything was fine, she also ordered me to do a repeat 24 hr urine collection and to have another bio physical profile next week. She again stated that if pre-e shows itself then most likely delivery would occur at 37 weeks and if PIH then delivery at 38 weeks. There is so much to understand, it is all so confusing!

[laney_p]

Checking in: how are you doing these days? I know I and the other ladies would love an update!

[IHNIWLTM]

Ended up switching midwife groups and saw the new ones this week and am feeling way more confident in my care! I am now 26w5d and am not on any BP meds, my BP this week was lower then last weeks reading--I def. have to sit still for a few min before taking it rather then right when I get to the office and have been rushing around. They new midwives have a plan for if by BP rises to 140/90 which made me feel a lot better and have asked that I bring in my home readings to every appointment. Am going to keep monitoring my BP and symptoms and hoping for the best. Thankful there is a safe place in this forum to talk about this issues because not everyone understands the risks and they just keep telling me to relax and that will make my BP go down -- as if I have control over whether or not my BP will stay where it is and whether or not I get Pre-E.

[sam10]

I am glad you were seen by the MFM. I am glad she gave you clear guidelines How far along are you now? And are you on any BP medication?

I hope that your BP will stay stable. Let us know how your appointment with the midwives will go.