Question about what Midwife told me...

Are you pregnant again after having preeclampsia once already in a previous pregnancy? Post your thoughts/concerns here - there are others who share your feelings. This is also the home of our Bedrest Buddies Support group.
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caryn
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Re : Question about what Midwife told me...

Postby caryn » Mon Aug 20, 2007 07:23 pm

It amounts to two recent abstracts, from a decent journal tho:

"...the concentration of IL-10 has shown different pattern as its level decreased significantly (0.001) in pre-eclamptic women (overall) in comparison with control subjects (pregnant & non-pregnant)..."

http://tinyurl.com/2lbfne

"...the median concentrations of serum IL-10 in patients with mild and severe pre-eclampsia were similar (P < 0.282) and was significantly lower than those of controls (P < 0.001) and patients with eclampsia (P < 0.001). In patients with eclampsia, the median concentration of IL-10 was significantly higher than that of all other groups (P < 0.001 for each comparison)..."

http://tinyurl.com/2lbfne

As usual the idea was the placenta was shutting down IL-10 to improve placentation... sometimes, anyway.

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catherine
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Re : Question about what Midwife told me...

Postby catherine » Mon Aug 20, 2007 04:38 pm

Caryn, I have to think that if our IL-10 levels sucked, we'd know about it.... any time we got sick with a pathogen that required the cell-mediated arm of the immune system.

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caryn
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Re : Question about what Midwife told me...

Postby caryn » Mon Aug 20, 2007 04:11 pm

Joni, you're quite right that usually, the hypertension cascade is first, because usually the soluble FLT is what's most elevated, so the endothelium damage is primary.

In HELLP, the soluble endoglin is what's most elevated, so the liver can go wack before the endothelium gets lots of damage.

At least one recent study says that in eclampsia, IL-10 levels are screamingly high, but in severe pre-eclamptics, there's an IL-10 deficiency. (Yet to be confirmed, but an interesting idea that might explain those eclampsia-out-of-nowhere women.)

So, it gets all weird really quick-like. [:)]

adgirl
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Re : Question about what Midwife told me...

Postby adgirl » Mon Aug 20, 2007 02:38 pm

I had protein show up first too -- in fact, one week it was +1 with no high BP, then +2 with no high BP, then I went to NO protein and elevated BP for 2 weeks straight. I was 38 weeks by then so we induced. My BP shot up post partum and still no protein. So, I don't know what happenned with me exactly other than the protein was the first indicator, not the second.

Odd that it went away though once the high BP kicked in. I'm one of those non traditional PE folks I guess.

I think that's why all the symptoms are so important to watch, not just BP -- paying attention to URQ pain, protein dips, vision problems, etc. The placenta is monkeying around with your body, and may affect different people differently. So, monitor all of it, not just the BP.


blythe
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Re : Question about what Midwife told me...

Postby blythe » Mon Aug 20, 2007 02:10 pm

If I've read correctly, increased blood pressure is just a symptom of the underlying disease, not a cause. However, I think I've also read that high blood pressures are what damage the kidneys... Sorry to be of no help whatsoever there... Ah ha! Found an expert response:

http://www.preeclampsia.org/forum/viewtopic.php?t=622
What causes proteinuria in preeclampsia?

Just regarding general disease progression and individual variability, I like Caryn's response here:
http://www.preeclampsia.org/forum/viewtopic.php?t=23502

Finally, I swear there's an expert response that says yes, they have seen HELLP syndrome and/or seizures with low bps, but it's rare and there is little data on those womens' blood pressures relative to their baselines. I've spent the last hour and can't find it, darn it!

I can definitely see why you'd want some reassurance that you'd have some warning just by watching your bp, and sorry to jump all over you and say "nope" [;)]. I think that's one of the things that is the hardest about complicated pregnancies, especially PE - sometimes there is just no warning. However, I hope your body follows the "usual" disease progression of bp first, *then* proteinuria, *then* liver/multi organ involvement - though hopefully it won't get that far!! How many weeks are you, now?

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Re : Question about what Midwife told me...

Postby jenndola » Mon Aug 20, 2007 01:11 pm

Joni, my BPs and urine dips were all perfectly normal until I was admitted to L&D, at which point my liver enzymes were through the roof. Unfortunately, HELLP can set in with none of the "normal" PE symptoms, which is why we're always telling women to get checked out for URQ pain.

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Re : Question about what Midwife told me...

Postby rachel a » Mon Aug 20, 2007 01:09 pm


rachel a
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Re : Question about what Midwife told me...

Postby rachel a » Mon Aug 20, 2007 01:03 pm

Nope, there are a few women here that had severe renal impairment (one in particular, I'll see if I can dig up her question in the Experts) that preempted elevated bp. We also have another woman here that suddenly developed HELLP with no prior symptoms of PE or bp issues. There are even reports of women having seizures with normal pressures.

It's not common, not common at all but it does happen.

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leftcoastgirl
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Question about what Midwife told me...

Postby leftcoastgirl » Mon Aug 20, 2007 12:00 am

I see my Peri's midwife between visits with him (since i'm in weekly now). At my last appointment I asked her if you would ever see protein or other symptoms of pre-e without an increase in BP. Since i'm monitoring my BP at home daily, it gives me some reassurance to think if I were going to develop pre-e I would start to see an increase in BP at home first (before protein in urine for example). However, the midwife told me that they have seen pre-e WITHOUT an increase in BP (normal BP) with elevated liver enzymes, and even having seizures without the elevated BP.

Does anyone know more info about this? I always thought it was the hypertension that cascaded to the decreased renal function, etc. therefore I always assumed you would see an increase in BP before other symptoms.

Anyone?


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