10 weeks already seeing MFM

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: 10 weeks already seeing MFM

Postby caryn » Sat Aug 20, 2011 02:59 pm

Medication is a tricky question. :) Your doc is quite correct to say that this is laid down at implantation, because preeclampsia is a placental problem. There's a lot more about that in the New Yorker article in my .sig and in some of the research posts at the main blog site, like this: http://www.preeclampsia.org/research-to ... eeclampsia

We have certainly had posters, even very recently, with severe PE early even on meds. Here's a link to one recent poster: viewtopic.php?f=30&t=43463

Here's the Preeclampsia Foundation's Medical Board on the topic of Lovenox or other anticoagulants: http://www.preeclampsia.org/forum/viewt ... 19&t=42978 They say I am not aware of any benefit based on scientific evidence and I suspect that most of us would agree that ROUTINE treatment of every women with a history of prior preterm preeclampsia is not indicated and As the PI (Principal Investigator) of an ongoing RCT (Randomized Controlled Trial) designed to help answer this question says, heparin is not candy - either in terms of daily inconvenience and pain, cost, and risks (heparin-induced thrombocytopoenia in particular) and Unless there is a current medical indication for prophylactic or therapeutic anticoagulation in a patient with a history of preeclampsia in the past, it has no value or place So I'd be very uncomfortable with a practice that scripped it for no indication other than a history. Since they're going to run bloodwork you'll know more soon.

(The docs are discussing the same metaanalysis you're discussing, Jasmin: http://www.ncbi.nlm.nih.gov/pubmed/20664402 is the abstract. So far as I know it's the only one that's found a benefit from early administration, and as the Experts note that's because it dropped the two big NIH funded studies into the question!)
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

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riehlism
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Re: 10 weeks already seeing MFM

Postby riehlism » Fri Aug 19, 2011 10:58 pm

Just to let you know, I am on meds including Lovenox and I do not have a blood clotting disorder, or other underlying disorder. Also, I believe that some of the new moms (miamibunnie, frogibe, christina89) are also free of underlying disorders but were placed on meds. I believe frogibe and miamibunnie were PE-free in their subsequent pregnancies. I'm sure there are others, but the names escape me right now.

Lots of moms may not need medication. But I had a loss, and the other moms I listed above had losses. My doctors (MFM and OB) explained their reasoning to medicate like this: with such a bad outcome, why risk NOT doing anything? Us ladies may very well be just anecdotal evidence. While I was apprehensive about meds at first, currently being 6 weeks more pregnant than I ever was, I am happy I did it.

Also, if you scroll down to the bottom of the link below it shows the citation for the article itself. If you give him/her the reference it should be easily found by your provider. Otherwise you have to pay for the article from J of OBGYN. It's a scholarly article so it's hard to find the full text article online for free.

It sounds like your doc basically said that at the time of implantation preeclampsia may already be pre-determined. A common theory is that shallow implantation causes poor development of the umbilical arteries resulting in poor placental blood supply. Placenta then gets angry and releases a host of hormones that drive up mom's blood pressure. In the link I posted earlier, it seemed to suggest that baby aspirin may play a role in improving umbilical blood vessel maturation through the 14th week. Of course providers vary in opinion greatly. I've heard women on this site who docs say absolutely no (because they believe it may be harmful), not until x weeks into pregnancy, or ones that say you should be on it while TTC. I was very confused myself. My docs said to take it while TTC. They agreed that baby aspirin while TTC would be a benefit because it can keep blood thin, thus allowing for deeper implantation of the embryo into the uterine lining.

Upon reading the expert discussion, they were referencing meta-analyses of articles with large patient populations of 35,000 people. The power is great, but they never mentioned if the article in discussion was a longitudinal study versus a study of prevalence, and in my opinion that makes a difference in my personal interpretation of the results. When people critically appraise articles there will always be a variables in how people interpret the results, study design, and overall impression of the article. That's kind of why people don't always agree about published studies. There's always something to quibble about. (Sucks, I know).

Then again, my opinion is going to be biased no matter how you look at it because I'm doing so well right now. I lost my son at 24+6, but I am progressing along this pregnancy without any BP issues or any protein in my urine. My mind will probably somehow find a logical way to sway the pendulum in my direction. And this is why the decision is between you and your doctors. At the very least I would want a discussion to take place about the pros and cons of both. Unfortunately, medication itself is not a guarantee. There are a lot of us here who share great outcomes, but who knows how many others aren't posting because of poor results even with the best medicine.

I guess this is my long-winded way of saying: I personally think the meds are helpful because of the results I have seen (read) in others and how my own subsequent pregnancy is going. And no matter what the decision between you and your doctor is, it's important that all options be discussed as well as the rationale.
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192

Abbysmama1109
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Re: 10 weeks already seeing MFM

Postby Abbysmama1109 » Fri Aug 19, 2011 06:26 pm

Ok now I am a little confused as to whether the medication is something I should be on. I talked to the dr. about being proactive as much as possible and she said that at the time the placenta implants into the uterus is the only time that the decision is made about whether I will be pre-eclamptic. I am wondering if you have any links to the baby aspirin study that I could print out and show her? Is baby aspirin something that should be taken across the board or only for those that have a clotting disorder? What about the lovenox and increased folic acid?

To answer a few questions:
I do not know if I have a blood clotting disorder, my labs have not been drawn yet. The MFM was surprised that the OB didn't draw them and have them sent to her so we are doing them on Monday in conjunction with the First Trimester Screening blood draws. Is there anything specific I should ask for them to check when they do my labs? Such as MTHFR? The labs are drawn separately from the hospital at the MFM office.

My blood pressure has gone down since the 158/98 reading, it has been hovering around 120/80 (my recent and lowest number) but I believe that is a bit high for me, my systolic reading is usually 110 or so.

Thanks everyone for welcoming me and for all the help in learning about pre-eclampsia studies and info :-)
Me (27) and Hubby (35) married 5 yrs
Mom to A (RIP Forever 4) - severe CP, microcephaly, seizure disorder, etc.
Stepson age 7 - ambiguous genitalia and hypospadias
DD age 21 mths - growth hormone deficiency, preemie at 33 weeks due to severe and sudden onset of PE
New Baby due 3/9/12, hoping and praying he is healthy!

mom29
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Re: 10 weeks already seeing MFM

Postby mom29 » Fri Aug 19, 2011 05:15 pm

Is your blood pressure still running high or just when you were seen in the ER?

mom29
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Re: 10 weeks already seeing MFM

Postby mom29 » Fri Aug 19, 2011 05:13 pm

Welcome to the forums! I started seeing a mfm doctor five weeks into my current pregnancy due to previous miscarriages, chronic hypertension, diabetes, and a history of pre-eclampsia.

I only saw the mfm concurrently during my previous pregnancy and the regular OB delivered my son at a local hospital. This time I am seeing just the mfm doctor. It is a night and day difference having a mfm overseeing this pregnancy. All my questions are answered, he gives long detailed answers, and he makes it clear that it is okay to call with any concerns. Having someone who is experienced in dealing with high risk pregnancies and saying he will be watching me very closely is such a relief.

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caryn
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Re: 10 weeks already seeing MFM

Postby caryn » Fri Aug 19, 2011 09:59 am

When your pressures start to rise this early it's generally a sign that you've got chronic hypertension, even if your pressures are normal outside pregnancy. I'm glad to hear you have an MFM on board just in case you fall into that 50% your doc has mentioned, and the monitoring schedule sounds very consistent with what I hear MFMs recommending.

Chronics often end up on labetalol or methyldopa, which doesn't lower PE risk but does lower your risk of stroke. Only women thought to have clotting disorders are recommended to blood thinners. Some docs recommend aspirin but only if they think you're in a group likely to benefit, and chronics often aren't in those groups. So don't worry if your doc doesn't believe you need medication. Many many women all over the world do nothing different in subsequent pregnancies and have healthy pregnancies. There is very little evidence suggesting any benefit from any meds at all; we have had posters sail through subsequent pregnancies on no therapies and we have had posters lose their babies in subsequent pregnancies to repeat PE despite having everything including the kitchen sink thrown at them.

Our Medical Board has commented on this extensively in the Ask The Experts forum; there's a lot of good reading there, including this discussion about aspirin early in pregnancy: viewtopic.php?f=19&t=40560

The Announcements and PE in the News forum contains links to a lot of the underlying science stuff about initial placental implantation.

And welcome to the forums! These subsequent pregnancies are nervewracking so I'm glad you found us.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

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riehlism
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Re: 10 weeks already seeing MFM

Postby riehlism » Thu Aug 18, 2011 06:48 pm

They aren't recommending any medication for you? A lot of us ladies were put on medication in subsequent pregnancies. I think if you stroll around the forums you will see in the signatures what meds they have recommended for us. I am on daily Lovenox injectables, baby aspirin, and folic acid. It seems that those women on some kind of medication regimen deliver at term, or closer to term with few problems. I don't know if you left that information out, but it's definitely something I would ask about.

Studies show that intervention prior to 14 weeks gestation (which is when the umbilical blood vessels mature) have better outcomes than those who do nothing, or start medicine after 14 weeks.

I am currently 29 weeks and have had not problems or symptoms. Last time, I started having symptoms at 21-22 weeks and delivered at 24+6.

And for you reading pleasure:

This is an article published The Journal of OBGYN just last year. It specifically discusses the use of baby aspirin and how it decreases the risk for preeclampsia. It was a 20 year retrospective study.

http://www.thedoctorschannel.com/video/3510.html
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192

honey
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Re: 10 weeks already seeing MFM

Postby honey » Thu Aug 18, 2011 06:33 am

hi my situation is a bit similiar i'm nearly 12wks with my third after ttc for 4yrs! i've had preeclampsia both times my dd was 37wks,was in hospital from 32wks my ds was an emergency csection at 32wks.i'm really scared i'll get it again and as you know its scary to go through.my ds was 3lb7oz and did very well but it worries me if i have to have this baby earlier.i havent told my mum yet as she'll worry about me being high risk.i'm in the uk so think its a little different over here i'm not even seeing the consultant until 18wks but this time i will push to get steroids early and if i see stars i will tell the truth! take care and let us know how you get on,at the moment i'm thinking its going to be a christmas baby!

Abbysmama1109
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Re: 10 weeks already seeing MFM

Postby Abbysmama1109 » Wed Aug 17, 2011 11:34 pm

I also wanted to add that when I was in the hospital having the ultrasounds with my daughter they said that the blood flow from the placenta to her looked fine, but they couldn't figure out WHY she was small. She was born at 33 weeks 6 days and she weighed 3 lb 10 oz. They attributed it to the PE but then they realized five months later that she has a rare growth disorder so now she gets injections every day to help her grow. So if she is IUGR in the US it could be from the PE or it could be because the new baby has growth hormone deficiency. So confusing!

The geneticist said at the very most the baby has a 25% chance of getting the growth hormone deficiency, that is only if it is a gene that my husband and I both carry. It is still unclear if it was just an abnormality that occurred that one time or a gene that is recessive. My daughters endocrinologist said there is no gene to test for to see if we have it since they are still in the research phase of finding out what genes are responsible for it. So it just adds another twist. Plus my first child was born with severe brain damage and microcephaly and they never found a cause, so they will be on the lookout for a small head. So far the baby is measuring ahead, they already had to change my due date from March 14th to March 9th. PHEW my hand is hurting from typing so much I am going to go read the forums, thanks for reading if you got this far :-)
Me (27) and Hubby (35) married 5 yrs
Mom to A (RIP Forever 4) - severe CP, microcephaly, seizure disorder, etc.
Stepson age 7 - ambiguous genitalia and hypospadias
DD age 21 mths - growth hormone deficiency, preemie at 33 weeks due to severe and sudden onset of PE
New Baby due 3/9/12, hoping and praying he is healthy!

Abbysmama1109
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10 weeks already seeing MFM

Postby Abbysmama1109 » Wed Aug 17, 2011 11:17 pm

Hello,
I had my daughter at 33 weeks in November 2009. I developed PE very suddenly and within days my BP was 200/115 (this was being in the hospital on meds). I also had it my first pregnancy but only during the delivery. I am now 10 weeks pregnant with my third. I had a bad case of strep throat a couple of weeks ago and while in the ER my blood pressure was high (158/98) and sent the doctors into a tizzy and the referral to the MFM.
This week I went to the new MFM departmet and saw a geneticist, a new OB, and had another ultrasound. She thinks I have a 50% chance of having PE again. I really liked her and she seemed very experienced and informative. She told me after the 18-20 wk anatomy ultrasound, she would see me for ultrasounds and checkups every two weeks and then in the third trimester twice a week for NSTs/US.
I asked her if there is anything I can do and she said no, if there is PE the stage is set at the time that the placenta attaches. She said bed rest can help sometimes but since mine came on so suddenly and so severely she doesn't see that being something that we will end up doing. I am already instructed to do a 24 hr urine to get my baseline protein so if it goes up later they will know what is normal for me.
I am of course concerned about the PE. My husband and I haven't told either of our families yet because I know my mom will flip over me having a high risk pregnancy.
Anybody else in the same boat?
Me (27) and Hubby (35) married 5 yrs
Mom to A (RIP Forever 4) - severe CP, microcephaly, seizure disorder, etc.
Stepson age 7 - ambiguous genitalia and hypospadias
DD age 21 mths - growth hormone deficiency, preemie at 33 weeks due to severe and sudden onset of PE
New Baby due 3/9/12, hoping and praying he is healthy!


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