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Re : Generally Concerned - looking for info

Posted: Fri Jul 29, 2005 08:52 pm
by akemt
From my understanding (which is next to nothing, btw), if the platelets get too low she'd be delivered. Where that point is, I have NO idea. I'm sure someone else can jump in on that one, and reading up on the HELLP syndrome info can offer insight too, though she doesn't have to have HELLP to have lowering platelets with preeclampsia, to my knowledge. Also, if her platelets lower enough, when delivery time comes, she may not be allowed an epidural. That really is all the info I have -my apologies.

Is your home cuff a regular cuff size and the office cuff a large one? Maybe this has been gone over, but that could account for differences.

Sending my prayers and well-wishes also! Congratulations on 29 weeks!

Re : Generally Concerned - looking for info

Posted: Fri Jul 29, 2005 07:37 pm
by kdreher
Not much to add except my continued support for your wife and babies health.

Re : Generally Concerned - looking for info

Posted: Fri Jul 29, 2005 06:34 pm
by anathor21
Received an email asking for an update and realized that it has been two weeks since I first posted here... figure others may also be interested in an update so here goes a summary:

We're now 29 weeks (horay!), BP monitoring at home is consistently borderline - i.e. floating around 130-140/78-90 range. BP in doctor's office is fairly consistent - and much lower (explain that one) today's was 12x/7x. Dr. office is taking us seriously - when we called Tuesday AM reporting that home monitoring had hit 142/90 they had us come in for appt - office reading was good (and I confirmed with my own cuff that I got same reading). We were sent for lab work and 24hr study.

Today (Fri) we talked with our doctor and learned that 24 protein was elevated (266). Also platelet count is down from previous, but not yet low enough to be abnormal (I'm just reading up on implications to this now - feel free to share any links etc).

The really good news though is that the ultrasound measurements today show he is now about a week ahead in growth with both weight and growth at around 71st percentile. That gives me some comfort!

We are now scheduled to go in weekly for blood work, 24hr study, and consultation/exam. So, we are feeling well cared for - and although the nurses at first seemed somewhat dismissive of our home measurements I think that my demonstration that I indeed could use the equipment right and got similiar measurement to what they did on Tuesday helped my cause...

We are continuing monitoring at home (staying with 2X daily measures) and will slow down mom's routine (not quite on bedrest, but it was suggested that she take it easy - no more playing tourguide for relatives!). Will be watching for any other symptoms, naturally, but we're aware that with Isabel Julie never felt bad or had anything noticable other than elevated BP and protein followed by IUGR (of which I can only measure BP at home...).

Open to suggestions/comments, and I will do my best to post updates for those interested.

Re : Generally Concerned - looking for info

Posted: Fri Jul 15, 2005 12:22 am
by akemt
My apologies for the abrupt ending to my previous post! DH came home last night and as he walked in the door (mid-post), said "We need to go to the ER." AH! LOL He had hit his eye with a pair of pliers (mechanic), but it appears that it just bruised the eye. So it was good news, he's had to have it literally drilled before! Okay, sorry for all that info about the events of last night.

Back to where I think I was...Though everything appeared to have started early and I even had symptoms in my second pregnancy that I didn't in my first (proteinuria -though no Oligo this time), some I'd had in both were worse (pitting edema to my knees), and I was sure this meant we were doomed to strict bedrest and early delivery, my body seemed to have hit a plateau and didn't budge. I had BP spikes every now and then, had symptoms come and go but pretty much stay the same, and I was able to be safely delivered via induction at 38 weeks. Whew! So I feel I was quite lucky. Still, even with my luck in my second pregnancy, I feel that I'm at risk for hypertension again in a third -better, worse, or the same kind of plateau, I don't know, but I'm one who would prefer to assume the worst than get caught off-guard.

To add to what Julie (pelote) said in regards to Anne's post regarding getting preeclampsia again, she had said that the majority of women who get preeclampsia again get it at the same gestation. And those who do get it again, tend to get it more severely. That is quite backwards from the general information floating around (and she was actually correcting my spreading of it at the time), but Anne knows her stuff and gets it from highly reputable sources.

My first was watched (well both, actually) closely for Intrauterine growth restriction (IUGR) via ultrasound. She was actually large for gestation on both weight and length (and still is to some degree), but her stomach was behind the other measurements. Because that pregnancy was also complicated by Oligohydramnios (low amniotic fluid), our doctor was paying very close attention to any signs of that affecting our daughter, mostly in the form of IUGR. He had told us at the time that if her stomach had fallen 3 weeks (maybe it was OVER 3 weeks -seems like we were already 3 wks behind?) her head and femur measurements, he'd diagnose IUGR and send us on our way to a larger hospital for the remainder of the pregnancy. What he had said was that when there is a compromise, blood and nutrient flow is automatically routed to the brain to sustain life and function there and the stomach size is usually the first visible sign of that change. So while it may end up being normal for this baby (my daughter ended up being just fine), it is probably something that should be watched closely should your wifes condition continue to progress towards hypertension (and maybe even if not).

I'm glad to hear that you've done some planning ahead and good for you for becoming as informed as you can be -that will help SO much in the months ahead. Best wishes!

Re : Generally Concerned - looking for info

Posted: Fri Jul 15, 2005 11:10 am
by youtan
Not sure I can add anything new - but I'll try to give at least my viewpoint on some of your questions?

1, 2, & 3. I completely understand your need for the numbers! After my 1st scary pregnancy, I consulted a peri - and he attempted to go through all the statistics. He had this 10 page roughed-out handout which described symptoms and had %-ages next to almost each of every risk factor imaginable in the scope of preE. I'm not sure that he had a 'scientific' algorithm - but he did combine these numbers for us and came up with a % risk factor for preE reoccurance based on my case history. Although for me, a scientist, it was reassuring (well, not really as our magic number was 68% for preE) to see the method - as you know statistics are just that statistics. Someone does win the lottery - unfortunately for us our chances are better... My 2nd pregnancy was stopped before preE was able to progress - a good thing - as my peri and I both believed that something severe was inevitable.

and your 4th question - what new thing can a peri bring to your table...
My response is that in the worse case scenerio its possible there won't be a lot of time for decision-making. A peri should be able to spot these cases - and take the needed steps. Have you guys been checked for underlying causes - there are lists of things that can increase the risk for preE. Sometimes its helpful to know - and there could be treatments for these conditions which may be helpful to decrease chances preE.

Having said that - a good relationship with the doc is also key. But even a good intentioned doc can miss something if not trained for it. Here is what I'd do - have a consultation with the peri. Let the peri help you decide IF a high risk doc is necessary. If so, many patients see a combo of the OB and peri. There are several scenerios that you could explore.

Good luck - and I hope that this pregnancy continues preE free!!

Re : Generally Concerned - looking for info

Posted: Fri Jul 15, 2005 10:17 am
by gordon k
Peace of mind, right now, is why I'd take my wife to a peri. If your wife had PIH/preeclampsia before, in my personal opinion, I'd take her to a perinatologist. To me, it seems they are more vigilant and knowledgeable in dealing with and treating (and in my wife's case, preventing) preeclampsia, and I felt confident trusting my wife and my twins' lives to her doctor.

I can't speak for all perinatologists, but finding the right one gives peace of mind and proactive treatment. From the very beginning my wife saw her perinatologist exclusivesly throughout our pregnancy, and I am grateful that she did. I can understand the desire to have your wife looked at by every specialist possible to make sure she and your baby are okay--finding a great perinatologist (in our case, hopefully in yours it will be, too), is like having "every specialist under the sun" with his expertise.

Hope that you find a world-class perinatologist and peace of mind for you and your wife. Thanks for keeping us posted.

Re : Generally Concerned - looking for info

Posted: Fri Jul 15, 2005 08:32 am
by kdreher
My dh and I went to see a peri prior to us deciding to TTC because of my history. I wanted to work with an OB who had a working partnership with a peri in case I get PE again. The peri did baseline testing for me to see if I had any underlying clotting disorders. I would suggest taking your OB up on her offer to refer you to a peri. Your wife may not need to see a peri (aka high risk doc) but it might be nice to touch base with one, let them know her history, find out how they would treat her if the OB needed to refer you to them for care, etc. Basically I find it just an extra element of support to have a peri. Our peri did make references to my OB regarding extra supplements, bed rest, chance of reoccurance, extra ultra sounds, etc. The peri I use is also part of a maternal-fetal team who is a major contributor to studying PE and that is another reason I like him.

Re : Generally Concerned - looking for info

Posted: Fri Jul 15, 2005 07:15 am
by anathor21
So many posts to reply to... Thanks everyone, can't quite respond to every comment, but believe me I have read all and all links too. I'll start from the top though...

kstevens - We don't currently have a perinatologist, although we did discuss it with our OB pre-pregnancy as an option if needed.

In gerneral we are fortunate in many ways, one of which being that we have great confidence in our OB (unlike the experience that hfwarner3 had!). With that said, perhaps someone can fill me in if there is anything in particular that a perinatologist could add at this point?

pelote77 -
re: Don't worry, if you get it again... - the thing that got me the most was that we delivered Isabel at a hospital that has an excellent reputation for both research as well as care and I kept noticing that folks expressed surprise - I figured they woudl have "seen it all." Perhaps they were trying to appeal to the need to feel individual and not appear indifferent to things... it does leave me wondering what I was missing though, heh.

Regarding testing, although I don't know exactly all the tests that have been done, we did go through some additional testing after Isabel once we suggested to our OB that we were not done...

Our OB is not a "high risk" OB, but as I mentioned above she has stated a willingness to refer us as needed (and I believe our relationship is good enough that if we expressed concern she would do so if at all medically justified). We are currently in a 2 week appt cycle and I check her bp daily now and sometimes more if she is feeling odd, notices more swelling, etc.. (So far fairly steady, btw)
No active extra monitoring for #3 yet - but we are not yet showing difinitive signs of trouble (however we have had postitive US's - perfectly in-line growth). This is actually something I have wondered about though since Isabel was so light at birth (her length was close to 'normal for age') I do wonder how long she was in trouble (i.e. did she lose that much weight in the last week? the day our OB sent us to the hospital I remember a comment that 'the baby's belly is smaller than expected' from the US tech.

Catherine -
thanks for the links - I really appreciate your taking the time to dig them up. Good reading - took a rather long time to read all 13 pages of hfwarner3's experience, couldn't stop reading though, what a nightmare!

Rachel -
No, not currently on any medications - (see prior post) she is not really "high" yet. With Isabel it went from this "slow drift" to a spike at 30 weeks with protein spilling about 4 days after the BP rise. Perhaps I should write up my "Isabel story" somewhere to reference so I don't repeat it in bits and pieces.. heh.

Akemet -
Thanks for the specific info related to bp trending. In the interest of accuracy I will get a copy of the offical records for all three of our pregnancies and see how they look when graphed (heh, maybe it won't change a thing, but I can feel like I have done something, right?)
We are preparing mentally and logistically for early delivery (was hard with one child at home, will be different with two of them) and are preparing the girls for mommy to be away in case she is hospitalized - the seperation being the most traumatic part for the girls. We have our plans/backup plans. Will hope for the best... every week that goes by we are happier (will likely have to celebrate crossing 31 weeks).

Gordon K -
You are I believe the third to mention having a perinatologist on the team... so I'll have to reiterate my question from above - at what point is it appropriate/necessary to bring in the peri? Although the ultra-conservative side of me wants to have every specialist in the world look at us "just in case" this doesn't seem to really be a good use of time and may just result in more anxiety. What would a perinatologist likely do at this point that would result in a different course of treatment?

Thanks again to all who responded and I hope I have answered all questions/comments as necessary. I appreciate the information and general support.

Re : Generally Concerned - looking for info

Posted: Fri Jul 15, 2005 01:06 am
by gordon k
Hello and welcome to the dad's forum. Glad that you found us.

From what I learned from my wife's experience (and again, I'm not a doctor), it seems to be (A) hard to predict if one will get preeclampsia (although there are high-risk symptoms to look out for, in your wife's case, previous PIH) and (B) when will it occur.

My wife should've gotten preeclampsia and delivered early, but didn't: she was on anti-hypertensive meds (atenolol), and was also tested for anything else that could've been wrong with her (underlying disorders, which in her case was essential/primary hypertension). She has a very proactive doctor who, in my humble opinion, kept my wife's preeclampsia "at bay."

Having a perinatologist that you and your wife trust, and who you can ask any questions, is so important. One of the frustrating things: you can't predict if and when preeclampsia is going to happen. But being familiar with its signs & symptoms, which I'm sure you are, (I KNOW that it's a frustrating statement that you hate, but unfortunately with this disease, it's the best we can do), helping your wife watch out for them, and having 24/7 access to her doc via a nurse or L&D are important.

Best of luck to you, please feel free to e-mail me [email protected] if you like. Please keep us posted...

Re : Generally Concerned - looking for info

Posted: Thu Jul 14, 2005 10:27 pm
by akemt
In general, a rise in baseline BP of 30/15 points is cause for concern, though no longer diagnostic.

Also, it may help you to look back through your records and see when the rise began. There is something we call a "second trimester dip" that may help you gain further insight.

To quote "Chesley's Hypertensive Disorders in Pregnancy":
In general, mean arterial pressure declines in the first trimester, reaching a nadir between 16 to 20 weeks' gestation with a return to control values near term. Diastolic pressures decline to a greater extent than systolic pressures, the average mean change being about 10mm Hg. (pg 70)

If her BP's rose durring this time period, that can be an indicator to watch closely (yah, I know, you hate hearing that!). And the National Institute of Health's Working Group Report on Hypertension in Pregnancy stated that the drop tends to be even more pronounced in those with chronic or gestational hypertension. (Full transcripts can be found here: ... p_preg.htm )

As you are aware, there is little to nothing that is concrete with PIH/preeclampsia.

I would think that expecting (and preparing for) PIH to show again and an early delivery is a good idea. If that does not end up being the case -you can be pleasantly suprised.

My own experience isn't much to go by. I feel like a bit of a fluke, honestly (but most of us probably do!). I had PIH in my first pregnancy, diagnosed around 29 weeks. In my second pregnancy, I followed a similar course, but my labile BP's and rise from baseline were noticed much earlier at around 20 weeks gestation with the addition of pitting edema, tachycardia, and some proteinuria, etc. How much of that was due to the fact that I was watching closely this time or whether it really came on earlier, I don't know. My body did a sort of stand-still.

GOTTA GO, Sorry! I'll try to finish later.