Re: second pregnancy management
Posted: Tue Feb 26, 2013 12:01 am
Depends on the headache. She clearly has preeclampsia at 34-35 weeks, which can be managed as inpatient or outpatient with twice weekly patient assessment if outpatient in order to evaluate the mother and the fetus. With a headache she needs to contact her physician who will ask her about the headache and other symptoms, particularly chest/abdominal pain, visual symptoms. Ideally low dose aspirin would have been started before 14 weeks of pregnancy given her history. Personally I would want the patient to come in to see me in the ER with this history so that I could check her CBC and LFTs and evaluate several pressures over several hours. In our series we saw about 40+ per cent of patients like this become severe prior to 37 weeks. Hopefully the BPP is fine for the baby and there is no evidence of severe fetal growth restriction.
second pregnancy management
Posted: Tue Feb 26, 2013 12:01 am
I had pre-eclampsia with my 1st pregnancy 3 1/2 years ago. The symptoms started to present itself at around 27 weeks. I had protein in my urine, headaches, dizziness, and my BP when they decided to finally take her at 34 weeks was 200/112. Here is my complete story from my first pregnancy (and how poorly, I think, they managed my pre-eclampsia).
I started getting some swelling at about 25 weeks. But I figured it was just typical for pregnancy and went on with life. But during one of my typical OB check-ups, (I think it was 27 or 28 weeks) they noticed my BP was elevated (I believe mine was around 150/90). So they had me take a non-stress test and see if laying down would lower it at all. It did lower it a bit.. So, since laying down worked, my doctor put me on partial bed rest. So, I made sure to sit down a bit more often with my feet up and lay on my left side as often as I could.
Then, I went in at my 30 week appointment and my BP was up quite significantly... I also had started to notice swelling all over. I don't recall what my weight was, I just remember gaining 38 lbs during my 35 week pregnancy.. So it was higher than what you were supposed to gain. But, another symptom I started having were these terrible headaches that wouldn't go away with Tylenol.. At my 30 week appointment, they said my BP was 180/100 and that I needed to go to OB again for a non-stress test. That's when they took my blood and tested for protein in my urine and apparently I was leaking quite a bit (but I am not sure of the exact number). They told me I was to be on full bed-rest and would start to have OB appointments every week so they could monitor me. That was also when they told me I officially had symptoms of pre-eclampsia but "not to worry". I tried not to, but it is a bit hard not to be!
Then, when I went in at 34 weeks (and some odd days), they took my BP and it was 190/105. My swelling had gotten a bit worse and so did my headaches. The headaches actually were pounding to the point that I would cry because of the pain I was in. At that appointment the doctor monitored me for 6 hours or so and ended up telling me to take more Tylenol and come back if I started seeing spots or my headache got worse. I went home... I tried to sleep that night, but the headache wouldn't allow me to. Then, I started to get this tight feeling in my stomach that would come and go and I was in a lot of pain between the two. So, I went back into the doctor. This time I was admitted and was told I was having contractions. So, they gave me medication to stop the contractions, magnesium for the BP, and morphine for the pain. My BP then was 200/112. I barely recall much over the next couple of days to follow. It all happened quickly and I was pretty foggy because of the medication. I do remember the nurse arguing with my Doctor about sending me to a bigger hospital. Finally, after 8 or so hours they decided to send me to ***** via ambulance.
Then, I spent the night at **** where they monitored my BP and it hadn't lowered. The doctor told me they thought it would be best if I delivered that day via emergency c-section. I had no idea that this issue was that serious! I asked if I could have a natural labor and they said that they wouldn't advise it since my BP was already very high. Apparently they were worried about me having a seizure and/or a stroke (again, news to me.. I didn't feel very informed). So, they said they'd schedule an emergency c-section 15 minutes from then. Sure enough, I went in there, they took her and she was born at 9:30 am the morning of May 21st. Unfortunately, because she was 5 weeks early, she went straight to the NICU. Also, due to my BP, I was unable to stand up to go see her. They wouldn't let me get up and continued the magnesium and morphine. I didn't get to see our daughter until 4 days later.. So all in all, I was very unhappy and upset with how everything got handled. I feel they could have done a bit more preventative stuff and maybe not let it get SO bad. Later, I realized how serious pre-eclampsia actually is and feel very lucky to have lived and have a healthy 3 1/2 year old. Now... Fast forward 3 1/2 years..
I am pregnant again. This time pre-eclampsia didn't start showing it's ugly face until I was 30 weeks along. I noticed some swelling and my BP was a little raised (140/90's). Right now, I am 34 weeks 5 days and displaying much of the same symptoms as I did with my 1st pregnancy: headache, dizziness, and sitting BP of 155/100. However, my urine comes back negative for protein every time. My 24 hour urine results were only 308 about a week or so ago and I have been told this is considered low and barely classifies me as pre-eclamptic. The doctor currently has me on partial bed rest, again. I am also seeing an OB this time for a non-stress test every week along with a BioPhysical Ultrasound. So, I do feel they are monitoring the baby better this time around. I am doctoring in the same town, but different doctor this time but I can't say I am not 100% pleased with how this one is handling everything yet. I am a little worried about myself and how well they are monitoring/treating me. So far, every time I lay on my left side my BP drops down to 135/85 or so. But the second I sit up it shoots through the roof and is 150's/90-100's.
So, I just was curious if it was normal to have pre-eclampsia with no protein in my urine and why my BP drops so drastically when laying down? Also, since it drops so drastically when laying down, I was curious if I should I be on full bed rest and not on moderated? It just seems odd that it is SO high when I sit up for 2 minutes. I just don't want to get as bad as I did with my 1st daughter.. It was very scary and I had to get rushed by ambulance to a bigger hospital plus I was not allowed to get up or do anything for 4 days. It killed me to not see my baby for that long and I really just don't want to repeat history. I do want to make sure I am not over-reacting too.. I know this is a serious disease and I guess I just don't want to end up as bad as before (or worse). So from a professional view, does it sound like my doctor is doing what she needs to be doing this time around? I am happy with how she is monitoring the baby, but I am not very happy with how I am only on partial bed rest and not on any medication or anything to control the BP from getting to the point it did last time. Currently, her plan is to keep me on partial bed-rest until 37-39 weeks and deliver via c-section again. But, with the way it spikes up the second I sit up, I don't know if I feel comfortable with that.. So, I figured it wouldn't hurt to get a 2nd opinion. I appreciate your time and thank you in advance for your advice!