Diagnostic criteria for PE?

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blythe
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Re : Diagnostic criteria for PE?

Postby blythe » Wed Sep 16, 2009 02:09 pm

Sara, I've always been confused about that "official" diagnostic criteria, too, especially since docs seem to diagnose "severe" much more readily than that. Maybe because of this study
http://www.ncbi.nlm.nih.gov/pubmed/15684147
that came out after that AAFP article (and the 2002 ACOG report it was taken from http://www.ncbi.nlm.nih.gov/pubmed/12094777) was written?
In the 24 patients being treated immediately before stroke, systolic pressure was 160 mm Hg or greater in 23 (95.8%) and more than 155 mm Hg in 100%. In contrast, only 3 of 24 patients (12.5%) exhibited prestroke diastolic pressures of 110 mm Hg or greater, only 5 of 28 reached 105 mm Hg, and only 6 (25%) exceeded a mean arterial pressure of 130 mm Hg before stroke....Maternal mortality was 53.6%; only 3 patients escaped permanent significant morbidity.
This article also mentions that study http://hyper.ahajournals.org/cgi/content/full/51/4/960
and notes: Our practice is to initiate treatment when BP is 150 systolic and 90 to 100 mm Hg diastolic.

I hope that helps a little.


alexa5
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Re : Diagnostic criteria for PE?

Postby alexa5 » Wed Sep 16, 2009 09:35 am

I definitely agree with Caryn and Anne, and only wanted to add that when I read your post, and saw your pressures and that you were 37 weeks, my immediate thought was that they felt it best to not risk it and get that baby out. And that most likely you did have severe pre-e, but everything happened so fast they didn't do all of the diagnostic things they could have in order to play it safe.

The other thing--not trying to take away your hope for this pregnancy, but want to mention that my bp was lower than normal throughout pregnancy until the 28th week or so, and then it skyrocketed suddenly. But up until that point I had lower than normal bp in my first and second trimesters. Once it elevated, I was considered just PIH, until protein showed up at week 33, and then I was quickly induced. I am sure with my pressures alone, if I had been farther along, they would have induced, but I was only at 28 weeks and not showing any other signs--thus best to wait to improve outcome for the baby.

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annegarrett
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Re : Diagnostic criteria for PE?

Postby annegarrett » Wed Sep 16, 2009 01:34 am

I'm just echoing in. Maybe we're particularly firm on this with you because a)I had this with baby #1, 3 and 4--#2 was fine. #3 nearly took me out. Later, after #4 was born, we found out I have an autoimmune disorder--a serious one that I've been told increases my risk of death before 60 to 75%--so my preeclampsia was a symptom of this serious underlying disorder--no amount of waiting would have changed the fact that I was going to get the disease again and again; and b) one of the women we lost, actually just this past Sunday, was from Stillwater.

We don't mess around with this disease because the cost of making a mistake is way too high. I'm not you but I know I was sold on doing things the most natural and least "invasive" manner. I had to settle for not getting sick and dying. It was ugly.

Chances are good that without the dip, you're in a good place, but the best way to be sure is to get a consult with an MFM (high risk doctor) because yes--your diagnosis with the last baby would have been right. A personal pet peeve of mine is the qualifiers used to describe preeclampsia.. "mild"..."serious". I'm sorry but the diagnosis of preeclampsia involves proteinuria which pretty much means your kidneys are not working properly. It is all serious--it's a dangerous syndrome that is the leading cause of maternal and infant death and the only cure is delivery. It goes from 0-70 in a matter of hours so I hope you'll follow up with an MFM. I'm frankly shocked, given your last experience, that you weren't sent there to start with, but then, a lot about the American health care system astounds me.

Take care of yourself and let us know we were wrong. We LOVE to be wrong. Best wishes and email me anytime.


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caryn
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Re : Diagnostic criteria for PE?

Postby caryn » Wed Sep 16, 2009 00:57 am

Sara, it's my understanding that the dx of PE requires two readings, four hours apart, of either of 140/90 plus a 24-hour proteinuria of +300 mg. Once that's met, severe PE can be diagnosed with one reading of either of 160/100, or proteinuria over 5000 mg, or severe headache, or visual disturbances, or a bunch of other markers. So if you'd had one prior reading of either of 140/90, they only needed one pressure reading to dx you with severe gestational hypertension.

The Experts have said recently a) that 140/90 is a squishy cutoff that might be too high for safety, b) that women with elevated pressures but not proteinuria might be best characterized as having non-proteinuric preeclampsia, and c) once you're potentially maybe getting around to being close to diagnostic after 37 weeks, deliver.

They think about this now as a placental disease driven by maternal-fetal conflict, and they're getting somewhat less determined to meet arbitrary symptomatic cutoffs as they get closer to a diagnostic test that will work several weeks before symptoms appear.

Removing the placenta starts the cure for the maternal disease, and there's just no point in messing around with it. We've had three maternal deaths mentioned on the forums in the past two weeks or so. Docs do not generally even want to take much time to explain what's going on with this syndrome before recommending treatment, delaying a thorough explanation until after delivery, unless you're a very slow-crawl gal.

Have you had an MFM consult with this pregnancy? Having preeclampsia in a pregnancy other than your first places you at higher risk of developing it again, because it's likely related to the development of some sort of underlying condition (chronic hypertension, autoimmune disease, etc.) that predisposes pregnancies to become hypertensive.

saramomofmany
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Diagnostic criteria for PE?

Postby saramomofmany » Wed Sep 16, 2009 00:34 am

Hi, I have a question. I saw on someone's post this:

Diagnostic criteria for severe PE
http://www.aafp.org/afp/20041215/2317.html
Severe preeclampsia Blood pressure: 160 mm Hg or higher systolic or 110 mm Hg or higher diastolic on two occasions at least six hours apart in a woman on bed rest

I am curious about the 2 occasions at least 6 hours apart...do they always wait 6 hours to diagnose PE? The reason I ask, with my 5th baby, I was 37 weeks and not feeling good, went in to get checked out, and my b.p. was high(144/102), they waited about 25 min. checked it again and it was 164/124. And 5 minutes later 150/110. At that point they decided to induce me on the spot.

Should they have waited at least 6 hours to recheck bp's and then decide about inducing/diagnosing me with severe PE? According to my medical records, during labor my bp was in the 150's to 160's over 90 to 105.

I'm currently about 27 weeks pregnant with baby #6, and so far, my bps have been good(I even got the 2nd trimester dip, which DID NOT happen with baby #5, so I'm more hopeful I won't get it again). I just still have trouble accepting that I really had severe PE...because if I didn't, just had eleveated bps, I have more hope/peace not to develop it this time either. Maybe I'm just in denial....

Thanks! Sara


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