High blood pressure

[BanditaMamacita]

I'm planning an "oops" UC, so I still see a mw/ob practice for prenatal. At my appt today, my blood pressure was super high for me... 134/80. I usually hover under 100/70. It was around 110/80 4 weeks ago at my last appt. I'm really really worried about this. I don't think I feel comfortable UCing with preeclampsia or PIH, and i would be risked out of the birth center i've been to before... and a hospital birth would just be horrible.

Am I overreacting? I don't know how much fluctuation could be normal. I have been ridiculously sick (getting over the flu, i think) and up all night taking care of a sick 2 and 3 year old. And our life situation is pretty stressful in itself right now. I also never, ever leave my kids, but I had left them at home napping for my appt today, i was prolly pretty nervous about hurrying things along to get back to them. So I'm hoping it was just situational and by my next appt in 2 weeks it will go back down or at least stay steady.

Anyway, i guess i'm wondering, if it doesn't go down, what you guys would do. And what your experience with blood pressure has been. And any tips on what I can do to try to lower it?

[mischievium]

*

[fyrebloom]

First hugs

Second your bp does raise at the end of pregnancy, i'm experiencing it myself atm. I'm normally like 100/65ish and am currently about 130/80 or 90. Do you have your own cuff? Could you be having some white coat hypertension? Does your bp drop when its taken laying down? Laying down mine is about 120/75 so I'm not concerned about mine. I had pre-e last time with my twins and when my bp was 156/99 I was considered to have mild pre-e. Try not to get stressed about it, stress will only make it worse and it never helps. Push protein, the more the better. Ｔｈｉｓ　ｃａｎ　ｏｆｔｅｎ　ｒｅｖｅｒｓｅ　Ｐｒｅ－ｅ．　　Ａｒｔｉｃｈｏｋｅ　ｅｘｔｒａｃｔ　ａ ｎｄ　ｒｅｓｔ　ｃａｎ　ｈｅｌｐ　ｔｏｏ．　　Ｔｒｙ　ｈａｖｉｎｇ　ｙｏｕｒ　ｐａｒｔｎｅｒ　ｔａｋ ｅ　ｙｏｕｒ　ｂｐ　ｗｈｉｌｅ　ｙｏｕ’ｒｅ　ｌａｙｉｎｇ　ｄｏｗｎ　ａｔ　ｈｏｍｅ．　　Ｉｆ　ｉｔ ’ｓ　ｖｅｒｙ　ｄｉｆｆｅｒｅｎｔ　ｙｏｕ　ｃａｎ　ａｓｓｕｍｅ　ｙｏｕ’ｒｅ　ｓａｆｅ．　　ＯＨ　 ａｎｄ　ｄｒｉｎｋｉｎｇ　１／２　ａ　ｈｏｐ　ｒｉｃｈ　ｂｅｅｒ　ａｎｄ　ｔａｋｉｎｇ　ｉｔ　ｃａｎ 　ａｌｓｏ　ｈｅｌｐ．　　Ｉｆ　ｉｔ’ｓ　ｓｔｉｌｌ　ｈｉｇｈ　ｗｉｔｈ　ｔｈｅ　ｈｏｐｓ　ｉｔ’ｓ 　ｍｏｒｅ　ｓｅｒｉｏｕｓ．．　ｊｕｓｔ　ｄｏｎ’ｔ　ｄｒｉｎｋ　ｔｏｏ　ｍｕｃｈ　ｏｆ　ｉｔ　ａｓ 　ｈｏｐｓ　ｃａｎ　ｃａｕｓｅ　ｄｅｐｒｅｓｓｉｏｎ．　　ＧＬ！

[BanditaMamacita]

Fyrebloom, you made me feel so much better... thank you so much! I feel almost panicky that something out of my control might force me into having interventions i'm not comfortable with. BTW, how far long are you now??? I wasthinking of you and how ready to go you must be Good luck, i'm sure it will happen any day!

Anyway, i did have a long talk with my provider about it, and she was really nice and non-alarmist about it. Said that blood pressures frequently rise towards the end, I don't have any other signs that something is going on, that all the factors I mentioned could certainly drive it up and its certainly well-within the normal range. Talked about diet and R&R and said we'd keep an eye on it, but not to get ahead of myself. She said all the right things.... I just started to envision this downward spiral of hospital birth, induction, fetal monitors, laboring/delivering in a bed.... eeeeeeek!

[Zangua]

High blood pressure alone does not mean pre-eclampsia or toxemia. If you have sudden swelling of the face/hands and there is protien in your urine, you may have pre- e.
Otherwise, rising blood pressure is normal later in pregnancy and yours does not seem to be dangerously high- However, you can help bring it down by eating a lot of raw garlic and increasing your fluids.

[fwlady]

I had a huge spike in BP at 20+ wks, when I went to the ER for a migraine. I have been monitoring my BP at home since. I have found that my BP creeps up right before and during the time I am sick; bad allergies one time and a terrible cold the next.

The drs mostly look for an increase of the bottom number, and watching closer is usually at 15 over baseline for diastolic. You don't have to have swelling or significant protein to have PIH/Pre-e. Most of the time, yes. The dip sticks are highly inaccurate, so that is why the 24 hr urine is suggested.

Headaches, seeing spots or blurred vision, "liver pain" or shoulder pain, these are added symptoms. And, although my BP seems to be way over what I normally am, and have had all the above symptoms (but not normally continuously), I still have yet to get any pre-e diagnosis or testing. My CNM MW is very aware of what I have been concerned about, but since I have not had protein in my dips for a while and no real swelling, she doesn't seem to think I have it, nor any reason to worry.

So, no, a cascade of interventions isn't always inevitable. I think that if your dr sees PG as a disease, he will treat as such, but if your dr/MW believes that childbearing is a natural and normal thing, they will treat it as such as well.

Of the research that I have found, BP must be taken on the right arm, while in the sitting up with feet on floor position to be considered accurate. Many times nurses will ask you to lay down and take it, and take that number, and okay a person to go home. But, in reality, it isn't a correct technique. It may help to keep your symptoms from worsening, but it doesn't mean you have no pre-e just because your BP is fine laying down. Kymberli

[nashvillemidwife]

It is normal for BP to "creep up" in late pregnancy only as much as it naturally fell earlier. You should see a dip in BP, usually by the end of the first trimester. At the end is should return to baseline, and no more.

High blood pressure alone does not indicate preeclampsia, but there is no such thing as "just hypertension". If you don't know what the adverse effects are you can google them.

[ShwarmaQueen]

Mine was a teeny bit higher than yours one time in the early 3rd tri. Freaked me out too. My MW didn't say much. All my others have been "normally" elevated ever since. It seems like the trend is more important than one out-of-ordinary reading?

[Hedgehog Mtn]

My BP always spiked about 2-3 days before delivery. It took until baby #3 that we put it together because I also always gave birth around 37 weeks. I have no other pre-e symptoms so my mw always said "okay let's keep an eye on this" only for me to deliver within a couple days.

I would see if you can borrow a bp machine or do as a pp mentioned and use the one at the grocery store/drug store often....although the ones around are not always accurate.

[MamieCole]

PIH is indicated by two separate readings taken 6 hours apart that are both 140/90 or higher OR if not that high, significantly increased from your baseline enough to cause your MW concern. Your BP should be taken with your arm at heart level and you should not be talking during the reading.
One random reading that is a little higher than normal doesn't mean you have PIH.

[mischievium]

Originally Posted by MamieCole

PIH is indicated by two separate readings taken 6 hours apart that are both 140/90 or higher OR if not that high, significantly increased from your baseline enough to cause your MW concern. Your BP should be taken with your arm at heart level and you should not be talking during the reading.
One random reading that is a little higher than normal doesn't mean you have PIH.

The Preeclampsia Foundation has this to say about hypertension and pregnancy:

Hypertension (High blood pressure)

High blood pressure is defined as blood pressure of 140/90 or greater as measured on two separate occasions within six hours. However, a woman who normally has a low baseline blood pressure, such as 90/60, could be considered hypertensive at a blood pressure of less than that - especially if she has other symptoms. A rise in the diastolic (lower number) of 15 degrees or more, or a rise in the systolic (upper number) of 30 degrees or more is cause for concern.

In 1990 the National Institutes of Health, National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy issued the following research guidelines:


In the past it has been recommended that an increase of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyperuricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present.


It should also be noted that 4 members of the Preeclampsia Foundation Medical Board and our Executive Director participated in this working group. There was significant debate over removing baseline BP as diagnostic which is why the final sentence was included. The Preeclampsia Foundation continues to encourage its women, particularly those with low baseline BPs, to know their baseline and to be aware of significant changes and to make any concerns about those changes known to their health care provider.

(bolding mine) I mention this because it sounds like the issue isn't quite as straight forward as two readings over 140+/90+ 6 hours apart.

The diagnostic criteria put forth by the American Academy of Family Physicians doesn't even mention needing two readings:

Diagnostic Criteria for Preeclampsia* Preeclampsia
Blood pressure: 140 mm Hg or higher systolic or 90 mm Hg or higher diastolic after 20 weeks of gestation in a woman with previously normal blood pressure
Proteinuria: 0.3 g or more of protein in a 24-hour urine collection (usually corresponds with 1+ or greater on a urine dipstick test)


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
Proteinuria: 5 g or more of protein in a 24-hour urine collection or 3+ or greater on urine dipstick testing of two random urine samples collected at least four hours apart
Other features: oliguria (less than 500 mL of urine in 24 hours), cerebral or visual disturbances, pulmonary edema or cyanosis, epigastric or right upper quadrant pain, impaired liver function, thrombocytopenia, intrauterine growth restriction
*-For the diagnosis of preeclampsia, both hypertension and proteinuria must be present.

I did a quick search to see what ACOG or ACNM's guidelines are (if they have seperate ones), but was unable to come up with any useful links. I might try searching again when I have more time later.

[BanditaMamacita]

I just wanted to thank everyone for all the info and encouragement. You guys are great I'm feeling calmer about it now. I feel pretty confident that it's probably related to my flu-bug, dehydration, and stress, so i'm working on those things and hopefully it will go back down by my next appt. If not, obviously I realize that medical intervention is a good thing in situations like this... I just hope I don't have to let go of my ideal Thanks for calming me down!

[violet]

Great advice above. I only wanted to add that walking helps a lot with pg in general and with bp and with "white coat syndrome" - I sometimes get nervous when the bp cuff comes out. I would arrive at my apt 20 minutes early and go for a walk around my OB office until it was time to go in. I was so relaxed and my bp stabilized and was never a problem in birth. No other signs of PE, so it was just a jittery heart! If the self care you describe above does the trick, I wouldn't give PE a second thought!

[GoBecGo]

I had really high BP with DD. At 11 weeks my "baseline" was taken - 146/85. They decided i was "just fat" (i was about 35lbs overweight) and just used it as my baseline. By the end i was having readings like 160/108 but they would just talk to me, let me lay down and relax and take it again. I had serious white-coat hypertension and could drop 10 diastolic points in 15mins if i had a nice MW talking to me and giving me some love. I had some facial and hand swelling but they kept doing my bloods to check my liver because i neverspilled even a trace of protein and they never found anything of note with me.

I had a lovely homebirth at 41+4.

When i was post-partum it turned out the large lump in my neck which the midwife i'd shownit to told me was "just my glands" was my THYROID gland and i'd had hypothyroidism for my entire pregnancy plus the years before (doctors kept sending me away when i explained i couldn't lose weight and told me "eat less"). Hypothyroidism during pregnancy can give many of the symptoms of PE, principally facial edema and hypertension.

This time, medicated with thyroxine, my baseline is 146/72 (the 146 is the whitecoatness coming out, plus i was talking to DD during the reading).

So while i agree that hypertension isn't something to be ignored, it DOESN'T only mean PE, and it ISN'T always a signal of impending doom. Eat a lot of protein, drink lots (of water not gin! lol), rest, try to enjoy life a little (it sounds like you're haing a stressful time) and try not to fret.

[gossamerwindweb]

Originally Posted by GoBecGo

So while i agree that hypertension isn't something to be ignored, it DOESN'T only mean PE, and it ISN'T always a signal of impending doom. Eat a lot of protein, drink lots (of water not gin! lol), rest, try to enjoy life a little (it sounds like you're haing a stressful time) and try not to fret.

I have white coat hypertension too. And even though I didn't before this pregnancy, I did once my anxiety kicked in. My highest numbers were 140/90 but no swelling or protein, followed Brewer Diet to the letter, laid on my left side a lot to relax, and had my UC anyhow.