Talk to me about preeclampsia, bedrest, and delivery

[PotreroHill]

I was diagnosed a few days ago with mild preeclampsia. For the time being, it seems to be stable. I'm starting bedrest next week at 34 weeks along. Can anyone tell me their experiences with preeclampsia, bedrest, and delivering the baby? What's the criteria for hospitalization with pre-e? Were you hospitalized? Did you go to 40 weeks? Were you induced early? How did delivery go? Is there a higher risk of a csection with pre-e?

Thanks mamas

[Siennaflower]

I've had pre-e with both pregnancies, I know how hard it is to be on bedrest and worrying about the outcome. I don't know if it will help, but I'll give you a run down of each of my pre-e experiences.

1st pg I was diagnosed mild pre-e around 34 weeks, put on bedrest and followed weekly. At the 37 week mark my bp shot up (high 140s, I believe, don't recall the bottom number), my legs swelled up severely from the knees down and I had a headache. I was sent to the hospital L&D to be evaluated, during which time my bp did not come down and given my other symptoms they made the call to induce me. I had a fairly easy delivery in the end and dd1 was born pink, alert and perfect. My recovery was fairly quick, by about 2 week pp the swelling was pretty much gone and my bp was back to normal.

2nd pg I wasn't diagnosed until around 36 weeks. Between 32 and 36 weeks my bp became elevated and I began spilling protein in my urine. Given my history with pre-e I was sent to the hospital for evaluation but sent home on bedrest since my it wasn't so high that they felt the need to induce immediately. From then I went in for weekly bp checks and it stayed pretty stable until 37 weeks and 5 days, when my face swelled up and I began having headaches. I went in to be evaluated again at the hospital and was induced that afternoon with a bp of 152/93. I had a very easy delivery I pushed once and she popped out, the Dr was so surprised he barely caught her, lol. I was given magnesium which made me a little hot and uncomfortable through the whole thing, but not too bad. I recovered a little slower this time around, the swelling and my bp took about a month to stabilize within a normal range.

As far as being higher risk for a c-section, all I can say is in my situation I was told that if the induction failed it would be the next step, since the only cure for pre-e is delivery. I wouldn't spend too much time worrying about that, though. The best thing you can do right now is stay positive and try to stay busy. Facebook games are quite addictive and time consuming, I highly recommend them for bed rest activities, lol.

[EmbracingBirth]

I think looking into what you can do dietary wise is a great thing for you and your growing baby. I think mostly raw is amazing if done properly. I hope you have a great rest of pregnancy and a fantastic birth.

[JTA Mom]

I had pre-e with ds2. I was diagnosed somewhere at 36 weeks with mild pre-e. I had some normal swelling, but that's it. No other symptoms. At 37weeks, when a rotating OB decided to look through my chart, they called me in to be induced. I was also put on magnesium. My doctors were really conservative in their approach. My levels were 500 (cutoff of 300), my bp was 140/90.

I ended up with a c/s. I think that was more impatient doctors and not being allowed to even sit up during labor than anything.

Recovery was fine, my bp stabilized the next day (ds was born at 5pm, I was fine the next afternoon).

With pre-e, they will NOT let you go to 40 weeks. The only cure is birth. And because even 'mild' pre-e with no presenting symptoms can get bad quickly (you have seizures, placenta abrupts, etc), they will bring you to as close to term as possible.

Because my labor was so long (22hrs), ds was exposed to the magnesium for a long time as well. Because it's a muscle relaxant, it affected him and his ability to breathe (his muscles were weak, takes muscles to take a breath). He was in NICU for 7 days. It takes babes about 3 days to process the magnesium, so once we were out of the 3 days ds got better by leaps and bounds. They kept him a bit longer because the last requirement to take a baby home from NICU is that they MUST gain weight.

ETA: if, for any reason your babe needs to be in NICU, you won't be able to visit them until 24hrs after the delivery. For me they kept me on magnesium for 24hrs after delivery. Due to it being a muscle relaxant and the fact I needed to be on IV and cathed while on it, I wasn't mobile. That, to me, was the worst part of the experience.

Ami

[mischievium]

Originally Posted by JTA Mom

ETA: if, for any reason your babe needs to be in NICU, you won't be able to visit them until 24hrs after the delivery. For me they kept me on magnesium for 24hrs after delivery. Due to it being a muscle relaxant and the fact I needed to be on IV and cathed while on it, I wasn't mobile. That, to me, was the worst part of the experience.

It actually depends on the hospital. I was a NICU nurse and we had moms come in in less than 24 hours (accompanied by their L&D nurse) with an IV and IV pump and catheter still in place (you can hang the urine collection bag on the wheelchair). But, I imagine it depends on how stable the mom and her blood pressure is at that point (as well as what that particular hospital's policies are).

[Bokonon]

Originally Posted by mischievium

It actually depends on the hospital. I was a NICU nurse and we had moms come in in less than 24 hours (accompanied by their L&D nurse) with an IV and IV pump and catheter still in place (you can hang the urine collection bag on the wheelchair). But, I imagine it depends on how stable the mom and her blood pressure is at that point (as well as what that particular hospital's policies are).

I was on mag. for several days after DS was born, and was able to visit him while on it (not for the first 30 hours though, because my BP was so high and he was on CPAP). With DD, she actually went up to the room with me at first, then had to go to the NICU later for mag. toxicity (I had been on mag. for a week). I visited her less than 24 hours later, with the mag. IV.

And I was mobile was on mag. before delivery - I was actually on it for a total of 2 weeks in 2 separate hospital admissions. I wasn't cathed except before my c-section.

[JTA Mom]

Huh, interesting. I guess I went to a bad hospital.

I didn't have an high BP after delivery. I actually asked them to turn the mag down a bit when my contractions were coming but a bit too far apart and got the whole 'studies show' crap.

The nurses in the maternity ward barely wanted to help me get to my baby in the middle of the night in a wheelchair when I was called by NICU to come (had to beg them, no way could I walk across the hospital 1 day after a c/s!), so I guess setting up a wheelchair would have been 'too much' for them.


OP, ask the hospital/OB about their procedures. That way you know, going in, what you can demand/get. Bokonon and Mischievium, thanks for the responses. Just solidifies that I'm NOT going to go to that hospital with this baby.

Ami

[Monkey Keeper]

Originally Posted by JTA Mom

With pre-e, they will NOT let you go to 40 weeks. The only cure is birth. And because even 'mild' pre-e with no presenting symptoms can get bad quickly (you have seizures, placenta abrupts, etc), they will bring you to as close to term as possible.

A COMPETENT care provider will not let you go to 40w. I went to 40w with "mild" pre-e though I was presenting with severe headaches and visual disturbances and protein for 2 weeks before that; PIH was diagnosed at 35w. Be sure to report any unusual symptoms including headache, nausea, and upper right quadrant pain to your provider PROMPTLY. Are you monitoring BP at home? It can spike dangerously with little to no warning.

I was on bedrest for 5 weeks, modified bed rest. Spent as much time laying on my left side as possible but was allowed an outing a day. I went for NSTs twice weekly. Had those been non-reassuring or had my BP gone over 140/90, I would have been delivered immediately.

I was induced with cervadil and then pitocin; before I was dilated to 3cm, my BP was so high that I wasn't permitted to be out of bed or even to sit up. I got an epi in hopes of lowering BP--it did not--and just laid there for 15 hours until it was time to push. At that point, my BP was peaking somewhere north of 180/120, and I had a severe headache. I did get my vaginal birth and a healthy, alert newborn. BUT I also nearly had to stay in the hospital after her birth and went home on BP meds. My BP was 160s/100s on meds 4 days after she was born.

All that to say that pre-e only gets worse, not better. Anything past 37 weeks is gravy; I wish I had been induced earlier, even with an unripe cervix. Risking a c/s would have been worth it. To this day, it completely freaks me out that my BPs were waaaay over the threshold for stroke/seizure--I was very, very lucky or very, very blessed to come out of it unscathed.

Best of luck to you and your little one. I hope you get some more baking time. I highly recommend the Preeclampsia Foundation's forums if you're looking for more information on the disease.

[Realrellim]

Originally Posted by mischievium

It actually depends on the hospital. I was a NICU nurse and we had moms come in in less than 24 hours (accompanied by their L&D nurse) with an IV and IV pump and catheter still in place (you can hang the urine collection bag on the wheelchair). But, I imagine it depends on how stable the mom and her blood pressure is at that point (as well as what that particular hospital's policies are).

I didn't have that experience at all. I was still on an IV and a catheter for the first 24 hours (emergency c-sec policies), but we wheeled the IV pole and hung the cath bag somewhere and off to the NICU we went. They wheeled me through the NICU still on the hospital bed just after I got out of recovery so I could see DD, and then I got out of bed and into the wheelchair to visit her again later that evening.

My BP didn't spike again until 24-48 hours after she was born. It returned to normal right after delivery, but only briefly. Once it did spike (back to 140s/90s, iirc) it wasn't severe enough to require mag or anything else, so they didn't confine me to bed.

[Siennaflower]

Originally Posted by JTA Mom

ETA: if, for any reason your babe needs to be in NICU, you won't be able to visit them until 24hrs after the delivery. For me they kept me on magnesium for 24hrs after delivery. Due to it being a muscle relaxant and the fact I needed to be on IV and cathed while on it, I wasn't mobile. That, to me, was the worst part of the experience.

Ami

Just letting you know you weren't the only one, this was my experience as well. Dd was not in the NICU, but I wasn't allowed to be alone with her for the first 24 hours in the recovery room, since I was bed bound and there is a chance of seizure with the mag. Dh had to stay with us the whole time, or else I would have had to let the nurses take her to the nursery .

[sanguine_speed]

I had PIH in my first pregnancy, and my BP kept going up. At about 35 or 36 weeks I had to go every second day for check-ups, and at 38 weeks I started spilling protein and was induced that visit--had to sign myself out to go and get my bags.

My understanding is that the risk of c-section is higher because the risk of c-section is higher with inductions, and inductions are more common in women with pre-e.

This pregnancy, at my 27 week visit, my BP was 160/84 and I was having visual disturbances and severe headaches. However, I went to the hospital for a full work-up and my BP dropped. I regularly get migraines, especially during pregnancy, and a visual aura often accompanies or precedes a migraine--so this is not unusual for me. Just makes it tricky to catch pre-e. But the blood work and urine showed no issues. I did make it through preg 2 and 3 without any signs of pre-e.

[HaikuMommy]

I had mild pre-e with my first pregnancy way back in 1987. Protein in my urine, swelling, somewhat high blood pressure, was put on bed rest. I was only 17 at the time. The doctor induced me around 38 weeks. I had pitocin to induce, no epidural or other pain meds. My daughter was fine and delivered vaginally within about 9 hours (only 3 of hard labor). We went home the next morning, although I honestly didn't feel ready to leave the hospital! I felt like I'd been run over by a train, but I'm not sure that had anything to do with the pre-eclampsia.

I did end up returning to the hospital a week later with a high fever, practically hallucinating. They catheterized me and gave me antibiotics, then sent me home once I started to improve (also not sure that was related to the pre-e - maybe a UTI? I was so out of it).

I hope you have someone to take care of you while you're on bed rest - I didn't and kept getting up for something to drink, cooking for myself, etc. Looking back that wasn't smart, but I didn't have much choice! Best wishes to you and your little one...

[makeuptalk]

I had pre-e with my first. It wasn't discovered until I was 37 weeks. My blood pressure was high and I had protein in the urine. They sent me to the hospital that day to be induced. At the hospital I was given pitocin and they broke my water. I didn't use any pain medication. Our son was born 6 hours later. My blood pressure didn't go down until 24 hours after the delivery so they wouldn't let me go home until my blood pressure was down.

I've learned since that getting enough protein through the pregnancy can help to prevent pre-e. Also don't cut back on salt to prevent the swelling. Not getting enough salt can actually make you swell up more. After I learned that I made an effort to eat more protein during my last pregnancy as well as this one. I didn't have pre-e with my daughter and so far so good with this pregnancy. I'm 37 weeks now and my blood pressure is excellent.

[mischievium]

Originally Posted by makeuptalk

I've learned since that getting enough protein through the pregnancy can help to prevent pre-e. Also don't cut back on salt to prevent the swelling. Not getting enough salt can actually make you swell up more. After I learned that I made an effort to eat more protein during my last pregnancy as well as this one. I didn't have pre-e with my daughter and so far so good with this pregnancy. I'm 37 weeks now and my blood pressure is excellent.

The evidence regarding protein consumption and pre-e prevention is shaky at best. It probably doesn't hurt to up one's protein, but I have not seen anything that convinces me that it prevents pre-e. Also, something like 80% of people who develop preeclampsia in a first pregnancy, don't go on to experience it in subsequent pregnancies (though that % is influenced by factors like how severe it was and how early or late you developed it) making causation in this type of case is pretty hard to establish. There are many people who follow high protein diets (the controversial Brewer's diet being one that seems to come up a lot) and who still develop preeclampsia in subsequent pregnancies.



For those interested in a more detailed explanation of the current understanding of the etiology of preeclampsia, there is a good thread on the Preeclampsia Foundation Forums that offers the clearest lay (as in, not requiring a PhD in Embryology) explanation, especially the 6th post down by Caryn and the 9th post down by Catherine, that I've yet to find. Also, a couple of good, and relatively easy to understand, articles on the current understanding of the cause(s) of preeclampsia are here and here.

[MyZymurgy]

Treatment varies SO MUCH from doctor to doctor. (Kinda goes to show that pre-e is still a "disease of theories".) With DS, I was dx with pre-e at 30 weeks. At dx, my 24-hour urine was 450 and my bps were 150/95 typically. My doctor had me on partial bedrest and medication. Then my bp went up to 165/100 and my doctor changed the orders to regular at-home bedrest and increased meds. My 24-hour urines were never higher than around 600. I was told that I had "mild and stable" pre-e. So I made it to full term (38 weeks) and they decided to induce. (Incidentally there was much bickering between doctors at my practice as to when I should be induced. I was sent to the hospital at 37 weeks by one doctor, and then sent home by another. It was frustrating.)

The induction failed - I had 24 hour of contractions but my cervix was closed tight. So I ended with a c-section. Then I developed HELLP and had severe hemorrhaging that required several transfusions and an extended hospital stay. So even though I had "mild and stable" pre-e, I ended up a serious medical crisis. It took a year for my liver to recover and get close to 'normal' bloodwork results.

This pregnancy I have PIH, but no pre-e yet. I hope to avoid it, but there is little I can do but wait and see. My bps have been very high (178/100 this morning) even though I'm on meds once again. I'm not on bedrest or anything... although I know many women with similar circumstances as me that are on total bedrest... so, again, the treatment methods and points of delivery vary so so so much from doctor to doctor.

If you haven't already checked it out, you may want to go over to the Pre-Eclampsia Foundation website. They have lots of great information and lots of BTDT mamas who are very generous in sharing their knowledge. I like reading the "asked the experienced" board in particular. http://www.preeclampsia.org/forum/forum.asp?FORUM_ID=4

[rootzdawta]

Moved from I'm Pregnant.

[mischievium]

Originally Posted by MyZymurgy

Treatment varies SO MUCH from doctor to doctor. (Kinda goes to show that pre-e is still a "disease of theories".)

And not only does management of pre-e vary from doctor to doctor (and facility to facility), but the presentation and progression of pre-e itself varies A LOT from woman to woman. They may have a better understanding now of the relationship of placental development and function to pre-e, but that hasn't yet really translated to improvements in managing pre-e or finding treatments. The only real "cure" for pre-e at this point is still delivery, everything else at this point is just about monitoring and managing symptoms.

I think it is important for women to have some understanding of the relationship of placental development/ function to pre-e, not because it currently translates to better treatment, but because a fair amount of people think the maternal symptoms of pre-e are the only issue occurring and don't get the need for more monitoring of the baby (NSTs/ BPPs) when pre-e is present.

[MyZymurgy]

Originally Posted by rootzdawta

Moved from I'm Pregnant.

Can I ask why this was moved? "I'm Pregnant" seems more appropriate as the OP is pregnant and asking about a pregnancy-related condition (pre-e).

I only ask because i sometimes post about pre-e too and wonder if I've been putting my posts in the wrong location.

[MyZymurgy]

Originally Posted by mischievium

And not only does management of pre-e vary from doctor to doctor (and facility to facility), but the presentation and progression of pre-e itself varies A LOT from woman to woman. They may have a better understanding now of the relationship of placental development and function to pre-e, but that hasn't yet really translated to improvements in managing pre-e or finding treatments. The only real "cure" for pre-e at this point is still delivery, everything else at this point is just about monitoring and managing symptoms.

I think it is important for women to have some understanding of the relationship of placental development/ function to pre-e, not because it currently translates to better treatment, but because a fair amount of people think the maternal symptoms of pre-e are the only issue occurring and don't get the need for more monitoring of the baby (NSTs/ BPPs) when pre-e is present.

You are totally right. I shouldn't have said "treatment" varies, because the only true treatment is delivery. But you know what I mean...

It always bothers me how inconsistent doctors/hospitals/etc. are when it comes to monitoring and caring for a pre-eclamptic woman. It give me less confidence in their choices. It is especially frustrating when doctors within a practice disagree. Right now I have one doctor who wants me doing regular NSTs, one who wants me to wait until 34 weeks and then start regular NSTs, and one who thinks NSTs are unnecessary until I start spilling more protein.

Meanwhile... I just want my little girl to be safe and make it to as close to full term as possible!

[miriam]

Magnesium is a muscle relaxant. How can they give you that during labor?