Preeclampsia

[Mamallama08]

Went in for my regular check-up and had high BP. My urine has protien in it as well. So, I went to the hospital for liver and kidney tests. My functioning is excellent. I was told that I have gestational hypertension, but not preeclampsia which is a huge relieve. I am 26 weeks, so I need to keep this bun cookn' for a good long time yet.

But I'm confused. They sent me home knowing full we'll that I have most of the symptoms they told me to call about. Seeing spots, epigastric pain, swelling under eyes, headaches, lower back pain. So, for what shall I call? If they sent me home how will I know what is actually serious?

[Bokonon]

It's so hard to know when to call or go in when you already have the red flag symptoms, but since the hospital ran labs that came back normal, your don't have HELLP Syndrome, which is what the epigastric pain often indicates (though that's a tricky symptom too, because it's frequently similar to heartburn!).

How high was your BP?  What were your discharge instructions?

I would highly recommend calling your provider first thing in the morning and asking the questions you asked above, like what are your "call-in" numbers for your BP, and what will your monitoring be like from here on out, and how will you know if your symptoms warrant a trip to triage if they are already bad?

A great resource is the forums at the Preeclampsia Foundation website, www.preeclampsia.org.  It is so confusing and worrisome to have pre-e/PIH this early on, and it is impossible to predict what will happen, but you could very well make it to term.  Please check back and let me know how you are doing.  I delivered my first at 32 weeks and my second at 34 weeks, both due to severe pre-e.

[Bokonon]

Oh, and did they run a 24-hour urine test?  That is the only way to determine if you have a diagnostic amount of protein in your urine, as the dipstick test is often unreliable.

[Mamallama08]

In the office my BP was 150/100, but it was as low as 128/79 when I went to the hospital. I did not do a 24 hour urine collection, and I was told to make a follow up office appointment for two weeks. I'll follow your advice on asking them for clarification. I suppose there is no real intervention at this point, so the attitude is don't get overly excited, and come back when there's something to be done. Believe it or not, I get that. Thanks again

[Bokonon]

Originally Posted by Mamallama08 

In the office my BP was 150/100, but it was as low as 128/79 when I went to the hospital. I did not do a 24 hour urine collection, and I was told to make a follow up office appointment for two weeks. I'll follow your advice on asking them for clarification. I suppose there is no real intervention at this point, so the attitude is don't get overly excited, and come back when there's something to be done. Believe it or not, I get that. Thanks again

150/100 is cause for serious concern, even if it went down, and IMO, 2 weeks is too long between checks.  I would highly recommend investing in a home blood pressure cuff and urine test strips to keep an eye on things.  

[phathui5]

Our guidelines here are that you would have to have a high blood pressure reading twice at least six hours apart to be considered hypertensive. One high reading isn't something that we get worked up about, however, we would have you come back in a day or two to check it again, not in two weeks.

[Monkey Keeper]

Originally Posted by phathui5 

One high reading isn't something that we get worked up about, however, we would have you come back in a day or two to check it again, not in two weeks.

I agree. A diastolic of 100 is something that would have my provider (and most, I think) on high alert unless yours run on the very high end of normal on a regular basis. Two weeks is far too long to go without monitoring with one reading that high. I'd be checking 2x/day at home just to be sure. Things can get works very quickly, without any warning.

[1stTimeMama4-4-10]

Wow, my BP was @ 128/88 and my providers pushed hard to have me induced. I initially agreed but I backed out after cervadil did nothing. The docs let me go with a 24 hour urine bc my BP went down. If I was @ 150/100 there is NO WAY my doctor would have let me leave the hospital without either constant monitoring, treatment, or a baby. I don't want to alarm you, but that leading is exceptionally high and you need to stay on top of it. Hypertension during pregnancy is dangerous for baby and mother. I wouldn't want to mess with it.

[Bokonon]

Originally Posted by 1stTimeMama4-4-10 

Wow, my BP was @ 128/88 and my providers pushed hard to have me induced. I initially agreed but I backed out after cervadil did nothing. The docs let me go with a 24 hour urine bc my BP went down. If I was @ 150/100 there is NO WAY my doctor would have let me leave the hospital without either constant monitoring, treatment, or a baby. I don't want to alarm you, but that leading is exceptionally high and you need to stay on top of it. Hypertension during pregnancy is dangerous for baby and mother. I wouldn't want to mess with it.

Was that at term though?  At 26 weeks, it's way too early to induce without fetal indicators or bad labs.

I had 180/100 BPs on Labetalol at 33 weeks, and the hospital tried to send me home without admitting me.  I stood my ground and demanded to be admitted.  My BP only went up and I delivered at 34 weeks with 190s/100s on the max dose of Labetalol.  My normal BP is 100/60.  But my labs were good, my protein was mild, and the baby was doing well.  Even when I was admitted to the hospital at 32 weeks with my first with 170/100, we waited until my 24 hour urine specimen came back at 6g before delivery.

It's a balancing act between if baby and mom are safer with baby in or out, especially so far before term.

[phathui5]

Originally Posted by 1stTimeMama4-4-10 

Wow, my BP was @ 128/88 and my providers pushed hard to have me induced. I initially agreed but I backed out after cervadil did nothing. The docs let me go with a 24 hour urine bc my BP went down. If I was @ 150/100 there is NO WAY my doctor would have let me leave the hospital without either constant monitoring, treatment, or a baby. I don't want to alarm you, but that leading is exceptionally high and you need to stay on top of it. Hypertension during pregnancy is dangerous for baby and mother. I wouldn't want to mess with it.

128/88 is not high blood pressure. Were you having symptoms of pre-eclampsia?

[greenmamato2]

I agree that 128/88 isn't high at all.  It is well in the normal range.

I had pre-ecclampsia with my first and they brought me in for non-stress tests every 3 days to check on my daughter.  I probably should have been delivered early but I kept her in until 39 1/2 weeks.  I would call your doctor to see what he/she would like for you to do, and tell them that you are not comfortable with no intervention at this point, and that you feel you need to at least be monitored more closely.  150/100 with protein in your urine is enough to cause concern.  I was put on bedrest for 8 weeks with similar symptoms, even though baby looked to be doing fine.  Please call your doctor and don't just listen to what the hospital had to say when they discharged you. 

eta - at the hospital did they have you lay on your left side and drink tooooons of water and rest?  that is pretty standard treatment for anything pregnancy related at the hospital and it will bring just about anyone's blood pressure down.  That doesn't mean that you don't have preeclampsia though, or that if you are up and moving around your blood pressure won't return to a high #.  Test it often on your own (go to Walgreens or Walmart where they do it free if you don't have a machine), and keep a log.  Talk to your dr!

[Monkey Keeper]

Originally Posted by phathui5 

128/88 is not high blood pressure. 

I think it might raise a red flag, though, if her baseline pressures were 90/60 and it happened all at once. That's 30-ish point jumps in both numbers which is quite significant.. If it was a sudden, big jump and she was at term or further or if there was another factor, I can see a conservative care provider saying, "Let's just get the baby out before things get worse."  And I would tend to agree. I had "JUST MILD" PIH until labor and then had full blown severe pre-e during and after delivery. 

[Fujiko]

 You're in my prayers. I had pre-e with my first and I know how it can be.

[Mamallama08]

Thanks everyone. Just an update here. I went to the doc today. BP was in the normal range and protenuria is"still trace." my liver function is very good and there is no sign of organ damage and the baby is just fine as well. She said the protienuria could be the result of vaginal discharge contaminating the urine sample, or my kidneys could have been fighting a minor infection. She also said that almost no one is diagnosed this early, and there is no treatment that is warranted by my symptoms at this point. She also said that bedrest, though recommended quite often, has not been shown to improve outcomes. Even though i'd like someone to tell me i have to rest, i know i would go nuts after a couple of days. I am supposed to, and have been, drinking tons of water. So that's what goin on. Thanks everyone for your comments and well wishes!

[phathui5]

I'm glad to hear that you're doing ok.

[Monkey Keeper]

So glad to hear that things have settled down for you. 

[Plummeting]

I know this has all resolved for you, for right now, but I've been curious ever since I read your OP a few days ago, was that ONE reading that was so high? Did they take it a few times in the office, or take it once, then send you to the hospital? I'm just curious, because I can easily get a high reading just by having some tension in my arm. Sometimes the nurses or medical assistants who take BP will just drop my arm down to balance on the little, tiny, wooden chair arm, then ask me every question they can think of, all while I need to go pee, and my BP is always significantly higher then. If they just hold my arm, let me sit quietly, and make sure my eyeballs aren't swimming in my own pee before we start - all things they're SUPPOSED to do! - it makes a difference, and it's not a tiny difference either.

This isn't about pregnancy at all, but here's a nice explanation of how common mistakes (improper technique for taking bp) can raise it: http://xnet.kp.org/permanentejournal/sum09/blood_pressure.html Oh, and they can be cumulative, contrary to what some people say.