Pre-Eclampsia Watch Dog on the loose. - Page 18

[aprilushka]

Can I ask those more familiar with preeclampsia about this situation? I'm on a Russian due date club also and a woman there was just told she had to be hospitalized because she gained a whopping 8.5 kg (18.7 lbs) at 26 weeks, 4kg (8.8 lbs) of which in 3 weeks and her legs are swelling a bit, but no protein in the urine or increase in blood pressure. Okay, maybe 8 pounds in 3 weeks is a bit much, but might be understandable if she had lower weight gain before. I'm pretty sure I gained that much in 4 weeks once last pregnancy. Swelling maybe a little early, but also happens. Her doctor said we're not going to wait until you spill protein, we're going to cure you right now, we're sending you to the hospital to be "cured"-- umm, exactly how are they going to do that at 26 weeks (except by delivery which I don't think they are considering)? Apparently some kind of drug will be given. And would preeclampsia typically be suspected here in this case?

It seemed a little odd and one of those cases where the cure may be worse than the disease which doesn't even seem to necessarily exist in her case.

[flyingspaghettimama]

Hmm, that is sort of strange. Some people do gain in fits and spurts. I do not think someone would be induced here for weight gain alone - they would do a screening HELLP panel to see if there was some organ failure first contributing to the water weight gain (if it's water at all). Perhaps her doc did this? You can have HELLP without classic preeclampsia symptoms first (I didn't know this either until recently).

[aprilushka]

Originally Posted by flyingspaghettimama

Hmm, that is sort of strange. Some people do gain in fits and spurts. I do not think someone would be induced here for weight gain alone - they would do a screening HELLP panel to see if there was some organ failure first contributing to the water weight gain (if it's water at all). Perhaps her doc did this? You can have HELLP without classic preeclampsia symptoms first (I didn't know this either until recently).

As far as I know, it's only because she has "pathological weight gain" -- ie, the 4kg in three weeks--and some swelling in her legs. I just can't figure out what the "cure" is, what I'm worried about is they'll start starving her.

[flyingspaghettimama]

Er, that's bizarre. The only drug they'll give you for pre-e that I know of in hospital is magnesium sulfate, and that's mainly a stopgap to prevent seizures. Usually the only cure is delivery. Starving a person wouldn't do anything except make them completely insane? Does she have headaches or other unusual symptoms?

I gained the way you described as well - I kept an eye on my weekly gains to make sure there was no sudden water problems; but I would frequently gain 5-8 lbs in a month after not gaining at all for the month previous - and repeat the cycle again.

I hope your friend makes out alright. Hopefully she can ask for the panel screening to rule out HELLP; and that would seem to indicate that she is OK, just gains weight a little funky.

[aprilushka]

Thanks, I don't know her she's just in a due date club I'm on in a Russian forum. If it comes up again I'll mention the HELLP screens.

[gossamer]

If they are concerned about pre-e, bedrest can be helpful and they could give magnesium for a while to stave off high bp. I am sure that if she is being hospitalized, they would do a full liver panel and probably a 24 hour urine which is more accurate than a simple dip. It can tell if you ar enot only spilling protein, but also how your kidneys are functioning. The only way they would deliver at 26 weeks is if her life is in danger. Please keep us informed.
Gossamer

[aprilushka]

The problem is I'm not sure if they do the HELLP screens over there. As far as I know they just get excited over weight gain alone.

I'll see what she posts when she gets out of the hospital.

Thanks for your replies.

[MontMama]

Wow, N., thanks for posting all the info. I had no idea that pre-e was such a complex condition.

Makes your new little babe all the more special, doesn't it?

[spruce]

Originally Posted by gossamer

3. Preeclampsia only happens once and only in the first pregnancies.
The leading risk factor for preeclampsia is actually a previous experience with preeclampsia. While rare, preeclampsia can occur in second pregnancies even if it did not happen in the first. It can occur in the first, then skip a pregnancy and reoccur in a third.

Hi, Gossamer. I had to chime in here and say a huge, "Thank you" for bringing so much information to the table.

I developed pre-e with my FIFTH baby. I'd never had high bp ever, and my pre-eclampsia didn't strike until postpartum . It's apparently very rare, but just as deadly. I'm lucky I knew that the signs I was having were definitely pre-eclamptic signs, even though my baby had been born. My bout with pre-e began in earnest within 16 hours of my daughter's birth. She was the smalles of all my babies, and the only one born on her due date (my babies are slooow cookers).

Without the knowledge I already had about pre-e and about normal postpartum recovery, I might have gone longer than I did without help. As it was, I waited (foolishly!) until my daughter was 6 days old to really pursue some relief, and didn't GET that relief until she was 8 days old and my bp was more than 70 points (systolic) higher than my normal pressure. Scary, painful, and a sad way to start out getting to know your baby.

I was lucky, I took her with me to the hospital and she never left my bed, so our nursing and bonding was only interrupted by the pain I was in. She is 20 days old now and my blood pressure is still out of control...but they tell me that will probably get better.

Thank you again, Gossamer, and all the Mamas who have posted such invaluable, life-saving information here.

love, penelope

[gossamer]

Dear Spruce,
I am so glad you were able to get help. What most people don't know is that most women who die from pre-e, die within the first 24 hours after giving birth and since the "cure" for pre-e is delivery of your child, it is hard to treat post-partum pre-e. It is stories like yours that keep me so devoted to spreading the information and debunking the myths. Once again my precious Mary Rose has helped a mama and her baby.
Gossamer

[flyingspaghettimama]

What Worked For Me

A disclaimer: I do not have any underlying health issues (blood clotting, heart conditions, etc). I had very severe, early onset (27 weeks) pre-e leading to HELLP syndrome and induction in my first pregnancy and gave birth in a hospital with many necessary interventions. This time, I wanted to do everything I could to avoid preeclampsia...even if it didn't work out in the end, I'd know that I tried. I do not think they really know what underlying condition causes pree, so I covered all my bases. This is what I did:

*One year previous to pregnancy, I exercised consistently 3-5x a week. There was a recent study noting a reduction of repeat preeclampsia in women who had exercised for one year prior to conception.

*I started prenatal vitamins and a very high-protein diet once pregnant. I'm a veggie who eats fish 1-2x a week, so this was sort of a challenge.

*My natural supplements included folic acid, magnesium, and calcium-magnesium; in addition, flax seed oil and oily fish 1-2x a week.

*I started low-dose aspirin therapy at 18 weeks until about 30 weeks.

*I monitored my weight and BP on a weekly basis, watching for fluctuations.

*I met with a high-risk specialist in pree issues at 20 weeks to get advice and go over what I was currently doing (he suggested the folic acid).

*I exercised heavily from conception to seven months (still running); prenatal yoga and walking from 7-10 months.

The irony is that I went overdue to almost 43 weeks and had a 9lb 1oz baby. I had an enormous, very healthy placenta, which my MW said was due to my healthy pregnancy lifestyle. No preeclampsia or even PIH this time though. I had my baby at home in a watertub. It was great! Perhaps it was nothing I did, it was just luck. But self-management helped me to feel some modicum of responsibility and power over something that's essentially a mystery.

Hugs to mamas with preeclampsia and those who've made it through the other side.

[massaginmommy]

thank you for sharing your story flyingspaghettimama It is wonderful to hear that someone beat the odds.

[2 in August]

Thank you Gossamer for starting this thread and congrats on your new little guy. I just read every single post and have learned soooo much!

I started to develop pre-e when I was pg with my dd who is now 4yo. I was lucky in that my ob and the others in her office watched me very closely. I however, had no idea what all the fuss was about. I was put on bedrest at 32 wks and delivered at exactly 35 wks. My dd was very healthy, although small (5lb 5oz). I had a really scary delivery and ended up with a massive infection but now I have a wonderful dd.

Now that I am pg again and knowing what I do now, I will be much more vigilant about knowing what is happening to me and my baby. I pray that I will avoid it all together this time, but I know I've got the risk so I will keep watch.

Thanks again to everyone who has posted their experiences here.
Jennifer

[greenmansions]

I haven't checked in here for awhile... I am now 37 weeks and still no signs of pre-e. My BP has been nice and low, last visit it was 107/70. I switched providers to a midwife in the hopes of increasing my chances for a VBAC, and in the process learned a lot more about my previous bout with pre-e as she reviewed all my records with me. I thought my OB had told me everything there was to know, but she had not. She was out of town the week I had DS though, so maybe she thought I had been told by those who attended me at the time - I felt a good rapport with her, so am just not sure what to think.

Turns out I not only had pre-e come on in the last day of my 4 day labor, but I also had HELLP with platelets down to 36,000 but no hemolysis or elevated liver enzymes at that point as far as we know. Initially, my BP was actually within normal range but my protein was going up and they weren't sure what was going on at first. Then the BP kicked in, and the HELLP. (It's not related, but I also had an infected placenta and cord, and had a rising fever - didn't know about this stuff either.) In an odd way I have found some comfort in knowing all this since before, I was never really sure my cesarean was needed, and I had such a long recovery that now makes more sense.

The midwife ran a whole series of tests like bilirubin, platelets, etc last week and everything came out normal. I did a 24 hour urine last Wed and will get the results at my appointment this week. (Such fun running to the frig with pee in a cup in the middle of the night!) She and her backup OB want to have a baseline for all these parameters, as well as just to make sure I am OK to date.

I'm wondering why my previous OB didn't check any of these things during this pregnancy. They did the usual BP and urine dipstick each visit - not sure if that is good enough or not. Does anyone know what is appropriate?

We'll see what the next few weeks hold, and I hope labor is shorter and easier this time around and that I don't get sick again. But I'm mentally prepared for another c/s if things take a turn for the worst...

[EStreetMama]

Remember to be monitored closely for signs of PE during the postpartum period, too!!!

[Satori]

Originally Posted by greenmansions

Turns out I not only had pre-e come on in the last day of my 4 day labor, but I also had HELLP with platelets down to 36,000 but no hemolysis or elevated liver enzymes at that point as far as we know.

Not questioning your mw but does she know what HELLP stands for? If you don't have hemolysis AND elevated liver enzymes w/ low platelets then you don't have HELLP and history of HELLP will risk out of a home birth/mw care and even regular OB care and you get stright to a Peri.

I too was told I had HELLP but after consulting some high risk OB's they agree I did not have HELLP but was on my way to getting it. We now know what caused my "HELLP" so it should not happen again but if you truely had it your mw would be risking every thing (including your lives) by taking you on as a client unless your also seeing a peri and plan a hospital birth as HELLP can develop within hours/days of birth.

[gossamer]

Originally Posted by greenmansions

I'm wondering why my previous OB didn't check any of these things during this pregnancy. They did the usual BP and urine dipstick each visit - not sure if that is good enough or not. Does anyone know what is appropriate?

I am really surprised at your doctor's lack of monitoring. During the course of my pregnancy I had 3 24 hour urine cultures and at least 3 maybe 4 blood draws to check my platelets, liver enzymes etc. A urine dip in the dr's office is not adequate for a woman with a history of pre-e in my opinion. Your hydration level can absolutely affect the results of a dipstick test. I was also monitoring my BP at home 3 times a day, faxing them to my cardiologist once a week and seeing my cardiologist every 4 weeks. Maybe I was over monitored, but after having lost a child, I was not taking any chances.
Gossamer

[flyingspaghettimama]

Originally Posted by Satori

Not questioning your mw but does she know what HELLP stands for? If you don't have hemolysis AND elevated liver enzymes w/ low platelets then you don't have HELLP and history of HELLP will risk out of a home birth/mw care and even regular OB care and you get stright to a Peri.

I think this really depends on what you're comfortable with. I had a history of severe HELLP and preeclampsia, but I was comfortable with my subsequent homebirth, as was my MW (and I did have to somewhat look for a MW who I felt was very supportive and not neurotic about my history). I felt like I would probably be THE most neurotic and overly worried about developing it again, knowing the signs in retrospect. I did not ever develop either HELLP or pre-e this time around, I feel in some small part due to my own diligence and self-care.

I did have two blood draws for platelet checks this time around; and they were responsible about checking for protein, swelling, asking about headaches, etc at each visit. During labor they also monitored me closely, but weren't taking my BP every 10 minutes either. I felt like they trusted me to contact them with ANY warning signs, which I would have. And they would've taken them seriously, unlike my doc in my previous pregnancy.

But dude, I hated my hospital and NICU experience and was not going to go through that again...unless necessary.

Edited to add: Two other factors that greatly increased my comfort - MW carried mag sulfate with her; and hospital is literally two blocks from my house. I'm not sure how I'd feel if I didn't have these two reassurances.

[greenmansions]

I am having a hospital birth attended by a midwife, with a back up OB. I was not comfortable with homebirth w/ previous c/s and pre-e. I think this is a good compromise, and I feel they are actually watching me more closely than my previous OB did.

I am wondering if since I got pre-e and all so late in the pregnancy (last day) if that might mean I am more at risk for having it show up after delivery this time? I don't think there's any data on this, just data that says that because it was so late I am less likely to get it again in pregnancy.

From what I read about HELLP, the platelets drop first, then the hemolysis kicks in, then the liver enzymes go up last, roughly in sequence. So maybe it was "early" in this process? What else would make the platelets go so low, given presence of pre-e? I believe I read the stuff about sequence on the AAFP site, tho it may have been someplace else. So it's not actually considered HELLP til you have all 3, full blown?

Thanks for the advice and info, as usual. This thread has been very helpful to me during this pg.

[funnygrace]

Hi, I'm not sure where to post this question, but many of you seem familiar with clotting disorders, so I'll start here.

I'm ttc #1. I've never been pregnant before (as far as I know) and I'm 34. My half-sister has tested positive for Factor V Leiden. She had a sucessful pregnancy before having a thrombosis event that prompted the testing. I've resisted getting tested, because I didn't want the pre-existing condition, but now that I am ttc, it seems like a good idea.

But here I am in the 2ww. I have an ob/gyn appointment around the time that I will find out whether or not I am preg. My reason for the visit is to ask about FVL and get a referral to a hemotologist. But I read something in this thread about not being able to do tests for clotting disorders during pregnancy. Did I misread? Would there be any reason for me to rush to a hemotologist now before implantation (positive thinking!)? Or will they still be able to do the blood test if I am (just barely) pregnant? Thanks!