Pre-Eclampsia Watch Dog on the loose. - Page 25

[chilliepepper]

Thrombophilia Testing: Should I fast?

My perinatologist has recommended that I be tested for the blood disorders that could be a factor in my risk for a repeat performance of pre-e/HELLP syndrome; specifically the congenital and acquired thrombophilias. I plan to go to the lab tomorrow morning. I'm just wondering if I need to fast for these tests. I called his office last week and the assistant/front desk person who answered the phone said no, I do not need to fast, but I just wanted to double check. The flip side of the question is if I DO fast (to be on the safe side) but didn't really need to, would that mess up the test results in any way?

[shannon0218]

Fasting shouldn't make a difference.

[sarah9774]

HELP ME!!!

My abdomen around my belly has been feeling tender and almost numb like.. and my belly feels like it is really bloated.. I don't know if this is something to worry about or not.. I am 32 weeks and 1 day preg and am not sure if this is normal.. I do not remember having this last time.. I called the nurse and she said if it got any worse to go to L & D to get checked out.. does this sound familiar to anyone.. placental abruption starting???? HELP!

[gossamer]

Sarah,
That does not sound familiar to me. I will keep you in my prayers. If you have any doubt, go to L & D.
Gossamer

[sarah9774]

Thanks- I did go to L& D and they don't have an explination. Baby looks good though..

[sarah9774]

gossamer- I found out why my belly is so tender.. I have too much fluid.. To much amniotic fluid.. do you know anyone else who has experienced this?? Dr. is sending me to get glucose test again to rule out GD..

[chilliepepper]

So yeah, I also have the MTHFR mutation

Ok, just for review: I delivered a healthy (but small---5lbs 5oz.),
full-term baby 16 months ago, despite being diagnosed DURING LABOR
with severe preeclampsia and HELLP Syndrome. I had no symptoms prior to that, and have had no lingering effects that I'm aware of.

Nobody suggested testing for thrombophilias until I was several weeks
(I think 9 or so) into this (my second) pregnancy, and then due to poor
communication between me and my perinatologist, the tests did not
happen until a couple of weeks ago (when I was 20 weeks) and I just got the results today---I am now at 22 weeks. I am compound heterozygous for MTHFR, and I guess I'll be starting Lovenox on Monday. I am TICKED that we didn't catch this sooner and the more I read, the more amazed I am that DS#1 came through with no problems and that I haven't lost this baby already.

I'm freaking out a little bit here, because from the reading I've done
today I'm gathering that the standard dose of folic acid in my
prenatal vitamin has probably done me no good whatsoever, and that I
should have been on a LOT bigger dose starting months ago (ideally
before I even conceived), and I should have started Lovenox months ago.

So I guess what I'm wondering is, is the damage already done (I think I read that the course for these things is really set during the first trimester or even before conception, at which time I was blissfully ignorant), and is there anything else I can/should do besides go see the doc on Monday and learn how to give myself shots?

Also, this week I had what I assumed was a stomach bug, but was just reminded that vomiting can be a symptom. That was four nights ago. I also had some diahhrea and stomach cramps, leading to dehydration which lead to a LOT of BH contractions and the baby jumping around like crazy for two days (low amniotic fluid due to dehydration I suppose?) Do you think that if it was pre-e or HELLP, I'd be seeing some more serious effects by now?

Oh---also, we just booked tickets to fly cross country on Nov. 2-7.
Now that I know I have this, I'm wondering if that was a bad idea.
Thoughts?

[sarah9774]

I know another girl who did not find out that she had clotting d/o until 18 weeks pregnant. She started Lovenox shots then and everything turned out ok.

I would not recommend any flying though.. just my personal feelings.. I will not stay in the car more than 30 minutes at a time...

I take 3 mg extra folic acid (plus the one in my PNV) and heparin shots 2 x's a day (lovenox is good due to 1 x a day, but I could not afford it) I also take 81 mg baby asp. 1 X a day.. it just depends on the Dr. you have.. try and stay hydrated... hang in there. you will be in my thoughts..

[chilliepepper]

Is the flying issue related to the altitude, or to the sitting in one place for so long?

Also if a person is on their blood thinners, shouldn't it be ok?

One more question (sorry)---I just went out and bought some baby aspirin, but on the box it says "it is especially important not to use aspirin during the last 3 months of pregnancy unless definitely directed to do so by a doctor because it may cause problems for the unborn child or complications during delivery." I know we're not in the last 3 months yet, and of course I'll talk to my doctor about it before I'm in the last 3 months---but I'm wondering if it's even safe now, because it also says to ask a doctor before use if you're taking a blood thinner. So maybe I should just wait till I see the doc on Monday before I start the baby aspirin, eh?

[sarah9774]

I would talk to your Dr. first, if he hasn't alreadly told you to take it (Baby aspirin). Some Dr.s recommend it others do not. I know people who have taken it with the thinners and others that have not. It may depend on the clotting d/o you have.. I would ask 1st though. I know that I will be taking the BA up until just before I deliver.. I will be 34 weeks on Tues. I may be delivering at 37 weeks due to excess amniotic fluid, but don't know.. I am having a c-section so I can go off the heparin like the day before, I need to clarify with my dr.

As far as the flying, I think it has to do with the sitting, but could also have to do with the altitude.. I don't think it matters if you are on thinners or not, there is still a risk of clotting. Hope that was helpful.. I am not an expert.. this is just what I have been doing as directed by my dr. Oh yes, and he should be checking your platelets monthly to be sure they are at an acceptable level.

[flyingspaghettimama]

Hi! I do not have a blood clotting disorder (that I know of - never tested) but did have Pre-E.

In my last pregnancy, I flew to Europe (16 hr flight total). I did take aspirin (baby aspirin only, at bedtime); I also wore support hose, which you can pick up at most pharmacies. They are GREAT for flying and helping with possible blood clotting issues. I also got up and walked around a lot (1x hour) and drank tons of water.

I took baby aspirin throughout pregnancy, right before bed; and lots of folic acid (I think 1000 mg/day? It was a lot).

[2 in August]

bumping to keep on the first page...

...update, my ds is now 5mo, very healthy. Still kind of small (13lbs) due to nursing/supply issues. But gaining good now. Meeting all his milestones on track.

Dh and I decided no more kids for us. Not worth chancing pre-e for a 3rd time. So we are done. Thanks again to the helpful mamas here. I'll try to remember to check in more to help other mamas going through this.

[ani'smommy]

I just read most of this thread and I wish I had read it two years ago when I was pregnant with Ani. I would have noticed I had most of the warning signs of pre-e. I had a pain in my upper right abdomen that I thought was the baby's feet poking me in the ribs. It never occured to me that it might be my liver. I was induced at 40 weeks and had a small, 5lbs 14oz healthy baby.

I'm now pregnant with #2 and hoping and praying for a homebirth this time. Is there anything I can do to avoid pre-e this time? I plan to start doing some kind of exercise soon, but would that make my bp go up? Should I be monitering my pb? urine?

I'm really hoping that there is somethind I can do to be proactive about this.

Gossomer, I am so deeply sorry for your loss. I can't fathom the pain. Thank you for this thread.

[maxmama]

Originally Posted by ani'smommy

I just read most of this thread and I wish I had read it two years ago when I was pregnant with Ani. I would have noticed I had most of the warning signs of pre-e. I had a pain in my upper right abdomen that I thought was the baby's feet poking me in the ribs. It never occured to me that it might be my liver. I was induced at 40 weeks and had a small, 5lbs 14oz healthy baby.

I'm now pregnant with #2 and hoping and praying for a homebirth this time. Is there anything I can do to avoid pre-e this time? I plan to start doing some kind of exercise soon, but would that make my bp go up? Should I be monitering my pb? urine?

I'm really hoping that there is somethind I can do to be proactive about this.

Gossomer, I am so deeply sorry for your loss. I can't fathom the pain. Thank you for this thread.

This may not be a route you want to try, but I did a prophylaxis of atenolol and lasix from 12 weeks on to treat increased cardiac output. I had normal BPs and never developed PE, after having had severe PE/HELLP at 36 weeks last time. But at least 85% of women who had PE won't repeat anyway, so was it the meds? I'll never know.

[yogamommy]

I've been reading this thread since last Thursday (have made it thru pg.7) when my bp went from a normal 100/70 to 130/90 and I had 2+ protein in my urine. Today I went for a follow up with my mw, my bp is still high and my protein is now 3+. My mw is turning my care over to an ob she works closely with because of the concern of pre-e, and she has ruled out my possibility of a homebirth...

A few questions for those of you with experience. The two above symptoms plus no change in my hemoglobin are my only major symptoms. I have swelling, but it has not moved to my face or hands. Today, my swelling has been primarily in my left leg only, is this normal? Is there anything else that could cause these symptoms? I am 35.5 weeks and others in my due date club have mentioned that true pre-e usually shows signs earlier?

Also, from what I have read so far, it seems many mommas were induced at 37 wks. Why is this? Is it because their bp spiked too high? If my bp maintains at its new higher level, will my ob still want to induce and/or schedule a c-section? I am afraid of being induced with pitocin if my body is not ready, then laboring for too long and ending up with a c-section. I don't see why if the ob feels I need to be induced, why should I not decline and just go immediately to c-section if there is any danger for me or the baby? Why go thru a struggling labor and open the door for more drugs if my body is not ready?

Any advice you all can offer would be appreciated!

[maxmama]

Originally Posted by yogamommy

I've been reading this thread since last Thursday (have made it thru pg.7) when my bp went from a normal 100/70 to 130/90 and I had 2+ protein in my urine. Today I went for a follow up with my mw, my bp is still high and my protein is now 3+. My mw is turning my care over to an ob she works closely with because of the concern of pre-e, and she has ruled out my possibility of a homebirth...

A few questions for those of you with experience. The two above symptoms plus no change in my hemoglobin are my only major symptoms. I have swelling, but it has not moved to my face or hands. Today, my swelling has been primarily in my left leg only, is this normal? Is there anything else that could cause these symptoms? I am 35.5 weeks and others in my due date club have mentioned that true pre-e usually shows signs earlier?

Also, from what I have read so far, it seems many mommas were induced at 37 wks. Why is this? Is it because their bp spiked too high? If my bp maintains at its new higher level, will my ob still want to induce and/or schedule a c-section? I am afraid of being induced with pitocin if my body is not ready, then laboring for too long and ending up with a c-section. I don't see why if the ob feels I need to be induced, why should I not decline and just go immediately to c-section if there is any danger for me or the baby? Why go thru a struggling labor and open the door for more drugs if my body is not ready?

Any advice you all can offer would be appreciated!

I had PIH that became "true PE" and then HELLP at 36 weeks, within about 6 hours.

C-sections have risk. If you can hold out a few days to have cervical ripening, the chances of a pit induction are improved. Sections without labor are more likely to result in breathing difficulties, esp. in pretermers.

[flyingspaghettimama]

Originally Posted by yogamommy

I've been reading this thread since last Thursday (have made it thru pg.7) when my bp went from a normal 100/70 to 130/90 and I had 2+ protein in my urine. Today I went for a follow up with my mw, my bp is still high and my protein is now 3+. My mw is turning my care over to an ob she works closely with because of the concern of pre-e, and she has ruled out my possibility of a homebirth...

A few questions for those of you with experience. The two above symptoms plus no change in my hemoglobin are my only major symptoms. I have swelling, but it has not moved to my face or hands. Today, my swelling has been primarily in my left leg only, is this normal? Is there anything else that could cause these symptoms? I am 35.5 weeks and others in my due date club have mentioned that true pre-e usually shows signs earlier?

Also, from what I have read so far, it seems many mommas were induced at 37 wks. Why is this? Is it because their bp spiked too high? If my bp maintains at its new higher level, will my ob still want to induce and/or schedule a c-section? I am afraid of being induced with pitocin if my body is not ready, then laboring for too long and ending up with a c-section. I don't see why if the ob feels I need to be induced, why should I not decline and just go immediately to c-section if there is any danger for me or the baby? Why go thru a struggling labor and open the door for more drugs if my body is not ready?

Any advice you all can offer would be appreciated!

1) Preeclampsia can show up at any time, but the earlier on (before third trimester), the worse it will usually be, supposedly. There are women who develop PreE while delivering, with no previous signs, and have seizures. It can happen at any time, although it's usually a gradual process.

2) Most women are induced after 34 weeks if possible (at 35 weeks the fetus' lungs mature), as close to 38 weeks ("full term") as possible, whether that's accomplished through bedrest, whatever. They usually take into account a combination of factors, not just BP - including your urine protein, and the function of your internal organs. It's a delicate balance - they don't want to induce too early, and end up with a premature baby; but they don't want to wait too long and end up with a seizing mama either.

You can labor with a very high BP - I think that indeed, preeclampsia can cause issues with blood clotting and they prefer NOT to do c-section (that's what they told me, at least). You just labor on your side, and with a whole buncha mag sulfate. If you are in that situation, I suggest GOING FOR THE EPIDURAL. I can't stress that enough. And I had my second at home, naturally.

If you are looking for a reason to go C-Section, then I'm sure it's possible. The possible downsides are recovering from a c-section and the issues that go with that; whereas if you deliver vaginally, you're mostly over the worst of it once you deliver. Unless you get post-partum PreE, but we just won't worry about that right now.

I would get that left leg checked, pronto. Assuming everything is OK, for temporary relief, I assume you're on bedrest; and taking epsom salt baths and extra magnesium supplements certainly won't hurt anything.

[myjulybabes]

I can't believe I read the whole thread!

First of all, Gossamer, I so appreciate you sharing your story and helping other women. Mary Rose was so beautiful, and I can see that her story has helped others here.

So, quickie history for me: First pregnancy at 19, all seemed normal until about 31ish weeks. I just wasn't feeling right, but I let the doctor blow me off, because I was clueless (rule #1, trust your body and your instincts!). Went for the 32 wk appointment, did the whole nurse routine, weight, bp, urine dip, then met a new doctor in the practice who introduced himself with "Hi, I'm Dr. D____, you're going to the hospital today." BP 154/100, had gained 30lbs in less than 3 mos, high protein, didn't ask, can't remember from the records. We were able to keep Nick in for 4 more days until I developed HELLP and he was delivered emergency c-section under general. Same brilliant doctor, who hadn't kept me updated at all on the seriousness of my condition, discharged me a week later with the sage advice "Now don't go feeling all sorry for yourself because you almost died..." Thankfully, the steroids had time to take and he just had to get bigger and keep his temp up, came home after only 17 days in the NICU.

Second pregnancy: very healthy and normal, modified bedrest around 38 weeks due to slightly elevated BP and protein. VBAC at 40wks, the pre-e kicked in during labor but resolved quickly with the nasty nasty mag.

Third pregnancy: Doctor was on the ball after 2 cases of pre-e. Caught it this time at 29 weeks, went on home bedrest with monitoring from a home health care company, induction scheduled for 37 weeks. BP went haywire (ultimately topped out at 170/110) at 36 weeks and wouldn't come down, so we went ahead with the induction, ended up with a c-section when he decided to flip from the vertex position we KNOW he was in when the induction started to completely transverse 12 hours later. It was too late for steroids and sadly, he was suffering from a case of "wimpy white boy syndrome"...ie respiratory distress even though he was very close to term. 2 weeks in the NICU with that one.

Fourth pregnancy: A rather happy oops that I just found out about!

Which, if you had the patience to read all of that, brings me to why I'm here. I'm on a little bit of info overload after reading 25 pages of this thread in one night, so I want someone to double check my plans here.

So. I want to get a baseline 24 hour urine and liver panel. Ask about potentially testing for clotting disorders. Dig out my home BP monitor and make sure the cuff is big enough. And in the "couldn't hurt, might help" category, think about eating more protein and supplementing with extra folic acid, Vit C, and...? I know I'm forgetting something here. And exercise. Perfect timing, the weather's getting good to walk!

I've obviously got time to decide, but any thoughts on VBA2C vs scheduled c-section as far as how it relates to the pre-e? I am really undecided on this one. In a perfect world, I'd want the VBA2C, but alas, this is not a perfect world.

Much love and peace and health to those expecting! If I can be of any help, or anyone wants to know more about my experiences, please don't hesitate to ask.

[Synchro246]

I don't know if this has been brought up before in this incredibly long thread, but because it's Cochrane I consider it to be of decent quality:

Calcium supplementation
http://www.mrw.interscience.wiley.co...059/frame.html

Authors' conclusions
Calcium supplementation appears to almost halve the risk of pre-eclampsia, and to reduce the rare occurrence of the composite outcome 'death or serious morbidity'. There were no other clear benefits, or harms.



--------------------------------------------------------------------------------

Plain language summary
Calcium supplements help prevent pre-eclampsia, lowers the risk of the woman dying or having serious problems

Pre-eclampsia is a major cause of death in pregnant women and newborn babies worldwide. Preterm birth (birth before 37 weeks) is often caused by high blood pressure and is the leading cause of newborn deaths, particularly in low-income countries. The review of trials found that calcium supplementation during pregnancy is a safe and relatively cheap means of reducing the risk of pre-eclampsia in women at increased risk, and women from communities with low dietary calcium. Women were also less likely to die or have serious problems due to pre-eclampsia. No adverse effects have been found but further research is needed into the ideal dosage for supplementation.

and another


Antioxidant supplementation
http://www.mrw.interscience.wiley.co...227/frame.html

Authors' conclusions
These results should be interpreted with caution, as most of the data come from poor quality studies. Nevertheless, antioxidant supplementation seems to reduce the risk of pre-eclampsia. There also appears to be a reduction in the risk of having a small-for-gestational-age baby associated with antioxidants, although there is an increase in the risk of preterm birth. Several large trials are ongoing, and the results of these are needed before antioxidants can be recommended for clinical practice.



--------------------------------------------------------------------------------

Plain language summary
Antioxidants in pregnancy, like vitamin C and vitamin E, for preventing pre-eclampsia

Pre-eclampsia can occur during pregnancy when women have high blood pressure and protein in their urine. In some cases, it can lead to serious complications for women and babies, including mortality. A possible contributing factor to the development of pre-eclampsia may be the presence of excessive amounts of chemicals called 'free radicals'. Antioxidants, such as vitamin C, vitamin E, selenium and lycopene, can neutralize free radicals and may help prevent pre-eclampsia. The review of trials found studies of not the best quality, which indicated antioxidants might reduce the risk of pre-eclampsia. However, although antioxidants appeared to reduce the risk of having a small baby, there was an increase in the risk of the baby being born too soon. Further studies are needed to confirm whether or not antioxidants do more good than harm. Several trials are currently in progress on this topic.

[gossamer]

Originally Posted by myjulybabes

I'm on a little bit of info overload after reading 25 pages of this thread in one night, so I want someone to double check my plans here.

So. I want to get a baseline 24 hour urine and liver panel. Ask about potentially testing for clotting disorders. Dig out my home BP monitor and make sure the cuff is big enough. And in the "couldn't hurt, might help" category, think about eating more protein and supplementing with extra folic acid, Vit C, and...? I know I'm forgetting something here. And exercise. Perfect timing, the weather's getting good to walk!

I've obviously got time to decide, but any thoughts on VBA2C vs scheduled c-section as far as how it relates to the pre-e? I am really undecided on this one. In a perfect world, I'd want the VBA2C, but alas, this is not a perfect world.

Much love and peace and health to those expecting! If I can be of any help, or anyone wants to know more about my experiences, please don't hesitate to ask.

Wow, you have sure been down the pre-e road haven't you? I would absolutely recommend getting the genetic testing done. There are some results that aren't quite accurate when you are pregnant, but you should get good results on most of them. I would also agree about the baseline 24 hour urine, liver panel and blood pressure. Monitor you bp at home at least three times a day. I also faxed my results to my cardiologist and ob every week so they could see what my bp's were doing. I would ask my Dr. about extra folic acid, there has been some research that extra Folic Acid, if it is not needed could be harmful. Ask your Dr. about taking a baby aspirin a day. I would take as much Vitamin C (sodium ascorbate) as you can handle and maybe even some extra Vitamin E. Have epsom salts on hand for taking baths. Eat healthy, cut out sugar and simple carbohydrates. Don't load up on protein, because you don't want to over work your kidneys, just eat sensibly and healthy. ANd of course keep us updated on how your pregnancy goes. We have had several success stories in this thread of little babies that have been brought home healthy and happy, we hope to include yours.
Gossamer