39 weeks, preeclampsia risk, need advise

[wendyland]

Hi, I'm trying to figure out what is healthiest for the baby and for me. I'm 39 weeks and 1 day. I went to the doctor Monday. My blood pressure has been creeping up. I don't remember the exact number, but it was very close to 140/90. I normally have fairly low blood pressure. I'm very swollen in the legs and hands. Now, I have edema on my belly. The swelling looks like I have a grapefruit hanging off my lower belly and it feels sore. I had a migraine all day Monday, but I've been fine since then.

He wants me to come back in on Friday. I don't know if he's going to want to induce, but I want to be prepared when I go in there. I want her to come when she's ready. I most importantly want to do what is safest for both of us.

For further background, this is my third. I had some swelling and elevated blood pressure with the first two, but not nearly as bad as this. I've been 3 cm dilated for a couple weeks, but during the last visit, he said she was still floating. (I know that she can go up and down especially since this is my 3rd)

Any advice?

[pamamidwife]

Pre e can only be diagnosed by a 24hr urine collection and liver panel. Increased bp at the very end of preg is not a bad thing...it shows that your baby and placenta are asking your body to pump up the volume a bit to meet their extra needs.

Edema is normal...esp @ this point in preg and when its really hot.

Increase your water, increase your protein intake, soak in a pool or bath every day and don't limit your salt at all!

I'm just amazed at what is called pre e...what you have is a normal physiologic response to the end of preg.

I'd refuse induction but then again I'm not seeing an OB.

Originally Posted by wendyland

Hi, I'm trying to figure out what is healthiest for the baby and for me. I'm 39 weeks and 1 day. I went to the doctor Monday. My blood pressure has been creeping up. I don't remember the exact number, but it was very close to 140/90. I normally have fairly low blood pressure. I'm very swollen in the legs and hands. Now, I have edema on my belly. The swelling looks like I have a grapefruit hanging off my lower belly and it feels sore. I had a migraine all day Monday, but I've been fine since then.

He wants me to come back in on Friday. I don't know if he's going to want to induce, but I want to be prepared when I go in there. I want her to come when she's ready. I most importantly want to do what is safest for both of us.

For further background, this is my third. I had some swelling and elevated blood pressure with the first two, but not nearly as bad as this. I've been 3 cm dilated for a couple weeks, but during the last visit, he said she was still floating. (I know that she can go up and down especially since this is my 3rd)

Any advise?

[lyttlewon]

Originally Posted by pamamidwife

Pre e can only be diagnosed by a 24hr urine collection and liver panel. Increased bp at the very end of preg is not a bad thing...it shows that your baby and placenta are asking your body to pump up the volume a bit to meet their extra needs.

Edema is normal...esp @ this point in preg and when its really hot.

Increase your water, increase your protein intake, soak in a pool or bath every day and don't limit your salt at all!

I'm just amazed at what is called pre e...what you have is a normal physiologic response to the end of preg.

I'd refuse induction but then again I'm not seeing an OB.

Yes please make sure you do the blood panel before jumping to any conclusions. BP alone may not be a problem. I seem to have high(er) blood pressure during pregnancy but so far it hasn't been pre eclampsia. They blood tested me every week for the last few weeks with DD to make sure I wasn't pre-e and it never was. My BP slightly elevated during labor, I think it got to 150/100, but that is all. Also monitor your blood pressure over several readings. I can take my BP one day and be 116/66 and another day be 140/90. You really need to average several readings to find a good number.

[wendyland]

Thanks! I knew I'd get good advice here. Midwives are being legalized in MO this year, so I hope there are better options for women here in the future. It's so hard to find a good OB here. I'll make sure more is done before being induced. I'm anxious to see my newest daughter soon, but I'd like her to pick her own birthday.

[Romana]

I just want to agree that doctors really tend to jump the gun with elevated blood pressure ("spooked" is the word I think best applies). I would insist on the blood test and be certain I really had pre-e before I considered an induction. I know of more than one woman who was told after an induction-turned-c/s birth that she didn't actually have pre-e, as it turns out (and isn't that good news, Mrs. X?). :

My BP was elevated during the third trimester. Mostly it was just elevated at doctors' appointments, but it did on average go up somewhat at the end. During active labor, I took it and it was 153/98; then I took it again one minute later, and it was 144/87. It was never dangerously high or out of control, but I bet if I hadn't gone into labor at 38 wks AND stayed out of the hospital as long as possible that things would have been quite different. It's only now that I discovered the doctor I was seeing (a very pro-NCB family practitioner, too), clearly didn't believe I'd have a natural birth. : There was no reason to think this, except the minor blood pressure rise and that I forgot to bring my "nutrition sheets" to one or two appointments and didn't want a 38 wk cervical check.

Sorry to talk about my own situation so much, but I really do think HCPs go overboard worrying about moderately elevated BP in late pregnancies. There are a number of studies that show it is not a big deal (so long as it isn't pre-e), which you can screen for with the liver panel as the pps suggested.

[QueenOfThePride]

My BP was up a little bit at my appt. this week (37wks). Later I realized it was probably due to drinking a cup of coffee that morning, so I'm going to avoid caffiene until the baby is here.

[Racecar]

Is it true that if your blood pressure is lower/average after...or while...lying on your left side that it's not PIH/signs of pre-e?

I just got elevated readings (for me--usually I'm 110/60ish and I've been up and down in the 111/60 to 135/82 range.) at my 39 week appt. and the seriousness of the midwives has made me pretty concerned. That alone can't be great for my bp. I've been taking the Susun Weed cream of tartar regimen and also lots of garlic and Vitamin C. Also, a good 75ish gms of protein and upping calcium along with that gallon of water per day. I go in again tomorrow for my 40 week appt. I'm just very keyed up about it because I'm a HVBACer and there is no transfer for induction at the hospital. If I have to go the hospital, it will mean surgery and I've worked SO hard to avoid that!

[pamamidwife]

if you're lying on your side and your BP goes down, that's a much better sign than if it stays high.

135/92 is a fine reading at the end of pregnancy - and if you're planning a water birth - even better! Your bp will go down to normal in the water. The only way to determine pre-e is with a 24 hour urine collection, liver panel and CBC.

There's no reason why you shouldn't be able to have your baby at home!

[Racecar]

Thanks for the reassuring info.! I am so ready!!

[SublimeBirthGirl]

If it were me I'd be going SUPER high protein and waiting. I'd definitely want a diagnosis, and not induce for high BP & swelling unless the BP got dangerously high.

[mwherbs]

the "migraine" is the part that makes me a bit more concerned in addtiion to the other symptoms you mention- I can't imagine why he is just waiting to do the blood work- maybe it is the 2 high pressures atleast a week apart that is what he is going by--
in any case I would suggest a bit of supplemental magnesium- Magnesium aspirate - and amoung its many uses one thing it can help with is migraines and can help the bowels to move and for many third trimester moms it is quite useful