high diastolic BP?

[mountainmidwife]

Greetings,
I have a client that is 38 weeks pregnant with her second baby. Her
blood pressure has been normal throughout entire pregnancy. Her first
reading at 22 weeks was 110/60, elevated slightly at 28 weeks to
112/70, but today at our prenatal she measured 115/90. She seems
healthy in every way no headaches, blurred vision, swelling. I have
read that I should see a rise in pressure towards the end of
pregnancy. Is this still a safe number or should we be getting worried?

[dinahx]

When I had similar numbers, my midwife did seem a little concerned. She had me go swimming all the time (at least get in the water), evaluate my diet (eliminate overly salty foods and add protein), go on a calcium & magnesium supplement, switch from regular salt to natural/sea salt, use moxa (chinese medicine), go on bedrest, and also I took some western herbs for blood pressure support. Oh AND I got massages with a circulation blend of essential oils but that was because of some swelling. HTH!

[momileigh]

:

[Reha]

Do you or she know what her pre-pregnancy bp was?

[Defenestrator]

How big is her arm -- are you using the right sized cuff?

I sometimes see numbers close together like that when a woman should have a larger bp cuff. If she gained weight during the pregnancy and her arms got bigger, she might have moved from one size range to another.

[mountainmidwife]

I don't think it is a cuff issue. Is it possible that the rise is normal? Or is a rise in BP always a reason to be concerned? It is odd because it is the diastolic number that has risen, the systolic number is normal??

[Reha]

Well, there is a normal drop that begins in early pregnancy (but this usually happens before a woman comes for a 1st prenatal even, and for sure before you 1st saw her at 22 weeks), and then it normally rises back up to non-pregnant baseline, or a bit higher, near the end of pregnancy. That is one reason it is hard when we don't know their non-pregnant baseline bp.

Personally, if it were me, I would see her again in a few days, just to casually retake it. You don't want to base any drastic changes in case on just one borderline ok bp reading. If I were really concerned, I would do blood work just to be on the safe side (CBC, liver panel).

[mountainmidwife]

Well, that's the thing. I don't really feel worried. My instinct tells me that she is fine. But, I sometimes worry that I will miss something important. Being a new midwife is hard sometimes

[Reha]

I wouldn't be too concerned if it were me, either.

[riomidwife]

Originally Posted by mountainmidwife

Her first
reading at 22 weeks was 110/60, elevated slightly at 28 weeks to
112/70, but today at our prenatal she measured 115/90. Is this still a safe number or should we be getting worried?

it doesn't meet the definition for gestational hypertension, but i'd watch it closely. how many weeks is she now?

what would be more concerning to me than a slight rise, or few high readings, is a BP that does not dip as it should around 26-28 weeks when blood volume should be greatest. this could be an indication that her blood volume is not aqequately expanding. when that occurs, you're looking at a larger picture of dysfunction beyond BP (preeclampsia, hellp, etc.), and potentially more serious complications.

the "normal" rise in BP that you referred to in your initial post is simply the BP climbing back up to its baseline after it has dipped mid-pregnancy.
i wrote a paper on hypertensive disorders for MWs a few years back, if you'd like a copy pm me and i'll email it to you.

[mountainmidwife]

She is 39 weeks.

[riomidwife]

i'd be looking at the overall pattern, like i said. one reading of 115/90 at 39 weeks is not that alarming to me, but if she's not hemodiluting and her BP has steadily risen, and continues to rise, that's a different story- one that imo warrants further investigation (labs) and frequent BP checks, then go from there. let us know who things proceed!

[mountainmidwife]

We hung out yesterday and so I took her BP just to see how it was. It was 110/70....

[Reha]

[babycatcher01]

The dyst. can be in relation to the kidneys. At her very pregnant state her kidneys are under more stress, is she drinking enough, baby pressing in a on a uritier or a uti. This has been an issue in my last two babies, the lower number often the 80s a few times 90s. If shes healthy other wise things should be alright.