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Question about pre-e..

post #1 of 21
Thread Starter 
My twins were born at 30 weeks, 2 years ago. My doctor can not give me a reason as to why but I think I may have the answer but before I ask him, I want your opinions....

When I was pg with my twins, it was a very uneventful pregnancy. Everything was great, no problems whatsoever until 27 weeks. I started going into labor, on internal exam, I was 2cm dilated. I was put on strict bedrest. The next week, I was 3cm. At 30weeks, I was 4cm. I was admitted to the hospital, put on all the monitors, all the labor stopping drugs, etc. After a few hours, my contractions were coming back to back (I didnt feel a single one), I was almost fully dilated and baby A was butt first and they decided my water could break at any moment and we would have a prolapsed cord, so they took them a few hours later. I remember the nurses commenting on how well my BP was, it was 137/90.

When they were 7 months old, I was dx with hypotension, my normal BP is 80/50. I discovered this after I had a kidney stone in Oct 2006 and afterwards I stopped my salt intake and I started to have black outs, dizziness, etc. I was told to up my salt again and so far, it manages my BP without any meds.

My question is, with me being hypotensive and having a normal BP of 80/50 and giving birth at 137/90 which is EXTREMELY high for me, could this have been pre-e but missed b/c no one knew that I had low BP? I have an apt to see my OB/GYN who delivered my girls for a check-up in May, and I am thinking of asking him if this could be the reason but I dont want to look like an idiot so I thought I would ask here first. What do you all think?
post #2 of 21
hmmm ... good question.

From what I know about pre-eclampsia (granted, not a whole lot, since I've never had it); it's not only based on b/p, but also proteinuria.
Pre-eclampsia
post #3 of 21
I have heard that sometimes care providers aren't aware of how low the BP is usually, and so when it gets to something like your pg one, they don't see any problem. Not sure beyond that, but sometimes I think you can just keep asking them to explain themselves as to why or why not on your question.
post #4 of 21
Are you trying to find out if you had pre-e, or why you delivered early?

I don't know about pre-e but I have done some research into premature delivery. One thing I'd read talked about how some women can have subclinical uterine infections and that they'll always deliver before 30 weeks without treatment.

You might get more answers if you post to the birth professionals forum. And are you sure your BP was that high? Mag can make you whoozy and I can't imagine any OB nurse commenting how "good" a blood pressure with a diastolic of 90 is (unless of course it'd been higher before that).
post #5 of 21
Thread Starter 
I remember that my top number was 137 and my dh says the bottom was 90.
post #6 of 21
I gave birth to my twins at thirty two weeks and 6 days, but my situation was somewhat different. I got kicked in the belly by a horse at 30 weeks. Soon afterwards, I started a little brownish bleeding. I didn't have any painful contractions, and my cervix seemed normal to my midwife. I passed my plug a week or so later (in denial, I'd tell myself it wasn't my plug). My waters broke at 32 weeks and 6 days. There was a fair amount of blood when that happened, and I was home alone, about an hour from the hospital. I called the ambulance, and when they got there, my blood pressure was almost exactly what yours was. It had been running about 110 over 60. I've wondered about it, too. It was probably just stress (I waited an hour an a half, alone and bleeding, for the ambulance). But a midwife later told me it could have been a partial placental abruption--that can make your blood pressure rise, too. There was blood in Baby B's water when they broke it at the hospital, and there was blood when Baby A's water broke at home. But my cervix tends to bleed a lot, so it could have just been bloody show (at home, anyway).

I don't think I'll ever know what happened.

I'm glad that my babies (now toddlers) are doing well today.

I've never been so scared in my life.
post #7 of 21
I think it sounds reasonable that your otherwise relatively normal sounding bp reading could be too high for you, since *your* normal bp is so low. But yes, pre-e isn't JUST high bp. It's also swelling that pits and protein in the urine. The combo of all 3 is what pre-e is. You might have issues with just having one or two of these symptoms, but w/o all 3 it isn't pre-e.
post #8 of 21
i had pre-e. it was diagnosed when i was spilling enough protein in my urine during one of those pee in a cup times. i think it's worth asking your hcp, though.
post #9 of 21
Having pre-e once doesn't mean you'll ever have it again. I don't really understand the reason behind the question, I guess.
post #10 of 21
Thread Starter 
Quote:
Originally Posted by wendyjoe View Post
Having pre-e once doesn't mean you'll ever have it again. I don't really understand the reason behind the question, I guess.
The reason is I'm sick and tired of telling people "I don't know why they were born early" I get the funniest looks like I'm either 1. crazy 2. didnt do something right or 3. dont know b/c I dont care to know. Alot of people when they find out they were ID (and know about twins) assumes it was TTTS, but my girls were di/di so that wasnt an issue. I just want a reason. The only thing my doctor has said is "your uterus ran out of room and your body said you had to deliver" I was 5'3, 115 lbs when I got pregnant. The day I delivered I was 173. I gained alot of weight, most of it was water weight. I was swollen like you wouldnt believe. I didnt know protein in the urine was a sign of pre-e, I remember him saying an a few occasions that my protein was high..Sounds more and more like it could have been pre-e but missed.
post #11 of 21
Quote:
Originally Posted by angie7 View Post
The reason is I'm sick and tired of telling people "I don't know why they were born early" I get the funniest looks like I'm either 1. crazy 2. didnt do something right or 3. dont know b/c I dont care to know. Alot of people when they find out they were ID (and know about twins) assumes it was TTTS, but my girls were di/di so that wasnt an issue. I just want a reason. The only thing my doctor has said is "your uterus ran out of room and your body said you had to deliver" I was 5'3, 115 lbs when I got pregnant. The day I delivered I was 173. I gained alot of weight, most of it was water weight. I was swollen like you wouldnt believe. I didnt know protein in the urine was a sign of pre-e, I remember him saying an a few occasions that my protein was high..Sounds more and more like it could have been pre-e but missed.

This is absolutely nobody's business but your own. It does not deserve any explanation on your part whatsoever. It falls into that category of twins comments/questions you can safely label "intrusive" and find a blanket response for.

If you seriously want to know, for your own information, your health history/present/future, etc, go for it. It's also important to know that your situation with early labor is more common with multiple pregnancies than singleton pregnancies. Dr. Barbara Luke has done TONS AND TONS of research on this. www.drbarbaraluke.com and her book is When You're Expecting Twins, Triplets, or Quads. If you have the book and had shelved it upon delivery, you might take it out again and see if it sheds any light for you.

But seriously. If people are treating you in a way that makes you uncomfortable about having preemies, it's their problem. Put on your brass brasiere, give a blank look, and move along. Hugs. You have two live children who love you and who you love. That's what counts when it comes to other people.
post #12 of 21
I had one idea, and maybe your care provider knew this, but when I first had my cervical length checked by u/s, the peri talked about the importance of checking internally as "funneling" can occur. He said a cervix can look "good", and the next thing you know the woman is in labor. I guess it's an inside/out dilation (not positive, this is what I gathered from his explanation). He said they weren't always aware of this, and I don't know how recent that finding is. Maybe this will help?????
post #13 of 21
Quote:
Originally Posted by AmyY View Post
If people are treating you in a way that makes you uncomfortable about having preemies, it's their problem. Put on your brass brasiere, give a blank look, and move along. Hugs. You have two live children who love you and who you love. That's what counts when it comes to other people.
:

If you want to know, know for yourself. You don't owe other people an explanation.

Back to topic, I'm not even sure pre-e is a cause of preterm labor. I'd have to look.
post #14 of 21
Thread Starter 
I do want to know for myself, but also to explain to others as well. I need a reason as to why this happened rather then "you just got too big" Granted I did get HUGE and fast. I was 5'3 115 lbs when I got pg, and gained 58 lbs in 30 weeks. So yes, I did get big, but I just dont see how that could be the reason?? And my bp thing has always bothered me since I was dx with hypotension.
post #15 of 21
To be honest, your docs explanation could be right. Or there could be something that can never be diagnosed that caused it-like a subclinical uterine infection, one baby wasnt getting enough oxygen, there are so many different possibilities. Your babies knew something was up and it was time to be born-whether there was something more serious going on or they just were getting too squished.
In order for it to be pre-e, you have to have protien in your urine. Period. High blood pressure on a regular basis, along with headaches, visual disturbances, and/or swelling is called pre-pre e, but its just a warning that you *may* start dropping protien. In my case, I had high BP/swelling for about 9 weeks and then at 39 weeks finally had protien start showing up in my urine. You were probably being tested every visit for it. And if your BP had been normal and you werent experiencing any swelling, then you didnt have pre-e. I'm not sure that the test for protien in the hospital, but it wouldnt surprise me.
More than likely, your BP was raised because you were freaked out over the babies coming so soon! I know mine would be Its normal during any delivery for your BP to rise to some extent, but when you're under extra stress, it can be even higher.
Just try to enjoy your babies and if someone wants to know why they were born so early just say simply, they are twins, its very normal for twins to arrive early. (though of course many arnt-but every person I've known with twins had them right around 30 weeks for whatever reason)
post #16 of 21
Thread Starter 
Thanks everyone, I guess it wasnt pre-e. Honestly, I'm a little sad b/c I really want to know what happened but maybe its one of those mysteries we will just never know. All I do know is that despite being born at 30 weeks, my now 2 y/o's are healthy, smart, active little girls, in the end that is all that counts.
post #17 of 21
Just wanted to chime in on the wanting to know and understand why things happen part (don't have pre-e experience to talk about)... but I totally get the desire to understand the body, the pregnancy, the whole thing. I often wonder what happened to make one embryo split into two -- why? Was it stress? An environmental factor? What happened that day (sometime 4-8 days after conception) that told my body to make that "normal" embryo turn into something else? (My own unanswered question, different from yours, but something I wish I knew all the same).

There is a lot out of our hands (and out of control) in a twin pregnancy and in raising twins, and so I think my desire to know as much as I can is a way for me to try to get a *tiny* bit of understanding and control about something that's usually out of control

So just sending on a note to say I understand that need to know -- even if it's something that will likely remain unknown.
post #18 of 21
I wanted to let you know that I see it as entirely possible that you did have pre-eclampsia and that it was undiagnosed because of your hypotension. I have hypotension, and was not diagnosed with pre-e because of this, despite the fact that I had protein in my urine and a multitude of other symptoms. I do not know if pre-e would cause an early delivery, in my case there were other complications. The way I found out the answer was to get a copy of my medical records from the OB who did my prenatal care and checked to see if I had protein in my urine. I strongly suggest you do so also, because knowing what happened and why it happened has helped me work through quite a bit of the confusion and self-doubt associated with that birth experience. I am now pregnant with my third, a suprise , and have taken the initiative to learn more about birth, the processes involved with natural birth and explore what I want for the birth of my child. I believe that if I hadn't have looked over the doctors records I would now be living with the nagging doubt that my body 'just wasn't good at birth.' For me this is not the case and I am now looking forwards to a home birth. Knowing instead of wondering really changed my attitude and outlook.
post #19 of 21
Yeah, I do agree you should check to make sure there was no protien showing up in your urine. Thats REALLY odd though that they wouldnt mention anything. It was my understanding that the protien was *the* diagnosis tool they used. Honestly I was sort of similar, although my normal BP is a wee bit higher than yours (around 100/70). When I said I had high BP, it really never went above the benchmark for that diagnosis-but because it had been low up until 30ish weeks and then rised so markedly-coupled with the swelling I was having-they got worried. My BP actually never went over the limit until I was in heavy labor-but the protien made my diagnosis of pre-e, not my BP. Honestly even if your doc doesnt concider having protien as being pre-e, the fact that he didnt even tell you is really kinda messed up. Do you remember what the numbers were? I was told a tiny bit of protien is ok....when I finally had it really show up, it was a +2, which my midwives say is still really low (like in that they wouldnt have dx it had I been with them and still could have had a homebirth since my BP was still within limits as well). Thats pretty much all I know about it.
Hey I guess thats one nice thing about doing the test yourself each visit huh? Hehe. (my midwives have their patients pee on the stick and check it themselves and if they see something abnormal, they ask the mw to check-its really fun seeing the vitamin C part turn bright orange!! )
post #20 of 21
It sounds like you just went into premature labor and there's just plain no answer why that happens in most cases. The b/p guidelines for pre-eclampsia are the same regardless of your baseline pre-pregnancy b/p. And it's pretty common for b/p to become slightly raised as the heartrate raises as well in pg due to the increased fluid in the bloodstream. B/p is only one indicator. Proteinuria is another, but this is not based on one urine sample in the doctor's office, but rather determined through the collection of 24hr urines b/c of varying amts. of protein spilling throughout the day. Most important however are your lab values (liver function tests, etc).

I'm new here, but this stuff I *DO* know what I'm talking about...lol...I'm a former L&D RN who spiraled down into severe pre-eclampsia while pg w/my twins. I started going downhill at about 25/26wks and was hospitalized at 30wks and they had to take the girls by c/s at 31wks. My cervix was NEVER an issue...my b/p was high, but not crazy high (150's over low 90's), but my protein spilling got crazy and my lab values went wacky too...and I swelled up like a balloon.

I find it odd that people have asked you why they were born early...most people I encounter just shake their heads when I say "They're 11mo, but they were over 2mo early, so they're more like 9mo's developmentally." I think most people expect that twins are born early.
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