Confused about advice given by midwife vs NICE guidelines RE proteinuria

[naggy095]

I have a history of hypertension in previous pregnancy and have been considered high risk for pre-eclampsia this pregnancy, so i've been having weekly blood pressure readings since 16 weeks. This week at 30 weeks, I had my blood pressure taken and urine tested. Blood pressure was fine, but the urine sample was ++ protein. The midwife said she'd send the sample off for testing and that I'd get a call by Friday with the result, nothing else about any further assessment, just to watch for symptoms and contact the DAU with any concerns.

Friday has come, no contact, so I called them in the morning for an update on the result. The midwife I spoke to said she couldn't see a sample even noted on the system and that she'd speak with her colleague who took the sample and will get back to me. I've been quite busy today and ended up being so tired in the afternoon I needed a nap, but I didn't get a call back and I wasn't able to chase up before my midwife team closed.

I then tried calling the DAU, but no one answered so I called the labour ward, as is the guidelines for my NHS trust as the DAU is not 24hours and I think I just missed the cut off time for the DAU. The conversation I had with the midwife went around in circles as I was having to repeat that I had a ++ protein urine sample and haven't had the result and asked if she could check on their system for the result. The conversation ended with her saying no she can't check and to call my midwife team on Monday for an update.

I've just now come across the NICE guidelines where it states women who present with a ++ protein sample and no hypertension should be sent for an urgent secondary assessment, even with no other symptoms of pre-eclampsia and that the assessment should be within 48 hours of the sample being taken. However, I have now started to get other symptoms such as headaches and swelling, but I have a blood pressure monitor at home all my readings are still within normal limit.

My question is now I've seen the NICE guidelines, do I wait for Monday as the midwife said or do I try to call the DAU tomorrow? Although every time I have ever tried to call my DAU they have NEVER answered. I'm pretty annoyed the guidelines state I should have been referred for further assessment and wasn't!

Pre-eclampsia is not.something to take chances with, I think you should press to get seen urgently particularly with headaches and swelling.

With the development of new symptoms along with the protein you should be seen this evening at the hospital so that they can take bloods and assess you properly.

I wouldn’t have been able to be seen last night as my assessment unit is not 24 hours. I’ve tried ringing again this morning and as per usual they’re not picking up.

If the assessment unit isn't 24 hours then women must be seen on the labour ward out of hours so I would call them. There has to be 24 hour access to care.

I did call the labour ward last evening and that’s when the midwife I spoke to said to wait till Monday.. I’m going to try DAU again and if they don’t pick up I’ll try the labour ward. I find it troubling that I can never get through to someone at DAU though every time I try

To be entirely honest, I would present at the hospital, and if they try to send you away, ask clearly why NICE guidance is not being followed and ask for their name. Also insist it is on your records that you have presented and been turned away. Would hopefully give pause for thought.

So I called labour ward, they magically were able to put me through to DAU instantly. I explained the situation to the midwife and she said- we’re not going to act on anything that a dipstick says. I explained the NICE guidelines to her and she said I understand there are the NICE guidelines but we have hospital guidelines and we have to go by that. She also checked the system and confirmed that the midwife I saw the other day did not note the ++ protein on the system or send a sample off. She was incredibly rude and condescending whenever I mentioned the NICE guidelines. She said I can turn up to the hospital if I want to do another dipstick and if it shows protein then they’ll send it off but they won’t be doing anything else and kept saying they’re not going to act on a dipstick. This is what the NICE guidelines say for 2+ protein on dipstick and not presenting hypertension…

Another vote here for presenting at the hospital. So sorry you've been spoken to in this way

Hospital and PALS.

Which nice guidelines are you reading? Because they look like the management of suspected UTI which would be irrelevant here.

TBH nice guidelines are just that and don’t really cut it in the real world - it’s very much a mumsnet thing of waving them at people to ‘scare’ them with your knowledge.

go by your symptoms - if you have changing symptoms such as a headache and swelling then go get seen!!!

https://cks.nice.org.uk/topics/hypertension-in-pregnancy/management/proteinuria-no-hypertension-after-20-weeks/

it’s these guidelines, proteinuria but no hypertension.

I’m considered high risk already for pre-eclampsia and in my last pregnancy I had symptoms which I expressed concern about and was ignored, which resulted in complications to myself and my baby so I’m obviously concerned about being treated correctly this time around.

I’m here now at DAU waiting to be called in, will update the thread later. Thanks for the comments so far

Just to update, I had my urine checked and had 1+ protein so they sent that off for testing. They then checked my blood pressure a few times and it had jumped up, bottom number for the readings were 93, 89 and 88 compared to low 70s only a few days ago and every check prior. The top number varied between 127-138. Also been having a headache every day that’s not being touched by paracetamol. So they wanted me to be seen by a doctor for the next steps.

Doctor takes my BP and it has come down again to low 70s, the urine results also came back as normal, and they’ve given me paracetamol just now to see if it helps before discharging me. Next step now is to come back to the DAU in a few days to repeat the blood pressure readings and a new urine sample.

My mind is now at ease that everything appears normal for now and hopefully it stays that way 🤞🏼

Fingers crossed everything stays stable.

Good on you, you absolutely did the right thing

Well I’m being kept in overnight now, my headache didn’t go away with the paracetamol so they’ve given me dihydrocodeine and will check on me in the morning. Blood pressure shot up again as well but is within normal limit, 121/86.

On a brighter note, with me being on the labour ward, I’ve heard 2 babies being born whilst I’ve been here and it’s very sweet to hear their little cries 🥹