Pre-eclampsia in 2nd trimester?

[glimmer]

I am currently 21 weeks pregnant and took my blood pressure today. It was 140/90 at 10am after a busy morning.
I had pre-eclampsia with my first child (diagnosed at 42 week pregnancy, so very late,
but it got "severe" within 12h), so am at increased risk for re-occurrence.

Obviously, I will go and see the doctor, if I have subsequent high blood pressure measures, but I would like to know what to expect. I have a "bit" of white collar fear, especially when it come to maternity issues and want as little intervention as possible.
Certainly won't put myself and my child at risk, but would like as much information as possible before going.

How do they treat high-blood pressure in the 2nd trimester? At this point, I do not know if I have protein in urine.

Thanks for any advice/info.

Well with me I was admitted on and off all the way from week 17 till week 38 when I had DS by CS. I had PET first time too, at post term. With a EMCS as a result.

They will monitor you frequently for several weeks and then offer betablockers if required to keep your BP down, unless it stays really high then they admit you.

Glimmer Have you seen this site www.preeclampsia.org/forum/default.asp ? I look at it a lot and although treatment diagnosis etc tend to be quite different between the UK and the US theres loads of really good info.

I got pre e with my first child about 31 weeks and it was managed until 35 weeks with bp meds and close monitoring. This time round my bp is up and I'm on bp meds but I'm at 36 weeks.

I think the "general rule" is that you get it later and milder second time round but that has a lot to do with if you have existing hypertension or underlying disorders. Its awfully complicated so that's why its always best to be checked out by doctors with any concerns.

Every case is different though and what you really need to do is get to see your doctor with your concerns as soon as possible

Good luck keep us posted!

Thanks so much for answering WMMC. I followed your threat when you gave birth to DS :-)
How long were you admitted each time?
Did they give you blood pressure lowering meds?
Did they work for you? Admittedly, I am a bit in a state right now, not really helpful and certainly not helping with the BP itself...

Mspotatochip - I hope the low-salt ones :-)
We crossposted. No, I haven't looked at that particular site, thank you very much, I will
check it out. I actually live currently in the US, but used to live in the UK. So, I don't have the option to go to a GP, but would go to hospital and I kind of now what happens then: they just follow their routines and rules and everything seems out of control. That's what I am so scared of. (Obviously, I have some traumatic experience with it...)

mspotatochip - please excuse my manners.
Sorry to hear you developed PET again, but it's good that you are 36 weeks already. I hope they can manage it a little bit longer....
Where you admitted to hospital at times?

Wonder if you can get the dipsticks "over the counter"

re low salt

One thing I really note about the US system from that site is there does seem to be a trend to more intervention but then again pre-eclampsia isn't really a condition to be messed with either?!

First time round in the UK I was admitted to be assessed 24 hr urine test etc put on drugs at 31 weeks and then the community midwife came to check on me at home for a few weeks. I got a 2+ protein at home around 34 weeks and went in to be checked and came home with DD. I was induced when my bp could no longer be controlled and I had significant protein and my platelets were dropping. Little one was fine I was unlucky and got a dural tap from the epidural and had problems with my bp afterwards as well so we were in for about 8 days after the birth.

This time round its a lot more hands off and I've been attending a day assessment unit a couple of times a week plus if I have any concerns I can ring up and be seen. I was labelled as "anxious" for monitoring my bp too much at home but we seem to have got past that ............

I took low dose aspirin up until 34 weeks, had a specialist 20 weeks scan with uterine artery doppler and four weekly then 2 weekly (from about 30 weeks) growth scans and consultant team appointments.

The approach seems to be to coax me along keeping symptoms stable for as long as possible. induction hasn't even been mentioned yet and I get the impression won't be unless things get significantly worse.

My midwife gives me the protein testing sticks. I asked in boots and they said they don't sell them. Not sure what would happoen in the US but quite sure there must be some where reputable on the internet to get hold of them.

What sort of health cover do you have in the US? Surely its a good idea to have basic bloods, urine checks etc done and then take it from there? They are big on bedrest but apparently there's no proof it actually works.

I was admitted for 38 days in total, the last time for 20 days so you can work out the rest - many 24 hour stays very boring. Much more time was spent sitting in the day assessment unit for four hours. I have massive white coat hypertension as well which didn't help.

I found a home blood pressure machine helped as I could monitor at home and call them if it got too wild.

The betablockers didn't affect my blood pressure and just made me feel like shit. But there are a fair few to try.

Protein is an indicator but until you have a 24 hour urine collect it's just an indicator rather than a diagnosis so the dip sticks will only show 'something is going on' not what. It can just be something like you have a cold or something and that will screw with your BP. So will stress obviously, living on coffee and crisps and listening to midwives too much

Thanks so much for your info. I am feeling already a little better. (Irrational, I know, but you have lived through it.) I just got a call that DS is sick and there is fifth disease going around. Took my mind of a little grin.

There is a theory that PET is utterly unpreventable btw and I subscribe to that - every single pregnancy I have will feature PET and in some senses, so long as it doesn't get bad till the end of the pregnancy and it doesn't develop into eclampsia, it's not actually a bad thing for me. It forced me to slow down and stop doing the silly-arse things I always do when pregnant. Well it sort of stopped me. A bit. I still did the pond when I was seven months gone but....

Hand hygiene btw on the fifth - v important.

What will be will be, no point in worrying. Be happy, you are creating another life. No point in stressing about numbers on the BP machine which change every fifteen seconds is there?

Hi,

I have had a stillbirth at 24 weeks due to PET/HELLP so it is possible for it to happen in the 2nd trimester. I had high BP for most of 2nd tri in that pregnancy but doctors never really seemed that concerned and although my BP was regularly high I suffered from the same naivety that most people have when pregnant - thinking that my baby couldn't die . My symptoms of swelling etc started about 21 weeks. I certainly don't want to scare you but it's best to get checked out if you have had PET before, even late.
I and they know much better now about what happens and in my 2nd pregnancy I was watched like a hawk and did everything exactly by the book. It still appeared at 29 weeks but this time I was prepared for the symptoms, they acted immediately and DS was born prematurely by C-Section.

I am recently pregnant again (a surprise - a frightening but happy one ). This time I will receive the same sort of care as last time, perhaps more so as they now know that (as WMMC said) it is likely to happen again now it has happened twice.

As far as the fifth disease is concerned, be aware that even after 20 weeks it can be very dangerous for your unborn baby if you are not immune. So best to get checked out. All the information in books say that it is not dangerous after 20 weeks, but I am a member of the SANDS forum and I know at least 2 ladies who were beyond that point who suffered a tragedy after being told that.
That said, most people are already immune so hopefully you won't have to worry.

Alexander - sorry to hear of your loss, it's every parent and potential parent's nightmare. I think the OP is concerned she will be railroaded into anxiety unnecessarily and will follow advice but wanted to know what she should expect. From her other posts she does take this sort of thing very seriously.

Congratulations on your current pregnancy. May I suggest you subscribe to a decent puzzle magazine for those many, many hours you will be sending in the day assessment unit!

Hi glimmer, I'm sorry you're having so much worry - it's unusual to develop PET earlier in second pg than the first, but it is possible, so a good idea to keep an eye on your bp.

I developed PET at 29 weeks in my first pg, ds was born at 34 weeks. I was also in hospital for a long time with a girl who had been admitted at 22 weeks, and her treatment was much the same as mine. 6-hourly bp checks, daily urine dipstick checks, weekly 24hr urine collections (they were lovely!). Bp medication (methyl-dopa and nifedipine) when my bp was consistently over 140/90 - it still kept going up though! We also had umbilical cord dopplers to check the blood flow through to the baby - the girl I was in with had them every day as she was much earlier in her pregnancy than me so they were keen to keep the baby in until the last possible minute.

Do hope your bp reading was just a one off after a stressful morning. If you do end up with lots of monitoring this time round, I've got an addition to WMMC's puzzle book suggestion - line up a lot of childcare! (as I am now 34 weeks into second pg and spent 3 hours at hospital yesterday with 2-year-old ds. It was lots of fun. Particularly trying to do a midstream urine sample whilst stopping him from pulling all the paper towels out of the holder and putting them in the sink).

Best of luck with your pregnancy

Thanks so much for all your posts.

WMMC - thanks for your summarizing my character - you hit it spot on. I hadn't realised how traumatised I still am by the past events, where I couldn't make fully informed decisions. But as much as I know that panic doesn't get me anyway, you can't will it away, can you....

Thanks also about hand hygene. I am extremely good at this (see also next post), because we got trained by the swine flu.
Before we leave daycare and after we come home DS will walk straight to the bathroom to get his hands washed...

AlexanderPandasmum - I am very sorry to hear about your loss. I had a miscarriage and know what you mean about naivety! And congratulations to your current pregnancy. May it PET-free this time - just one less thing to worry about.
Thanks also for your info on fifth disease - I know that it can be fatal throughout pregnancy and I believe only 50% of adult women are immune. The problem is that there is one after the other fetus-damaging disease every week at the daycare (flu, swine flu, 5 desese....) and I have come to the conclusion that you either have to accept the risk that you might loose the child you are bearing or you have to pull them out of nursery and stay home. Latter is not an option for us right now. I do not say this lightly BTW, I say this after weeks of agonising, having contacted health authorities (to change the childcare's rules on swine-flu cases and travelling staff) and after having suffered a loss myself.
After reading WMMC paragraph it has become clear to me, that I am after the information, so that the hospital machinery won't take over completely and leaves me feeling out-of-control again. Neither myslef or my son would be alive without it and I am grateful for this, but if it would have happened differently, I would not have been traumatised. Sorry, I am veering away from the OP which is really about preeclampsia.

Just been thinking about all this while having my snooze . I don't think we should be ashamed of our collective white coat hypertension / issues. I suspect it would be weird not to have it!

I got so upset a few weeks ago when anxious got written in my notes then every hcp started conversation with "so you seem anxious!!!" Total waste of energy.

I second liege point re childcare. I have been lucky that either MIL or nursery have been able to mind dd1 each time I have had to go and spend hours at DAU. It would be a nightmare otherwise (mind you they would have seen my "real" BP). Also always have a book even when they say it will only be 20 minutes. 20 minutes usually means 2 hours while they "grab" a doctor to review your notes

Glimmer I think a certain amount of birth trauma and severe pre eclampsia are interlinked. I had every intervention possible short of c section in the end and the only thing that kept me relatively calm was the calm and serene staff. If the staff had stopped reassuring me or ignored me it would have been an entirely worse experience than the unpleasant experience it was.

This time round I have had a lot of flashbacks to the more horrid bits as I keep having to recount the whole experience to multiple different doctors. This is where the US system could really work for you I think as you are more likely to be able to consistently see the same doctor who knows the story and doesn't need it repeated ad nauseum than on the good old NHS?

Hi all. Bad news here. I have 1+ protein, bp still up and something about "brisk" reflexes.
I will see an obstetrician tomorrow (tried for today) and assume they'll keep me in hospital.

LiegeAndLief - thanks for your post. So I take it you were admitted for 5 weeks?
Great, that you made it already to 34 weeks in your second pregnancy and hope you won't develop any symptoms this time around.

Mspotatochip. I agree with you on that we shouldn't be ashamed of out anxieties, but as you know from experience, it so easy to get stamped "anxious" by the system and then they won't listen to you anymore. I had an obstetrician (!) that wanted me on antidepressant but refused to give me a scan.
At this point I was bleeding into my abdomen since I had a complete cervical stenosis after an ERPC and could have died any time. I had the wits to go to another obseterician (privately) and was in surgery the next day
You do have a point about more continuitey in the US health care system (and I luckily have very good insurance), but they tend to give you even less choice and tend to more more restrictive, because they are scared of being sued. So I think if anything, being more informed is even more necessary.

A few general questions: if this is 2nd trimester preeclampsia, what are the stats that I will have a premature baby? I assume it depends if I react to the bp drugs or not. I couldn't find anything on the internet. Also were you on magnesium sulfate. Will post now on the pre-eclampsia forum in my state and spend quality time with DS while I can.

Thanks you all have been a BIGGG help.

Liegeandlief - may I suggest you utilise vomit bowls as hats and play 'inflate the disposable latex glove' (these can kill several hours if you borrow a marker pen and paint faces.

Glimmer - okay don't panic I went from three pluses to one in twelve hours - it can be worse if you are dehydrated for obvious reasons! You will need an ultrasound for sure though - hopefully your hospital will be able to scan the cord to look for probs there as well and probably keep you in to do a 24 hour urine collection (oh the glamour for Glimmer ).

Right a few facts, they will endeavour to get you to 28 weeks at least with bedrest and blood pressure drugs unless your 24 hour collection shows pronounced PET or the start of HELLP syndrome. Yes that does mean seven weeks in hospital if you are unlucky. At least.

If the baby is not doing so well in there obvious he/she gets evicted pronto. Expect four hourly CTGs (you have to stay still for them as well, tis a pain in the bum) day and night.

Pack too much stuff - you will need it (and then some).

If you can get to 24 weeks, your baby has a much better chance than at 21. Every day counts. Go and have a look at Bliss for percentages if you really want to know. It's not great but for me I'd rather know, but I'm just a bit like that you know.

Good luck Let us know how you get on.

oh glimmer....... Hopefully they will control it and well with medication. Is there any chance that you may have chronic hypertension / underlying kidney disorder?? did they test you for all this before? strange thing to wish for I know but sometimes pregnancy can "unmask" this and its easily controlled??

To answer your question I never had mag sulfate or at least if I did at the end no-one told me! A lot of the last 24 hours before dd was born are a bit of a blur.

Good luck, don't be afraid to quiz those doctors and don't panic

I never had mag sulfate either - was told there was no bloody point once things had got to the point of confirmed PET. But that may have been bollocks.

Ask: what do you suggest and why; what if we do nothing; are there any alternatives; can I think about it for 24 hours before making a decision?

The clinic just called and wanted my to pay before I come in (I have been there before, I have paid them before, my file is on record). I guess they are concerned I won't make it long enough to pay their bills
. I refused by the way ...

I had mag sulfate by the way. Within two minutes my BP was 50/19 (this is not a typo) and everybody ran. They said I shouldn't be conscious. Oh well, thanks for the info. They tried to switch it on twice afterwards but the consultant finally stopped them, saying that the intention was to help me not to kill me . This is what he said, I swear. He is fab by the way, just the wrong continent.

Ah well glad you are maintaining a sense of humour if nothing else!

... if nothing else...

Ah I didn't mean it like that - I meant 'you may not have the enlightened support you need' medically but you are getting through it.

Are you getting the betablocker blues? Reducing your blood pressure does make you feel completely awful and depressed.

Mind you I bet you feel quite bleak at the minute anyway, you've had an awful shock to develop PET at such an early stage, I was raging for weeks.

But you are doing all the right things, as long as your baby is all right you just take things one day at a time

So sorry about the bp and urine glimmer, hope you manage to get your obs appt soon and it goes well. If it's any consolation, those dipstick things aren't always very accurate - I've had 1+ prot at my last 2 hospital appts but when they send the sample to the lab it's never anything significant. Maybe a combination of that and white coat hypertension? (hopefully!)

I never had magnesium sulphate. I think I read somewhere that it's much more popular in the states than over here, but have no idea why!

Am at work and have to scoot to a meeting, but wishing you lots of luck, let us know how you get on.

Thanks for entertaining toddler in hospital tips WMMC, hope I won't need to try them out! Am trying to persuade dh to have a few hours off next time... sadly clincs are never on ds's nursery days...