Maternal hypertension anyone ?

[hub2dee]

Hi all,

dw is 31+4 (edd 2nd August) and has been 120/80 throughout pg. Thursday night she had shivers and headaches so MIL (retired doc) checked BP. This was high so we went to the hossie late at night for the pros to check her over. SIL has just visited from the States and was due to leave a couple of days later (they're v. v. close), and the emotional stress could be a contributing factor.

They traced the baby (little one is fine, supported by a scan the next day) and did occasional bp checks. Pressure remained high (I was stressed, and didn't note any readings, but IIRC it was around 160 - 195 / 87 - 97), so they kept her in overnight and BP but was closer to normal the next day. Urine and bloods on admission returned normal, 'slight trace nothing to worry about' (proteinuria) in the AM.

As dw has a few risk factors for PE (MIL's a food-controlled diabetic, dw is overweight), and I wasn't super happy with the monitoring at the hospital or the 'wait till Monday and we'll see',. I chose to check BP at home with an upper-arm digital cuff. (I'm aware this is sometimes not considered helpful, but I'm not prepared to risk missing very high BP / early PE).

She has remained between 150 - 160 over around 90 this weekend. She had headaches and vomitted a few times the night before last, but no visual disturbances / upper right chest pain.

1. Does anyone have experience of developing maternal hypertension in their pg, and can you advise what levels they 'mointored closely' and at what level they sought to medicate ?

2. Mears, I searched archives for previous posts you'd made on hypertension, and noticed you made the point essential hypertension can be separate from PE and does not necessarily imply PE is inevitable. I also found from a post a few years ago a useful link to a BP article in midwiferytoday. Can I ask what the current mindset is regarding maternal hypertension / levels / duration before medication, and if you had any experience with clients who did better on particular meds than others ? (Also, once meds start is it likely to be until birth, or is it feasible to gradually reduce dose to zero after a given period to evaluate if the medication in still necessary). DW doesn't smoke / drink and has had no caffeine since falling pg).

Thanks for any input, apologies for the long post.

(Slightly worried hub).

Hello hub2dee, no knowledge of hypertension at all I am afraid, but just wanted to say hope you both ok, must be really worrying for you both. I will keep my eye on you X

Me! I averaged 160/92 for the entire last trimester of my pregnancy. But it was NOT PE. In fact, even though I was very athletic all my life and having never been overweight, my BP has always been quite high thanks to the paternal side of my family.

I was taken off work and had a blood pressure monitor to use at home. In fact, they didn't have to give me one - my dad leaves one here for his visits. His BP is controlled with 4 separate drugs and he's on thinners as he's had a heart attack twice and two of his immediate family died of heart attack in their 30s. I also started a weekly course of accupuncture that helped stablise the BP.

I had scans every fortnight after 31 weeks. Baby was fine.

I started meds after birth.

It could be that she has hypertension. If she is overweight, losing weight after the baby comes can help the condition if it doesn't improve. I'm able to control my condition - right now - through exercise and hope to continue doing so. Exercise can also help diabetics. My FIL has been able to stay on oral insulin b/c of his level of fitness - despite having had diabetes for 13 years. He also follows the Low GI diet.

Thanks pink, expat.

Quite a cocktail for your dad, hey, expat ! BTW, you say you started meds after birth. I presume your bp was normal before the last trimester then ? Doesn't it typically return to normal after birth ?

Both dw and I need to get the weight thing in order and modify food and lifestyle to ensure beanette has good role models, and of course for our own health and happiness too.

Hiya hub2dee,
With my ds, I had my blood pressure checked by mw, who said it was high (130/85), and to get it checked again in the morning. Following day, it was 140/95, and was told i have to go stright to the hospital, for further checks.
I was then kept in for 6nights!!! Was on tablets for the remainder of the pregnancy, but as soon as i give birth, i only had one dose and then they stoped giving it to me.
Hope everything goes ok for you dw.

Hi hub2dee,

During my 1st pregnancy my usual BP was about 110/80. During the 3rd trimester I kept getting BP 'spikes' where one minute it was fine and the next it shot up. The MW sent me to the hospital for monitoring when the second figure went up to around 100. The monitoring was done in the Foetal Medicine unit and basically involved me sitting in a comfy chair with drinks and magazines for a few hours. The foetal heartrate was monitored throughout and my own BP was checked every 15mins or so. The idea was to check whether the high BP was having an effect on the baby. At the end of the monitoring I was told that at one point my BP was 150/115 - even though I felt very calm and relaxed. There were no traces of protein at all and I was allowed to go home when the BP profile was finished.

The following week my BP was high again so the MW booked me another appointment at the FM unit where I went through the same thing again. This time I had the BP profile again and a scan just to make sure that ds1 was okay. He was absolutely fine.

The MW arranged several home visits where she came and measured my BP at home and to keep an eye on things. I only had traces of protein once but definitely no PE. During the final week the MW visited every day to check my BP. Ds1 still hadn't appeared at 41 wks so the decision was made to induce labour rather than take the risk that my BP might cause problems.

During my 2nd pregnancy my BP was probably the lowest it has ever been and there were no problems at all. HTH

I know it's not terribly scientific to explore anecdotes, but it is nonetheless interesting and useful to see the range of experiences people have had. Thanks to sobernow, jofeb04 and coppertop for sharing relevant info.

We did one BP check on waking, and another a few hours later and the numbers are much better. We won't check all day as I appreciate the impact these frequent checks can have on the anxiety levels, but at the same time, high BP spikes can have serious consequences for mother and child, so I'll still keep a quiet, sly eye on dw and bean. We've got a hossie check tomorrow lunch, so with a bit of luck and a lot of dw's angel music / yoga CDs I hope to have her super-relaxed before long.

Hi Hub

I had hypertension with DS .. from 32 weeks .. they worried if the bottom figure got in the 90s (don't pay any mind to the top figure at all IIRC)

I was medicated for it .. and hospitalised once or twice overnight ..and had fortnightly, sometimes weekly BP checks in labour ward (hooked up to automatic machine) and I showed NO signs ever of developing PE

I assume you know all about white coat syndrome and how the very nature of checking BP can raise your BP

don't worry too much, personally I wouldn't self-check

love to Dee (when you're feeling better ..yadda yadda)

Thanks for your info Twig. Have e-mailed. Glad you went high but didn't develop PE IYSWIM.

Part of the problem is I am not exactly sure how 'sudden' a raised BP becomes clinically significant, IYSWIM. I will enquire more tomorrow at the hossie.

Yeah, I know about white coat syndrome (I'm one for fainting when they propose extracting my red stuff or doing other nasty things with my lovely juicy body ), but I still wanted to make sure that if the BP climbed to a dangerous level we spotted it early....

Dee says hi.

bumping for any other relevant comments / experiences.

Most of the day in the hossie. DW's BP was high at lunch, somewhat down in the PM (147/86 - usual baseline 120/80). My calming forearm stroking fingers are tired.

Been prescribed Labetalol 100mg one tablet twice per day, and we're supposed to go back tomorrow lunch for urine / BP / CTG.

Yawn.

Has anyone had this drug with decent, swift response in their BP levels, or moved to another, or any mws / docs suggest other good anti hypertensives (no allergies / unusual reactions in dw's history) to consider / ask about ?

i have pre-existing hypertension & have been on methyldopa throughout this pregnancy. currently on 3x500mg/day, started off on 2x500mg/day. i think i do have slightly raised bp but get terrible white coat syndrome. i test it at home and it's the low end of normal, & the hospital made me wear a 24 hour monitor which was a nightmare but again came back normal. err, sorry, not sure any of this is relevant to you! i was on labetalol when i breastfed ds with no problems.

Thanks hc, it is relevant. I am interested in learning more about it so I can best help my dw and understand what the docs propose....

We're both semi-white coat syndrome too. Getting better with the endless desensitisation programme though !

May I ask all those who posted on this thread (if you read this)... could you add whether you delivered CS or vaginally ?

Thanks.

2 x CS .. but due to other reasons not high BP per se

hth

oh and BP was totally normal throughout pregnancy with DD

induced at 39 weeks, ds eventually hauled out with ventouse & forceps. however, the induction was entirely because of my diabetes, blood pressure not an issue. they are distinctly uninterested in me this time, will be induced again at 38-39 weeks.

probably irrelevant but i did have PE with ds, consequently my BP was always greater than 95 (diastloic). It reached 105 at times and eventually i was started on Labetalol.
I continued to be in and out of hosie from about 32 weeks until i gave birth at 36 weeks.
I was on labetalol for aprox 72 hours prior to the decision to induce, so not very long. But it did nothing to reduce my hypertension and i began to hullucinate and feel very unwell.
The community team were very concerned and wouldnt allow me to drive home, insisting that i phoned dh to pick me up.
In Hosie, they were very blase about it and checked it maybe twice a day, each time it was very high.
This is a very worrying time for you, having been there i/we feel for you.
My experience isnt a nice one but i felt cared for and safe with the hospital staff. I felt that they knew what they were doing but were reluctant to make any rash decisions.
This obviously was excruciatingly frustrating for me as i enterd my third week as an in patient.
It all turned out ok in the end and im reassured that it probably will not happen again next time round.
Good luck and try to remain calm and focussed.
HTH

I haven't time to read the other answers - but here is my experience.

My booking BP was 120/80.

They monitored closely - every few days once my BP got over about 140/90. I was taken into hospital once it got over 150/100 I think. I was given protein testing urine sticks to do daily at home.

I was admitted when I went for an antenatal check and it was 170/120. I was induced 2 days later. I was never diagnosed with pre-eclampsia - but had what they called very labile blood pressure - basically it kept going high but whenever they were about to start treatment it dropped. In then end they induced because I was 38 weeks and they had no real idea of what was going on.

My blood pressure remained high and was treated with adalat (I think) after pregnancy, and also while pregnant the second time (kept at about 140/90). It dropped a bit after second pregnancy and treatment stopped.

sorry just read your add on, i had C~section after all that carry on!
Undiagnosed breach. But dilated to 10cm before they realised............what was my BP then..........200/240 surely!!!!!!!!!!!!!LOL

Suffered too with this from about 32 weeks, coupled with high glucose and protein in all samples from about the same date.

I was monitored very closely from then on, (urine samples and ctg's every 3 days) but as had no other symptoms, did not medicate. Was admitted once overnight at around 34 weeks for very high proteinurina and high bp.

At 38 weeks started having visual disturbances, with bp and protein still high (always 92ish) and was induced.

Hope all goes ok for you and dw, let us know how you go xx

Hmmmm... in a slight tizzz....

As discharge BP tonight was 147/86 (usual 120/80), and this has been as low as it's got the last couple of days, I was wondering about stalling on the meds for one day, or possibly paying to see a consultant first privately before we begin meds.

We were attended to by a doctor on call, but as you've never seen these people before / built up a rapport / know how long they've been practicing, IMHO it requires a lot of trust to jump in. These are beta blockers after all.

Perhaps I'm being an ass.

When one of the mws said to this doc that there was a woman to be seen with SPD - the doc asked what that was as she didn't go by / know this abbreviation.

I wouldn't normally question / hesitate, but the drug has a 'do not suddenly cease' type warning, so wouldn't want to start, see a consultant tomorrow, and then be told something else would be better....

Oh dear. Maybe I should just be a good boy and shut me gob and stop questioning and do as the doctor says... must admit, gut reaction deffo says 'not 100% sure'...

Hmm.

Off to NCT now, so can't reply till later.

TIA for any comments.

honestly, take the drugs.

hope it all goes well for you - it's great that you are able to get so much info for Mrs Hub.
I had high bp and went very swollen all of a sudden which eventually became pe (c section at 37 weeks. I'm only writing that because I am convinced that I went a bit loopy (which I blame on the high bp) and didn't want to take the meds, didn't take it all too seriously, wasn't taking it as easy as I should have done etc. Looking back, I think I was barking - it wasn't me at all. A second opinion sounds a great idea if you're not confident in your doc but if I were to do it all again, I'd try to do exactly what you are doing, get as informed as pos, and then let an expert I had confidence in prescribe the meds/bed rest I needed and try to relax aobut it all a bit. easier said than done of course
hope that makes some kind of sense to you - I mean it in a positive vibes way.