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).

Our dipstcks do hub. They are G* sticks if that makes you any the wiser.

Checked with my mate who works in daycare - 24 hour urines can be dome for women with + or more protrinuria but blood tests are favoured.

Thanks for asking your day care colleagues, mears.

I will have a nosey to see if they are G sticks for my insanely knowledge-thirsty brain. Are Gsticks specific to protein checks only (ie. the regular sticks I think show lots of other stuff like glucose and leucocytes for example as well as proteinuria).

Anyway, did you have a nice day, baby-catcher ? I hope any deliveries went well.

(Not sure if you routinely work 'hands on' or have more of a supervisory position ?)

how's it going?
regarding bp, other factors influencing readings (you know all about stress etc) are the arm it is usually measured by as each one will be different and the size of the arm band thing used to measure the bp (this is definitely true for children and I would guess also applies to adults - no idea of the science behind it)
for protein, again I don't know why but it is perfectly pos to fluctuate as you describe. 24 hr urine test gave a much better result for me used in conjunction with bloods. 24 hour also gives you an idea of the volume coming out (working on the theory, what goes in should be coming out unless something is going on)

Meant to type G8 sticks (not *)

They have everything on as well as leucocytes and nitrites, SG and alkalinity. And protein of course.

Multistix 8SG even!!!

hi morocco, mears. I did't actualy look at the stix today - I clean forgot (hossies aren't my favourite places) - but I will look / ask next time.

119/88 followed by 118/82 1/2 hour later whilst lying down after CTG tracing. No protein, no growth from Monday's urine, all looking dandy.

I expect it's a combination of the Labetalol pills kicking in, Dee chilling out / lying down for testing (and resting a lot during the day), and using a manual machine instead of digital. Either way, it's a nice feeling. Possibly at Friday's antenatal clinic we can request BP checks at the GP, or more irregular attendance at the Day Assessment Unit, which would be nice.

Thanks again for your input.

Thats good news. Can community midwife not check BP at home?

Glad things are going well

Realsied I didn't respond to a question earlier, sorry. I am on holiday this week so having a sort of restful time. Am trying to complete a research module for my masters degree but am having no luck. Writer's block I am afraid. I work in the delivery suite as a co-ordinator so am around births all the time although not necessarily 'doing'them IYSWIM?

I'll ask about the possiblity of home checks by the community midwife. We used to see her in the GP's surgery as this is so convenient. Maybe in London they are loathe to offer this as they'd be stuck in traffic for too much of the day ?

TBH, I'd be just as happy buying stix and using a quality upper arm digital tester at home according to whatever frequency was deemed appropriate... it's not exactly rocket science, and we could 'check in' with the midwife / GP / DAU if a home reading read particularly low or high.

Perhaps they feel fetal CTG is a necessary component ? (Although having said that we've got a Sonic Aid rip off as a manufacturer's sample through someone who was looking to represent new brand of handheld machines them in UK. It displays bpm, but I'm not sure it's as accurate as a Sonic Aid machine - before anyone asks, no, we don't home check. I think we've used it twice in 6 months. I think it was useful though when antenatal checks were only every 4 - 8 weeks. I appreciate it only does spot checks rather than tracing over time).

I bet your job can mean odd hours and it must get fairly stressful if there are multiple demands on the available rooms, mears. Enjoy the rest of your week off ! I hope your research becomes more fruitful or that the writing starts to flow ! Is the subject more politicy / adminy or more bio / medical ? I hope the Masters is still holding interest for you - I presume you are coming to the end of it as it June already ???

Hi Huggy. Glad to see the capitals are back !

I am sure BP check would be preferably done by MW or GP than home monitor. As far as I am aware digital BP recordings are not well calibrated accurately enough. They have been questioned re accuracy. Actual manual recordings with good old stethescope are the way to go. Appreciate London traffic issues and that MW may prefer visit to surgery.

I am on a late submission as far as assignment goes. Trying to look at issue of women attending hospital in hesitant (prelabour) labour. Their journey through hospital is not very good ATM.

hiya, OK, OK, I'll put the home monitor in a draw.

I hope your sumbission comes together in the next week or two then ! And that subsequently your findings can be put to good use !

Hope you're getting some sun where you are !

Just a little update incase anyone reads this thread for info in the future etc.

dw self-admitted overnight Friday (high bp). This, despite, bp being normal in the afternoon at the hospital. Given Nifedipine which is a fast-acting drug to lower BP and compliment the labetalol. She responded well and was discharged the next day, and labetalol dose was doubled. (ultrasound for growth, bloods, urine all still fine, which is great).

dw self-admitted overnight last night Sunday (high bp). By the time we got to hospital her bp was a little lower so they just kept her in overnight. She'll stay in for maybe another day or two for monitoring but the bloods they drew last night were fine.

I'm happy they're on top of the situation, and we're lucky bloods and urine are consistently returning normal. I imagine they'll continue to tweak the anti-hypertensive dosage and frequency until they are confidant she is in an acceptable range. One thing that is difficult is seeing a new doctor for EVERY antenatal appointment / review / ward round - you seem to spend an awfully long time attempting to bring them up to speed with your history / present situation... expecting them to make decisions which incorporate the nuance of prior / very recent discussions which is pretty difficult.

Large doses of patience and a good attitude are most helpful.

We've had to push (a bit) with the checking / monitoring, and yes, we felt we needed to self-admit, but I have been very pleased so far with the care we've received. We may have a private consultation today to speak with an expert in the field to better understand treatment options / implications for birth (type and timing).

Forgot to say mears is fab. She's explained loads to us.

Thank you mears.

X

May you soon be blessed with a foot in good health and an Apple Mac.

its good bloods etc coming back ok.

how many weeks is she now ?

hiya misdee ! yeah, great sign bloods coming back routinely good.

dw is 34+6 today ! She's doing well. They're guesstimating an inducation at 38 weeks (does that mean 37+0 - ie. week 38 or 38+0 through 38+6 ? I'm not sure).

probably be 38 weeks +

38+0 onwards.

they like to keep the baby in as long as possible.

hopefully she can hang in there for a few more weeks then. She (and you) will be heartily sick of the hospital by then .

I had extermely "labile" blood pressure - basically it got very high - but everytime they were about to start treating it, it dropped !
No signs of PE (lots of blood tests and 24 hours collecting of wee).

I was induced at 38 weeks - it took 3 lots of gel to get going (over about 2 days), when it did finally get going it was all over in about 12 hours. Labour pains started early afternoon, I had my waters broken and a syntocinon drip at about 9pm, baby born at about 2am.

I also had twins induced at 35 weeks (one stopped growing) - labour started with first lot of gel and was over in about 6 hours, no drip that time.

Hub2dee understand exactly how you feel about seeing different people at the hospital. When I spent 4 wks in hospital for high BP I saw various consultants and registrars none of whom wanted to make any decisions about what to do because they weren't my assigned consultant. I got fed up of explaining my symptoms and of never seeing my own consultant. I had moved house during my pregnancy and was admitted to a different hospital than the one my consultant worked at. Eventually one of the midwives got fed up of all the indecision and phoned my consultant and forced him to come to the hospital.

DW is back home !

Discharged earlier this evening.

We saw a private consultant for a second opinion / discussion session and chances are we're looking at a C/S at 37 weeks.

DW isn't too thrilled, but can see the benefits and rationale, and knows that we'll just have to see how things go.

We'll continue to keep a very close eye on BP/ bloods / urine / CTG and review the situation every few days. I am confidant the anti-hypertensive, albeit with dosage tweaking, will work well and look forward to no more late night visits to the labour ward !

So, hub2dee has only a few weeks to get everything in order. Not much mumsnetting for me then !!!!

Night, and thanks for the everyone's posts.

Dee's BP again went pretty high again last night. We had only seen the consultant that day, so I paged him and because she was asymptomatic (and he's seen blood / urine results earlier) he was happy for her just to take her pills, sleep, and see him in the morning.

Just back from that appointment and we've provisionally got a c/s at 37+2 - Next Thursday !!!!

Bit of a shocker really.

mears - if you see this, is there anything Dee and I can do to encourage milk to come in early for expressing after c/s ? Should she be doing anything in the week ahead to prepare nipples etc. ?

Also, and sorry to use your brain like a sponge of knowledge, but is it very likely the baby will need incubator / neonatal intensive care at this level of maturity ?

I understand there is an injection to encourage the maturation of the baby's lungs. Do you know if this is still requried at this age, and when it is usually administered ?

Finally, I know this sounds strange, but in your experience, what kind of things can we do to prepare for the c/s, and still make it a special birth experience IYSWIM ? (I appreciate this is major abdominal surgery, I'm not trying to jolly it up, but if Dee is scheduled for a c/s I still want the 'run up' to it to feel like a special period IYSWIM)... I was thinking a special bath to music and candles, etc. etc. some kind of scrapbooking / family tree photo album thingies etc. just wondered if any activities or mental preparation was useful...

(sorry if that last question is too weird and vague... mind is buzzing at a million miles an hour)...

(((((((((hub, dee and bean)))))))))))