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).

Sorry, my dates are wrong. That should be 36+2.

Thanks huggy.

When I had mine, hub, I was assured that after 36 weeks the baby is considered full term and it was unlikely that anything would be needed in the way of special care. Of course each case is different. My milk came in without any problems after the section as well, although again each case is different.

Fingers crossed, and thinking about the three of you.

Great news WWB. Thanks for posting so soon. I'll tell Dee when she wakes up. She'll be pleased and relieved to hear that !

X

all the best fro the 3 of you, and dont forget - WE NEED TO KNOW THE NEWS FIRST!!!

Hub - will forward you an e-mail I got about antenatal colostrum expressing!!

There is a chance that bean will need to go to SCBU because of possibilty of retained fluid on lungs at that gestation. 36+2 weeks is usually fine, but with elective CS babies can be prone to TTN (transient tachypnoea of newborn). That is because there hasn't been the etimulation of labour and the squeezing out of fluid at delivery. Fear not however, because it will resolve itself.

Steroids injections for lung maturation are not used usually after 35 weeks. It won't be of any benefit.

You pre-section preparations sound really good - I have nothing else to suggest. I am not very arty - farty Will you get a theatre tour do you know pre-section?

All the best to you both
I know me and dh were both pretty stressed out at this stage of the game so I'm thinking of you both. looking forward to hearing all about your beautiful baby some time in the not too distant future

Thanks morocco !

Thank you mears. If you lived near me I'd be sending you for a massage at a nice place to thank you. You've been so helpful. X

Thanks for the SCBU comments. I may have mentioned due date by LMP was in our favour by a few days (26th July) compared with EDD by scan (2nd August), so I'm hoping bean will be fat enough and healthy enough to be fine. She certainly seems to be putting on weight very well in the last few weeks.

Yeah. the pre c/s stuff was more 'abstract' than normal bear grappling hub2dee.

Still, it's a big day, and she'll probably be very nervous, so I'll try and make everything as calm as I can.

Do your planned c/s patients usually get admitted the night before ?

I don't think there's a theatre tour, but I might call and see what's possible. I do understand the room can look mighty intimidating, full of people and equipment... Maybe even ask just to look in at the SCBU window to see the size of the babies, and the tubes, and lamps, and ventilators and all the other bits... I'd been planning to shoot some photos during birth (keen photographer) but I think Dee will require permanent arm tickles / strokes so that might be out of the question, plus, of course, it's tricky surgery, so am not sure the consultants would appreciate invasion of the papparazzi !!!

(Hope I won't bloomin' well feint either... I'm not terribly fond of RL gore )

best of luck hub2dee, dont faint.

Hub, you won't faint; if my wuss of a dh can do it, so can you. You get a nice big screen put up between you and the gory bits; you can have a look if you want to but you don't have to. You might not even be allowed to do the arm-tickling bits either; I don't know if it's standard or if they just thought I was a psycho but my arms were tied up in the air out of the way and tickling of them was very much discouraged.

And I bet you'll look very fetching in your green scrubs with your shower cap on your head and plastic bags on your feet

Stay calm; you don't want to end up with pregnancy-induced hypertension too.

can u check your email please hub.

can I ask why a c-section ?

I was induced at 35 weeks with my twins - we had the steroid injection for their lungs - no big deal - just a quick injection two days running (can't remember if I had it with DS1 - induced at 38 weeks).

They spent 1 day in special care being fed hourly because of low blood sugar, and also spent a night under uv lights at 3 days because of jaundice.

No problems with milk coming through. If she needs to express try and do it every 3 hours.

Good luck.

Yes, PIH is deffo infectious, WWB.

throck: I think the c/s is being proposed because of the extreme lability of dw's bp - which I understand you had too. The decision may be revisited depending how she responds to current meds. I understand the consultant is also considering possible / likely bp spikes during labour, or the possibility of 'fulminating pre-eclampsia' (thanks mears) too in making his decision. We are seeing him again on Friday for a scan and further chat, so it may be possible to fully assess all possibles then.

Thanks sobernow for your post too. Hoping bean has time on her side !

Hi hub2dee,

yes I had very labile blood pressure. I was never given regular medication (although was after the birth and through my second pregnancy).

I was induced at 38 weeks (took 3 lots of gel). I had a drip so that they could treat if necessary. I did have a lot of saline - can't quite remember why - think it was to help stabilise blood pressure.

I also had a syntocinon drip to speed up labour (mine sort of stalled after a couple of hours) - I hated the syntocinon - made contractions almost continuous. I had an epidural at my request (no-one suggested it before as a treatment for high BP - although they did at my second pregnancy/birth (twins)), when I was told 4cm dilated (so supposedly another 6 hours of labour at 1cm per hour which is what the drip was supposed to achieve). By the time I got it 1/2 hour later I was in transition !

No-one mentioned c-section to me ever.

Hope things go well - I think the waiting and not knowing what is going to happen is the worst - and almost worse for the DH since he is one step removed.

by the way baby was 6.5lb, and is now a healthy nearly 4 year old (birthday in mid July), due to start school in September .

We saw the consultant today and he scanned Dee too. It is great the obstetrician is also an expert sonographer.

Dee's BP is being reasonably well-controlled by the drugs, but the placenta is showing signs of slight calcification, and the baby's growth has come down from the 'mean levels', plus there is reduced amniotic fluid, so he's booked us in for a c-section next Wednesday and we are expecting a wee 5 pounder.

We hope she will be a little toughy and not require too much 'extra attention' following birth, but are aware she might.

Dee is in good spirits and I'm keeping her rested, fed and entertained !

Every day is now 'our last Friday' (or whatever) without a child !!!!!! Wow ! I'll post some pics when I get the chance.

((((((((hub, dee and beanette)))))))))

It does sobernow. Thank you.

Hiya Huggy ! Haven't had time to see how you're doing, hope everything is fab and that the meditation is a useful tool.

Hub2Dee - glad you have a definate date.... a July 2005 baby.... from a mummy of a July 2004 baby!

Cant wait to see the pics and take care of all of you x

undler msy be a bit big then

bundler

My ds was 5lb 2oz when he was born at 37 weeks, and he was fine - just very very small! no SCBU, or anything! All the best for next week and the CS. Be nice to Dee afterwards - it hurts!

my twins were 3lb 13oz and 5lb 5oz at 35 weeks - they were scbu for 1 day being fed hourly - and are now 2.5 and have never had any problems.

Good luck - and try and make the most of the next few days - lots of rest !