I’ve had a lot of questions in the past several days, so I thought I’d try to give a brief summary of preeclampsia for those who are interested.
Preeclampsia has two major diagnostic criterion – high blood pressure combined with protein in the urine after 20 weeks of pregnancy. For a diagnosis of preeclampsia, there need to be two measurements of blood pressure at least four hours apart where either the top (systolic) or bottom (diastolic) numbers are greater than 140/90. There are several other warning signs that preeclampsia might be on its way or present (large weight gains in the course of a day or week, lots of swelling in legs, intractable headaches, visual disturbances, severe pain in the upper right side of the belly) but those are not diagnostic like blood pressure and urine protein.
When I went for my prenatal appointment this past week, I wanted to talk with my doctor about preeclampsia because my morning blood pressures had been rising and because I had some of those other warning signs – I was gaining 2-6 lbs of fluid daily (although mostly losing it overnight), had developed pretty severe carpal tunnel (caused by fluid retention in my wrists), and was having painful swelling in my legs and feet as each day progressed.
In light of this, we did labs (including a test for urine protein) despite my blood pressure falling under the 140/90 threshold for a diagnosis of preeclampsia. I had protein spilling into my urine – and, at my appointment the next day, my blood pressure was over the line. This is when we arranged for me to have 24 hours of monitoring in hospital. Note that I didn’t yet have an official diagnosis of preeclampsia because I hadn’t had two blood pressures (taken at least four hours apart) “over the line”.
While hospitalized, I received a couple of steroid shots that will help mature baby’s lungs in case early delivery is required. Otherwise, I sat or laid around in bed between blood pressure checks, which occurred every 2 hours.
Of the 18 blood pressure checks I had in the hospital, five were at or above the 140/90 line that fits the diagnostic criterion for preeclampsia – the rest were in what, in non-pregnant folks, we call the pre-hypertensive range (top number between 120 and 140, bottom number between 80 and 90.) Prehypertensive blood pressures aren’t normal or healthy – they’re a sign to start taking care – but they’re not a sign of imminent danger either. If you showed up at your doctor’s office routinely with pre-hypertensive blood pressures, your doctor probably wouldn’t start you on medicine, but they might schedule you an appointment with a dietitian who can help you develop eating habits that are known to be helpful with managing blood pressure (both the Dash diet and the Mediterranean-style diet have good evidence for blood pressure control). Your doctor would likely also encourage regular physical activity and, if indicated, weight loss.
Given that my blood pressures were right there on the line during my hospitalization, I returned home yesterday afternoon. I will continue at home with outpatient monitoring at present.
As far as monitoring goes, there are three main potential indicators that I need to head back to the hospital and/or have the baby right away.
First, baby could stop growing or be in distress because of what’s going on with me. To make sure this isn’t the case, we will do weekly biophysical profiles which use ultrasound to measure baby’s growth, activity, and amniotic fluid.
Second, my blood pressure could rise to severe levels – greater than 160/110. I will continue to monitor my blood pressure at home at least once daily and I will go into the doctor twice a week to have in-office monitoring. (Louis had to be delivered at 34 weeks, 3 days when my blood pressure rose persistently into the severe range.)
Finally, other organs in my body could be affected (additional kidney problems, liver problems, blood cell abnormalities) which would be an indication for delivery – Tirzah Mae was born at 32 weeks, 1 day when my liver enzymes and blood cells indicated multiple organ involvement. I will have weekly labs to monitor for this last potential indication for delivery.
But, unlike during my pregnancies with Tirzah Mae or Louis, we have caught the preeclampsia while the majority of my blood pressures are NOT in the preeclamptic range. This makes outpatient monitoring a possibility and makes our likelihood of delaying delivery until the c-section we were otherwise planning for 36-37 weeks much higher than it was with either of our first two children.
So we are feeling fairly optimistic about the prospect of staying pregnant longer and maybe even avoiding a NICU stay this time around.
We do appreciate your ongoing prayers – we know things can still change pretty rapidly in this game and that we need to be ready for anything. We also want our children to be able to enjoy as normal a life as possible while we wait for the new baby to arrive while at the same time not hastening baby’s arrival – so we will need lots of wisdom as to what I should and should not be doing and how to truly love and wisely parent all five of our little ones as we wait.
Daniel could also use additional prayer as much of the added burden of parenting, meal preparation, and homemaking falls on him – and all this in the midst of a fairly busy season at his day job.
I got to looking at my old blood pressures to give an idea of the differences between my first twenty four hours of hospitalization with each case of preeclampsia.
|Total BP readings||42||36||18|
|Normal BP readings (<120/80)||0 (0%)||0 (0%)||1 (6%)|
|Pre-hypertensive BP readings (120-139/80-89)||12 (29%)||5 (14%)||12 (67%)|
|Preeclampsia BP readings (140-159/90-109)||20 (48%)||29 (81%)||4 (22%)|
|Severe preeclampsia BP readings (>160/110)||10 (24%)||2 (6%)||1 (6%)|
A few notes: I had a lot more blood pressures taken with the first two pregnancies because each high blood pressure generally triggered a follow up after I’d had a chance to sit quietly for a while, in hopes that it would come down a little with extra rest. With Tirzah Mae, I was on IV magnesium sulfate for the first 24 hours of hospitalization to prevent seizures and lower blood pressure. Even with this intervention and no movement whatsoever, my blood pressure was still above the line (orange or red) 70% of the time. Contrast this with this pregnancy, where I received no medication and had no enforced restrictions (although I did mostly sit or lie down when I wasn’t getting up to use the restroom) and had blood pressures below the line (yellow or green) >70% of the time. The one “severe” blood pressure this time around was from when I was telling an animated story while my blood pressure was being taken (that’s a no-no – you’re not supposed to talk while your blood pressure is being taken.) A second pressure taken 5 minutes later when I wasn’t talking was at the low end of the hypertensive range.
Of course, I should add the caveat that I am not a medical doctor and cannot diagnose or treat any disease. I speak as a mother who has experienced preeclampsia three times, twice with severe features necessitating preterm delivery. If you have or suspect that you have preeclampsia, please contact your maternity provider so an individualized treatment plan can be made that takes into account your unique medical considerations.