how high of bp is too high?
 

Okay, so with my rising bps I am wondering how high is too high, and at

what level should I definitely just go deliver rather than arguing with

anybody about waiting longer? I think I have both pre-existing
hypertension that was helped with the aldomet, and then PIH which is
making my bp creep higher and higher. My platelets have also dropped
some, but I have a platelet disorder, so not necessarily a sign of
pre-e. I do get hand and foot swelling, but no protein in urine or
other laboratory signs of pre-e.


Just now in the peace and quiet of my own home my bp was 150/100 at
35.5 weeks pg. It is a bit scary, so my initial desire not to be
induced is wavering, and now I am not sure how much I would fight to
not be induced after 37 weeks, and especially after 38 weeks, assuming
that my bp will continue to rise before then.


I'm also already taking a load of herbal bp remedies too.


KC

wrote in message
oups.com...
Okay, so with my rising bps I am wondering how high is too high, and at

what level should I definitely just go deliver rather than arguing with

anybody about waiting longer? I think I have both pre-existing
hypertension that was helped with the aldomet, and then PIH which is
making my bp creep higher and higher. My platelets have also dropped
some, but I have a platelet disorder, so not necessarily a sign of
pre-e. I do get hand and foot swelling, but no protein in urine or
other laboratory signs of pre-e.


Just now in the peace and quiet of my own home my bp was 150/100 at
35.5 weeks pg. It is a bit scary, so my initial desire not to be
induced is wavering, and now I am not sure how much I would fight to
not be induced after 37 weeks, and especially after 38 weeks, assuming
that my bp will continue to rise before then.


I'm also already taking a load of herbal bp remedies too.

150/100 isn't induction level for the perinatal center I went through,
although if it's continually that high, more or different medication may be
indicated. They only induce if there are other symptoms of damage in the
mother or if the baby is showing signs of compromise. Have they done a BPP
to check on fetal oxygen flow and growth?

FWIW, when I went into L&D at 35 weeks in this last pregnancy, my BP was
180/105, and they still weren't talking induction, until they discovered
that I was contracting every 5 minutes, at which point, it was decided the
baby was telling us it was time.

wrote in message
oups.com...
Just now in the peace and quiet of my own home my bp was 150/100 at
35.5 weeks pg. It is a bit scary, so my initial desire not to be
induced is wavering, and now I am not sure how much I would fight to
not be induced after 37 weeks, and especially after 38 weeks, assuming
that my bp will continue to rise before then.

I ran in the 150s-160s/90s-100s pretty consistently from 35 weeks until I
consented to induction (by AROM only) at 40w2d. After my son was born, the
midwife examined my placenta and admitted that it showed no signs of
hypertension and that I could have safely continued the pregnancy for quite
a bit longer. I'm not really sorry I had the induction--it turned out well
and I avoided pitocin and monitoring--but if I'd known then what I know now
(I was at 5cm when I checked in and I think I'd have gone on my own within
the next couple of days), I might have put it off a little longer.

FWIW, it's diastolic numbers up into and over the 100s that start getting
people freaked out. From what I understand, however, seizures and eclampsia
aren't particularly common until you get up into the 110s.

In your shoes, as long as there are no signs of pre-eclampsia and the baby's
biophysical profiles are looking good, I'd hold off until spontaneous labor
or until my BP was hitting the 160s/mid-100s consistently. At that point,
I'd agree to induction, but I'd certainly try AROM alone first. In a multip
like you, AROM has a good chance of being successful. (In my case, it put me
into labor within 5 minutes.)

Good luck and HTH!
--
Be well, Barbara
Mom to Mr. Congeniality (7), the Diva (5) and the Race Car Fanatic (3)

I have PMS and ESP...I'm the bitch who knows everything! (T-shirt slogan)

Donna Metler wrote:
wrote in message
oups.com...
Okay, so with my rising bps I am wondering how high is too high,
and at

what level should I definitely just go deliver rather than arguing
with

anybody about waiting longer? I think I have both pre-existing
hypertension that was helped with the aldomet, and then PIH which
is
making my bp creep higher and higher. My platelets have also
dropped
some, but I have a platelet disorder, so not necessarily a sign of
pre-e. I do get hand and foot swelling, but no protein in urine or
other laboratory signs of pre-e.

So long as they continue to monitor you closely (and you continue to
monitor *yourself* closely) for those other signs. :-) I admit to
being a worrywart, though for good reason I think. The biggest concern
in your situation, I would think, would be that if things go downhill
rapidly, the standard solution is to get the baby out *now*, especially
since the situation can continue to worsen postpartum for some time --
and the platelets make a C-section a difficulty. On the plus side,
they'd have to be really serious about it to section you. :-)

I would not be terribly comfortable waiting much past a sustained
160/110 but I am not a doctor and only play one when I read Medline.
If your doctors are following along and aren't concerned, then unless
*you* have reason to become concerned other than that you have been
reading horror stories, like that your face is swelling and you haven't
peed for 6 hours, I would guess that they are convinced you are falling
within safe parameters.

150/100 isn't induction level for the perinatal center I went
through,
although if it's continually that high, more or different medication
may be
indicated. They only induce if there are other symptoms of damage in
the
mother or if the baby is showing signs of compromise. Have they done
a BPP
to check on fetal oxygen flow and growth?

Also, for monitoring your own situation at home, I'd watch for bubbles
after urinating (when you spill protein, the surface tension of your
urine changes) and for general agitation (a sign of hyperreflexia,
which can sometimes lead eclampsia.) Of course you should also do kick
counts.

FWIW, I was 220/116, which convinced OB triage people that they needed
to go get some more bp monitors because that one must have been broken.
But I did *not* just have high bp, but also just about every clinical
symptom of PE, all of which had spiked in the past week. (I'd had an
appointment with my midwife one week prior, at which point I'd a bp of
130/80 and trace protein on a dipstick and dependent swelling in the
ankles.)

--
C, mama to two year old nursling

writes:
: Okay, so with my rising bps I am wondering how high is too high, and at

: what level should I definitely just go deliver rather than arguing with

: anybody about waiting longer? I think I have both pre-existing
: hypertension that was helped with the aldomet, and then PIH which is
: making my bp creep higher and higher. My platelets have also dropped
: some, but I have a platelet disorder, so not necessarily a sign of
: pre-e. I do get hand and foot swelling, but no protein in urine or
: other laboratory signs of pre-e.


: Just now in the peace and quiet of my own home my bp was 150/100 at
: 35.5 weeks pg. It is a bit scary, so my initial desire not to be
: induced is wavering, and now I am not sure how much I would fight to
: not be induced after 37 weeks, and especially after 38 weeks, assuming
: that my bp will continue to rise before then.


: I'm also already taking a load of herbal bp remedies too.


: KC

OK. I posted some advice on another thread you wrote about BP,
but I forgot to include our URL:
http://home.comcast.net/~l.mcmahan/

I don't think the 150 is too bad, but the 100 is a bit worrysome.
Would that you get it under 90 and preferably to 80. Be sure
and try my suggestions about a quart of RRL per day, and the other
things. Oh, and I forgot the garlic and calcium supplements.

Be sure and read the stuff we did. Your BP is no worse than
Monika's was with Niel, and we successfully homebirthed.

Larry

Thanks Larry. I did read your site before and have started alot of
things on it. I seem opposite of Monika though in that I find the hops
and valerian to make more of a difference than the RRL tea. I don't
think the under 80 is gonna happen until this pg is over, but my
diastolic level does go down to 90 sometimes. The herbs definitely
make a difference. I am pretty sure I would be over 160/100 now
without them.

KC

Circe wrote:
FWIW, it's diastolic numbers up into and over the 100s that start
getting
people freaked out. From what I understand, however, seizures and
eclampsia
aren't particularly common until you get up into the 110s.

In your shoes, as long as there are no signs of pre-eclampsia and the
baby's
biophysical profiles are looking good, I'd hold off until spontaneous
labor
or until my BP was hitting the 160s/mid-100s consistently. At that
point,
I'd agree to induction, but I'd certainly try AROM alone first. In a
multip
like you, AROM has a good chance of being successful. (In my case, it
put me
into labor within 5 minutes.)


Thanks that is very helpful advice.

KC

wrote:
Donna Metler wrote:

So long as they continue to monitor you closely (and you continue to
monitor *yourself* closely) for those other signs. :-) I admit to
being a worrywart, though for good reason I think. The biggest
concern
in your situation, I would think, would be that if things go downhill
rapidly, the standard solution is to get the baby out *now*,
especially
since the situation can continue to worsen postpartum for some time
--
and the platelets make a C-section a difficulty. On the plus side,
they'd have to be really serious about it to section you. :-)

I would not be terribly comfortable waiting much past a sustained
160/110 but I am not a doctor and only play one when I read Medline.
If your doctors are following along and aren't concerned, then unless
*you* have reason to become concerned other than that you have been
reading horror stories, like that your face is swelling and you
haven't
peed for 6 hours, I would guess that they are convinced you are
falling
within safe parameters.



Those sound like good numbers for me to not want to exceed, thanks. My
doctors aren't overly concerned right now, but are talking 38 week
induction, and that is what I don't want to do if I can avoid it.

Thanks,

KC

Donna Metler wrote:
150/100 isn't induction level for the perinatal center I went
through,
although if it's continually that high, more or different medication
may be
indicated. They only induce if there are other symptoms of damage in
the
mother or if the baby is showing signs of compromise. Have they done
a BPP
to check on fetal oxygen flow and growth?

Yes, they have tested me and the baby alot. No signs of problems
except swelling and bp.

KC

In article .com,
wrote:

Okay, so with my rising bps I am wondering how high is too high, and at

what level should I definitely just go deliver rather than arguing with

anybody about waiting longer? I think I have both pre-existing
hypertension that was helped with the aldomet, and then PIH which is
making my bp creep higher and higher. My platelets have also dropped
some, but I have a platelet disorder, so not necessarily a sign of
pre-e. I do get hand and foot swelling, but no protein in urine or
other laboratory signs of pre-e.

OK, the lab signs of PE do NOT include swelling, and in Australia, proteinuria
is not a *required* symptom. Here's our list:

A *clinical* diagnosis of pre-eclampsia can be made when the following
criteria are fulfilled:
Hypertension arising after 20 weeks gestation and the new onset after 20 weeks
gestation of one
or more of:
* Proteinuria - 300 mg/24h or spot urine protein/creatinine ratio 30 mg/mmol
* Renal insufficiency * serum/plasma creatinine 0.09 mmol/L or oliguria
* Liver disease * raised serum transaminases and/or severe epigastric/right
upper quadrant pain
* Neurological problems * convulsions (eclampsia); hyperreflexia with clonus;
severe headaches with hyperreflexia; persistent visual disturbances (scotomata)
* Haematological disturbances * thrombocytopenia; disseminated intravascular
coagulation; haemolysis
* Fetal growth restriction

The BP cutoffs for *acute* antihypertensive treatment are given as 170
systolic and/or 110 diastolic.

General indications for delivery a
* pre-eclampsia occurring at term (37 weeks)
* inability to control blood pressure despite adequate hypertensive therapy
* deteriorating liver function
* deteriorating renal function
* progressive thrombocytopenia
* neurological complications or imminent eclampsia
* placental abruption
* concern regarding fetal welfare

I can see 3 reasons you are likely to be encouraged to have an induction.

Just a comment about your platelet disorder: your Drs will probably err on
the side of caution and interpret progressive thrombocytopenia as a PE
symptom, rather than as a symptom of your disorder. Not that low platelets
are a good thing to have at term, whatever the cause...

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"In Melbourne there is plenty of vigour and eagerness, but there is
nothing worth being eager or vigorous about."
Francis Adams, The Australians, 1893.