If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below. |
|
|
|
Thread Tools | Display Modes |
#1
|
|||
|
|||
Checking BP/preeclampsia signs in labour
I'm wondering (possibly a bit late!) what the best thing to do is re making
checks of blood pressure and other possible signs of pre-eclampsia in labour. The background: I am apparently at somewhat higher risk than average of pre-eclampsia because of my age (37) and because I had a high hCG level in the second trimester. The latter is very much a research issue (which I wish I didn't know about, since I never consented to have the hCG level checked in the first place, but that's another story) so it's hard to say how much extra risk I have; probably not much. I'm 40 weeks pregnant today, and so far I've had no signs of pre-eclampsia whatsoever; no protein in my urine, no swelling at all, BP which when I take it with my own monitor after a leisurely breakfast is generally 10x/6y for some digits x and y; it's been creeping up very slowly from around 100/60 in the late second trimester, but this is AIUI totally normal. However, I know from a few experiments that it can come out much higher at other times of day (diastolics in the 80s, sometimes even the high 80s, and this is from only a few checks) depending on what I've been doing. In particular, I think from taking it when I had bad back pain that it goes up easily in response to pain. I'm planning a homebirth with an independent midwife. My midwife says that she would normally take my BP a couple of times in labour, more if there was any concern or it was a long labour. She is however perfectly happy for me to decline to have it checked (at all or so much) provided I understand the risks and benefits. So, that's what I want to do. I know that pre-eclampsia can, rarely, come on out of the blue in labour, and that if it does that's a very serious situation. So I do want to be checking for that somehow. But given the volatility of my BP, I am just not sure that checking my BP under stressful circumstances is really the best way to do it. The obvious alternative would be to check for protein in my urine, and only check BP if that check was positive. My midwife said this would be OK, but pointed out that it might be hard to get an uncontaminated sample of urine because of blood, amniotic fluid etc. around so one might get false positives. The other thing I'd like to understand is how big a rise in BP would have to be before it was genuinely worrying enough to transfer to hospital. One time when my midwife took my BP herself (in the afternoon, when I was in pain), it was something/80, and she got really quite twitchy about this, came back the next day to recheck etc.,; so I am not 100% convinced that she might not overreact to the kind of rise which might actually be quite normal in labour; I worry that I might end up transferring to hospital "just in case" unnecessarily. But on the other hand, I don't want to take the risk that I might underreact... I suppose the main questions a - what protocols have people encountered for checking BP and other signs of pre-eclampsia during labour? - in the absence of proteinuria, what BP would be worrying enough to be a good reason for transfer? - same question in the presence of proteinuria? - are the other signs of pre-eclampsia (epigastric pain, headaches, visual disturbances etc.) the same in labour as in pregancy? Can pre-eclampsia still show up without any of those signs? - is the wide variation (20+ points range of diastolic pressure) in my BP unusual and/or a cause for concern, or is it normal? - just how unusual is it for pre-eclampsia to show up out of the blue in labour? - is pre-eclampsia actually the only concern here, or are there other possible BP-related problems too? Any comments? Sidheag edd today! |
#2
|
|||
|
|||
Checking BP/preeclampsia signs in labour
"Sidheag McCormack" wrote in message
... I didn't have pre-eclampsia, but I did have transient gestational hypertension, so I might be able to answer some of these based on that experience. - what protocols have people encountered for checking BP and other signs of pre-eclampsia during labour? During my labor with Vernon, my BP was monitored half-hourly at the same time as the fetal heartbeat was checked. - in the absence of proteinuria, what BP would be worrying enough to be a good reason for transfer? This is practitioner-dependent. I was already in hospital, and was told their protocol would be to put me on magnesium sulfate during labor (to prevent seizures) if I had diastolics consistently in the 100s or higher. Fortunately, except for a single 103, they stayed in the 90s. Generally speaking, I would freak out if I had occasional readings during labor as high as the 170s over the upper 90s/low 100s, but systolics the 180s and/or diastolics in the high 100s/110s would definitely have me transporting if I were doing a home birth. - same question in the presence of proteinuria? Sorry, can't answer this one. That said, I never had my urine checked for protein during labor, so I'm not sure how you'd know. - are the other signs of pre-eclampsia (epigastric pain, headaches, visual disturbances etc.) the same in labour as in pregancy? Can pre-eclampsia still show up without any of those signs? No idea. - is the wide variation (20+ points range of diastolic pressure) in my BP unusual and/or a cause for concern, or is it normal? Personally, I don't think diastolics in the 80s are the *least* bit concerning for a woman in the final weeks of pregnancy, even if her diastolics were in the 60s to begin with. My understanding is that it's typical for BP to drop during the first/second trimester and then rise in the third trimester. Face it, come the third trimester, your heart has to work extra hard to get all the extra blood around the body and sustain the fetus. My diastolic BP in *all* of my pregnancies started in the 60s and gradually rose to the 80s at term. No one blinked an eye about it until my third pregnancy, when my BP was up to the 150-160/90-100 at the 35th week. I never had proteinuria, though, or any other signs of pre-eclampsia, and ended up going on for 5 weeks with these BPs without ever developing pre-eclampsia. (I was 37 at the time, FWIW.) - just how unusual is it for pre-eclampsia to show up out of the blue in labour? No idea. I should think it's quite rare (though one of our former regulars who still posts occasionally at mkb actually developed full blown eclampsia following the birth of her fourth child). - is pre-eclampsia actually the only concern here, or are there other possible BP-related problems too? Well, very high blood pressure *can* cause seizures even in the absence of pre-eclampsia, so you definitely don't want to go there. Blood pressure that's too high can also restrict the flow of blood to the placenta, so one of the things they tend to watch for in women with transient gestational hypertension is placental calcification, drops in amniotic fluid, and other signs that the baby isn't doing well. There's at least some possibility of IUGR due to hypertension during pregnancy, but when you're already at term, it's not really something to worry about. Also, some women never spill protein even when they have true pre-eclampsia, so it's fairly typical to order routine blood work to check for enzymatic signs of liver problems and other potential pre-eclampsia markers if a woman develops true high blood pressure in pregnancy. (You don't *have* true high BP yet, BTW--your readings are borderline.) All of the studies I read when I was dealing with my pregnancy-related hypertension suggested that there was *no* difference in outcomes for babies or mothers when high BP was the *only* issue. In the absence of signs of true pre-eclampsia, high blood pressure in pregnancy appears to be largely benign. It's also worth noting that studies suggest that if high BP comes on as a harbinger to full-blown pre-eclampsia, the average time it takes to progress from high BP alone to proteinuria and other signs of pre-eclampsia is 6 days. So the longer you go with high BP and *no* signs of pre-eclampsia, the less likely it appears to be that you'll actually develop it. Good luck and HTH! -- Be well, Barbara (Julian [6], Aurora [4], and Vernon's [19mo] mom) This week's special at the English Language Butcher Shop: "Together we help the future grow." -- School slogan Daddy: You're up with the chickens this morning. Aurora: No, I'm up with my dolls! All opinions expressed in this post are well-reasoned and insightful. Needless to say, they are not those of my Internet Service Provider, its other subscribers or lackeys. Anyone who says otherwise is itchin' for a fight. -- with apologies to Michael Feldman |
#3
|
|||
|
|||
Checking BP/preeclampsia signs in labour
- same question in the presence of proteinuria?
Sorry, can't answer this one. That said, I never had my urine checked for protein during labor, so I'm not sure how you'd know. and if you did it would be very inaccurate, any amniotic fluid in the urine shows up exactly the same as genuine proteinuria |
#4
|
|||
|
|||
Checking BP/preeclampsia signs in labour
On 13 Oct 2003 16:59:02 +0100, Sidheag McCormack
wrote: Any comments? Well, I had severe pre-eclampsia, and I am glad to see that you are thinking about this. However, my pre-eclampsia came on before I was in labor at 37w6d. DD was taken by c-section because she was not engaged and induction failed. Since I was delivering in a hospital, I am sure that our experiences would be different. However, I will be happy to tell you what they did to monitor my PE. I also found an excellent site with excellent information that may help with some of your questions. The main page is: http://www.preeclampsia.org/ The 2 pages that may be the most helpful a http://www.preeclampsia.org/symptoms.asp http://www.preeclampsia.org/FAQ.asp -- Daye Momma to Jayan "Boy" EDD 11 Jan 2004 See Jayan: http://jayan.topcities.com/ |
#5
|
|||
|
|||
Checking BP/preeclampsia signs in labour
Circe writes:
C I didn't have pre-eclampsia, but I did have transient gestational C hypertension, so I might be able to answer some of these based on that C experience. I was hoping you would :-) C During my labor with Vernon, my BP was monitored half-hourly at the same C time as the fetal heartbeat was checked. Yikes - but it made sense to check it so often because your BP was worrying before labour, I guess. S - in the absence of proteinuria, what BP would be worrying enough to be S a good reason for transfer? C This is practitioner-dependent. I was already in hospital, and was told C their protocol would be to put me on magnesium sulfate during labor (to C prevent seizures) if I had diastolics consistently in the 100s or C higher. Fortunately, except for a single 103, they stayed in the 90s. C Generally speaking, I would freak out if I had occasional readings C during labor as high as the 170s over the upper 90s/low 100s, but C systolics the 180s and/or diastolics in the high 100s/110s would C definitely have me transporting if I were doing a home birth. That's about what I was thinking, and it gives me quite a lot of "headroom" above even the highest figures I've ever recorded. Good. S - same question in the presence of proteinuria? C Sorry, can't answer this one. That said, I never had my urine checked C for protein during labor, so I'm not sure how you'd know. Well, I could be asking for my urine to be checked (or even checking it myself, since I have some sticks) - always understanding that a positive reading might not be information since it'd be likely to be caused by contamination, it still seems to me that a negative reading would be somewhat reassuring, especially if BP were marginal. I know that there are women who don't have proteinuria even with serious pre-eclampsia - but it all goes into the probability calculation, which might be useful if it's hard to tell whether one should be suspecting pre-e or not. C Personally, I don't think diastolics in the 80s are the *least* bit C concerning for a woman in the final weeks of pregnancy, even if her C diastolics were in the 60s to begin with. [...] (You don't *have* true C high BP yet, BTW--your readings are borderline.) I'm not really worried, I'm more worried that my midwife might get worried :-) The main thing that reassures me - though I'm not sure to what extent it should - is that I'm still getting diastolics in the 60s every day, even though at other times of day they may be in the 80s. Most of what I've read suggests that unless it's sky high (so that it's dangerous right then), "high BP" doesn't actually count as such unless it stays high consistently. (E.g. standard management of a single high BP reading always seems to be to ask the woman to rest and take it again a few hours later, and not worry unless the later reading is also high. So far, it's very clear that that protocol would always give me a low BP reading the second time round - but in labour, resting for a few hours is not really an option :-) Given readings like this morning's 98/69, I'm not inclined to think of myself as someone with even borderline high BP. But what I'm trying to get a handle on here is where the boundary between confidence and complacency is... Good luck and HTH! Thanks, and yes it does, somewhat. Sidheag edd yesterday |
#6
|
|||
|
|||
Checking BP/preeclampsia signs in labour
Anne Rogers writes:
- same question in the presence of proteinuria? Sorry, can't answer this one. That said, I never had my urine checked for protein during labor, so I'm not sure how you'd know. and if you did it would be very inaccurate, any amniotic fluid in the urine shows up exactly the same as genuine proteinuria So a + would not be very informative, true, since you wouldn't be able to tell whether it was genuine or not. Still seems to me that a - would be worth having though; it still wouldn't prove anything, because of some women having pre-e without proteinuria, but it would be a little piece of evidence decreasing the likelihood of pre-e. Sidheag edd yesterday |
#7
|
|||
|
|||
Checking BP/preeclampsia signs in labour
Daye writes:
Well, I had severe pre-eclampsia, and I am glad to see that you are thinking about this. However, my pre-eclampsia came on before I was in labor at 37w6d. DD was taken by c-section because she was not engaged and induction failed. Since I was delivering in a hospital, I am sure that our experiences would be different. However, I will be happy to tell you what they did to monitor my PE. I also found an excellent site with excellent information that may help with some of your questions. The main page is: http://www.preeclampsia.org/ It is a great site, so I've quoted the URL again. However, the questions I was asking were really the residue after I'd read all of that sort of thing I could find! Looking at Medline etc. I could really find nothing about pre-eclampsia that begins during labour, which is what I'm most interested in (the decisions about what to do if it shows up between now and labour being rather easier). Maybe it's just too rare to be easy or motivating to research, which would in itself be good news! (My midwife has seen one case of it in her career so far: clearly it was a scary experience for all concerned, though the outcome was good.) I did, however, find a study that is suggestive that the high hCG level that made us think I'm at higher than average risk may not be something I should still be concerned about at this stage - it provided some evidence that high second-trimester hCG is associated with early-onset pre-eclampsia, which clearly I don't have, rather than with late-onset pre-eclampsia. So maybe I should go back to assuming that I'm at the same risk as anyone else of my age and parity, i.e. really pretty low, having got this far with no signs. Thanks, Sidheag, as always trying to worry without being paranoid :-) 40w1d |
#8
|
|||
|
|||
Checking BP/preeclampsia signs in labour
Sidheag McCormack ...
I suppose the main questions a Hi. I didn't have pre-eclempsia but I did have high blood pressure. I can't answer all your questions but I'll share my experiences on some :-) - what protocols have people encountered for checking BP and other signs of pre-eclampsia during labour? Blood pressure checks when they checked the fetal heart rate which was about every hour....a little less often in the beginning. - in the absence of proteinuria, what BP would be worrying enough to be a good reason for transfer? I started out in the hospital so I don't know what the transfer rate would be. During the later half of my pregnancy my doctor was clear it needed to not go higher then 140/90 give or take a few points. I did manage to stay in that range. I believe it did creep up during labor but it never wildly spiked up. If there was concern about this from the doctors and nurses they never let on to me about it. - same question in the presence of proteinuria? I wasn't tested during labor but right before I was induced I think. I did have trace amounts of protein in the last month or so. I was told that trace amounts don't really mean much. - is the wide variation (20+ points range of diastolic pressure) in my BP unusual and/or a cause for concern, or is it normal? My blood pressure goes sky high with lots of internal stress or with pain. Hunter was not weaned yet when I had my first appt. My blood pressure was 160/110. STRESSS :-) I hurt by back earlier this year...it was up in that range again. Oddly enough I didn't really have that same issue with labor pain (and I did not have pain meds). - is pre-eclampsia actually the only concern here, or are there other possible BP-related problems too? I'm not really sure. I think it depends on labor management and medications you might receive. Good luck...FWIW in my totally useless opinion your blood pressure sounds fine :-) -- Nikki Mama to Hunter and Luke |
#9
|
|||
|
|||
Checking BP/preeclampsia signs in labour
Nikki writes:
Blood pressure checks when they checked the fetal heart rate which was about every hour....a little less often in the beginning. Are you sure about that? It would be usual to check the fetal heart rate more often than every hour (but if midwives are good, it's quite common for women not to particularly notice it being done). My blood pressure goes sky high with lots of internal stress or with pain. Hunter was not weaned yet when I had my first appt. My blood pressure was 160/110. STRESSS :-) I hurt by back earlier this year...it was up in that range again. Oddly enough I didn't really have that same issue with labor pain (and I did not have pain meds). That's interesting. Good luck...FWIW in my totally useless opinion your blood pressure sounds fine :-) Thanks! Your opinion is not useless at all :-) Sidheag edd yesterday |
#10
|
|||
|
|||
Checking BP/preeclampsia signs in labour
On 14 Oct 2003 12:14:19 +0100, Sidheag McCormack
wrote: I did, however, find a study that is suggestive that the high hCG level that made us think I'm at higher than average risk may not be something I should still be concerned about at this stage - it provided some evidence that high second-trimester hCG is associated with early-onset pre-eclampsia, which clearly I don't have, rather than with late-onset pre-eclampsia. So maybe I should go back to assuming that I'm at the same risk as anyone else of my age and parity, i.e. really pretty low, having got this far with no signs. Well, we're the same age, Sidheag, and the same parity, and my BP has varied between 100/60ish to 120/80ish (sometimes up, sometimes down) and no-one's mentioned that I might be at risk of pre-eclampsia. The hospital was fairly conservative about a lot of things but my BP was never a worry. The community midwives are very laid back and have mentioned that my BP does vary, but have no problems with it. I'd assume your risks are about the same as mine and not worry too much. Easy to say... -- EDD 1/11/03 37 weeks |
|
Thread Tools | |
Display Modes | |
|
|
Similar Threads | ||||
Thread | Thread Starter | Forum | Replies | Last Post |
Midwives & Home birth vs. an OB & hospital ? | LSU Grad of '89 | Pregnancy | 54 | October 12th 03 09:26 PM |
Chances of early labour? | shaz | Pregnancy | 6 | September 22nd 03 04:35 PM |
Signs of labor? | Kari | Pregnancy | 3 | September 17th 03 03:04 PM |
Did you have any indication that labour was iminent? | Alicia Elliott | Pregnancy | 14 | July 22nd 03 10:22 PM |