June 22, 2009

blah, blah, blah, pregnancy induced hypertension, blah, blah, blah

A long post that will really only be compelling to those interested in pregnancy induced hypertension or the general category of scary pregnancy stories: abbreviated version - things are fine.

Had a good OB appointment on Friday. My BP was up ever so slightly (hopefully just because I was late and raced up the stairs to the office). But it gave me a chance to ask some questions--and I actually got some good answers!

I don't know if I ever accurately reflected how stressful the hypertension issue was last time. I originally made my blog public with friends and family who knew we were doing IVF as a way of letting them know what was going on without having to ask questions that might have been difficult (or me having to give difficult answers, particularly when I didn't feel like talking about bad news). I didn't want to scare anyone too much and those of you to whom the pregnancy-induced hypertension issue is important already knew enough to be scared for me. It's also just my nature to be weirdly level and pragmatic about things I can't control, so I tended to share key details but might not have really expressed the sense that we were always right on the edge of a dire situation.

I'd actually been dealing with hypertension for five or six weeks last time before I thought much of it myself. I was admitted to the hospital for monitoring several times, during which my BP would always eventually drop, usually after two hours or so of lying still connected to the monitors. It never rose much above the danger mark of 150/90 and I never had any other signs of preeclampsia, so it didn't set off major alarms with my OB.

But when I went to the MFM at 32 weeks it was another story. The IUGR was detected, and I started to learn about all the risks facing growth restricted babies (including stillbirth and motor and neurological disabilities). This was a big shock since all the time I'd been monitored for hypertension by the OB, I was repeatedly told the baby was very healthy. She looked great on the monitors but the fact was her growth had slowed and dropped from the normal curve. It is possible that small babies just run in my family (I was about five pounds) but IUGR was consistent with the drop off in development at a late stage after hypertension had set in, and finally with the terrible condition of the placenta at delivery - very small, fragmented, and calcified. The connection to hypertension is that the blood doesn't flow well to the placenta and so the baby doesn't have as much nourishment as it should.

The worst part was in the final weeks before I was induced - I hadn't expected so much of that decision to fall on me. I thought there would be some sort of medical standard for assessing the risk/benefit trade-off, but because the MFM and the OB have different ideas about how much risk to tolerate, it all culminated in a conversation with me stretched on a gurney in the hospital, my OB explaining the risks of underdeveloped lungs, and asking me if I wanted to go through with the induction. I decided to trust the MFM, who I adore, and who had said to me "I just really think this baby is going to thrive when we get her out of there." And of course she did.

Anyway, all of that is a long way of explaining why I'm a bit hung up in trying to understand this whole hypertension thing this time around. Of course my main focus has been on whether there's anything that I or the medical team can do to prevent a repeat performance. My primary OB said to me at the first appointment: "Basically the only way to be sure this won't happen again is to not get pregnant. That's not to say you shouldn't get pregnant, but the fact is this is your body's response to pregnancy, and its not your fault and not something you can necessarily control." But the interesting fact I learned on Friday is that pregnancy-induced hypertension only repeats in a second pregnancy about 15% of the time. Now of course I have found myself on the short side of the odds before, but that's still nice to know.

My normal BP is in the one-teens. I think it was 112/75 at my first OB appointment this time. It was at 126/something at the second and 130-something/80 at this latest appointment. All of these are very much in the normal healthy range, but the fact is they are higher than normal for me and they seem to be creeping up. So I asked about medication. This was another tricky thing last time, some docs thought I should medicate, others disagreed, saying we didn't want to "shock" the baby by suddenly dropping my BP, afterall, the baby appeared to be thriving in the high BP conditions until we saw the IUGR in the final weeks. So I had wondered if it would be wise to start medication earlier this time, at the first sign that BP was increasing, to maybe somehow head it off before it was so high. I've asked this question before and keep getting answers like "We just have to keep a close eye on it and see," but this time I got a clear answer: no. We don't want to medicate unless we absolutely HAVE to because there are some risks with medication. We need to keep monitoring it, but the hope is that I will be in the 85% who don't have to go two rounds. I am to stay well hydrated, watch my salt, and not get overly worked up about it. Which all sounds good to me.


Sarah Beth said...

I just wanted to leave a comment and tell you I will be watching and rooting for you that you are in the 85% that don't get it again. I had a baby in Aug 2007 he was born at 35 weeks, and was only 3 lbs 4 oz. He had severe IUGR, I had HELLP syndrome. All of this was completely undiagnosed until I was in the OR having a C-section basically. Anyways... blah blah my way of saying that we are contemplating #2, and the stress of just the contemplation for us has been enormous, add to that the difficulty with infertility and m/c that I have, and it is definitely a trip! I have found it frusterating that there is very little info about IUGR and reoccurance/prevention etc.

Oh... my "little guy" will be 2 in about a month is is 28 lbs and healthy as can be now. We are blessed!

Good luck to you and baby #2!!!!

Artblog said...

Hope it stays down until they can induce youa again, must be a worry though!


Kate said...

Ack! The title got me worried, but I am glad it is all OK. It's good to have those questions answered. I am glad you are having more visits with MFM now, too. When is the next one?

So glad to know the low odds. I had no issues with PIH with Child, but definitely so with Baby. I wonder if the stats work in reverse--in other words, was there a 15% chance that I would develop PIH the second time if there wasn't any the first time?

Glad you have easy nonmedicated answer for the time being--and hopefully for the remaining four/three (?) months. Thinking of you!

Red said...

You just taught me a bit about a subject I had no knowledge of.

I hope your blodo pressure stays down and you don't have to use this information yourself again.

Best of luck.

mekate said...

Hi sweet Sarah,
here's wishing on you no added excitement of elevated blood pressure or constricted anythings.

So glad the stats are in your favor. I want everything to be just perfectly fine for you this time around.
I am glad you are watching and they are watching, and you are all being vigilant. And how great if you can just skip having to deal with it all.

Thinking of you and wishing you calm good things,

Prairie said...

Don't think too much about it because it is in the big guys hands...of course, stay away from all the bad stuff...I had cravings for salt, pizza and salt-covered pretzels for some reason...what I would do different if given the opportunity a second time around...I did so much right, but then I think of the pizza and pretzels...certainly didn't help. Anyway, just keep a positive attitude and pay attention to doctors orders...and I'll be checking back to see how things are going. Good luck with baby #2.

Prairie said...

oh and did I mention that I was with the wrong man too? :)

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