pre-e ladies - question regarding 24 hr urine collection

LittleDucky

They've been monitoring me for PIH/pre-e for the past week and a half and I just found out that my 24 hour urine that I turned in last Thursday was 400 something, which I know is not good.  I turned it in to the hospital when I went for one of my twice-weekly NSTs and they told me the results today when I was back for another NST.  My urine dip today was negative though - not even trace protein.  My other labs looked okay and my BP is okay as long as I'm lying down but goes up when I'm sitting up.

 I'd love to keep this little guy cooking for a few more weeks, but I'm nervous that they are going to start talking about delivering early, especially because I have a pre-existing chronic condition that makes my platelets low.  I'm on steroids to try to get my platelets up but I'm nervous that if I end up with pre-e my platelets will drop regardless of the steroids.  On the one hand I know that it is best to keep LO baking, but on the other hand I will be so relieved once I know he is safely out and my health problems can be resolved, so I am definitely conflicted.

I see my OB tomorrow so I will talk to her about all my various tests then, but I have a feeling that I am looking at a preeclampsia diagnosis soon.  How high was your 24-hr urine when you were diagnosed?  Or how high did it get w/o you being diagnosed with pre-e?  Thanks ladies.

 

MSUMamaof2

My 24 hour urine that earned me my pre-e diagnosis was in the 500s.  Anything over 300 with a BP 140/90 for 2 hours is considered pre-e, from what I understand.   

The highest 24 hour urine I had with my second son (no pre-e) was conducted at about 35 weeks.  It was in the mid 200s.  That's as high as it got during my second pregnancy.  I did have high blood pressure with #2, but because my protein never rose to the 300s, I wasn't diagnosed with pre-e.  They had me on a modified bed rest just in case, however.  

I would be relying on the 24 hour sample, not your drops at the OBs office.  But they know that.  

LittleDucky

MSUMamaof2:

My 24 hour urine that earned me my pre-e diagnosis was in the 500s.  Anything over 300 with a BP 140/90 for 2 hours is considered pre-e, from what I understand.   

The highest 24 hour urine I had with my second son (no pre-e) was conducted at about 35 weeks.  It was in the mid 200s.  That's as high as it got during my second pregnancy.  I did have high blood pressure with #2, but because my protein never rose to the 300s, I wasn't diagnosed with pre-e.  They had me on a modified bed rest just in case, however.  

I would be relying on the 24 hour sample, not your drops at the OBs office.  But they know that.  

Do you mean your BP has to stay above 140/90 for 2 hours?  My BP has been above 140/90 when I'm sitting up, but it always goes way, way down once I lie down (like to 110-125/60-75).  I guess we'll see what the OB says tomorrow.  Honestly, whatever they want to call it is not that important (pre-e, PIH, etc) as long as I know they are monitoring me and the baby closely and making sure we are both safe.

Halo79RN

*justducky*:

Do you mean your BP has to stay above 140/90 for 2 hours?  My BP has been above 140/90 when I'm sitting up, but it always goes way, way down once I lie down (like to 110-125/60-75).  I guess we'll see what the OB says tomorrow.  Honestly, whatever they want to call it is not that important (pre-e, PIH, etc) as long as I know they are monitoring me and the baby closely and making sure we are both safe.

they need two separate readings >140/90 taken at least 6hrs apart.    I would consider it as a high reading if you're sitting up and get it.

with my dd... my dipsticks never showed any reason to worry.. it was none or trace.  my b/p started staying up at around 31-32wks.  when they did the 24hr at 35wks it was 1050, I was 2+ by dipstick the day I got the results... the next one later that week was 1350... when I got those results I was scheduled for induction the next morning. then 4+ by dipstick the morning of the start of my induction.  my b/p got up to 150s/120s (baseline was 90/60).  

I would think with your preexisting condition they'd be concerned about HELLP and/or DIC  and will be watching you blood labs closely.    I'd record any pressures you take, times and position (but don't go nutty checking it) and any questionable symptoms.  watch for the right sided pain or sudden mid upper gastric pain/mid back pain... headaches... feeling crazy or talking crazy (tell so)... I felt like a mad person when I had pree... just an anxiety feeling like I've never felt other than when in Pree (even prior to the diagnoses)... with my second, I  knew my pressure was up b/c I felt crazy and my nose started bleeding.  

 

rest. drink fluids. take care of yourself.  good luck. safe and healthy delivery to you and your peanut.  

austenreader85

I don't have pre-e, but I do have PIH.  Let me tell you, I have been paranoid about pre-e for over a month now when I started having some extreme swelling and then headaches and finally the high bp.

They will definitely prefer to go by the 24 hour collection compared to the office dipstick, that's the whole reason for that way of testing.  My bp responds a little bit to rest.  It is lower when I am resting on my left side (most of the time at least) than even if I've been resting and then sit up to test.  So they put me on modified bed rest.  This evening I actually had to heat up some soup because DH ran out of time before going into work and I could feel that even spike it up.  If they don't suggest bed rest, I'd mention it to them.  Having elevated bp is bad for LO as it can cut off blood supply to the placenta which decreases oxygen and food supply via the umbellical cord to him.

Watch for other symptoms such as headaches, dizziness, visual disturbances etc.  My headaches were just dull and I wouldn't even notice them most of the time and didn't mention it for over a week.  It dawned on me all of a sudden that it had never really gone away and it had been a week, even though it wasn't terribly painful (at the time).  Upper gastric pain would also indicate complications such as HELLP syndrome.  Which with your low platelet levels I'm sure they'll want to check fairly often.  They've been doing labwork on me weekly for the last several weeks.

And I have to disagree.  I think it does matter what they call it.  Well, as long as they call it something.  I just found out today (after being concerned for weeks because I'm a wussy and didn't mention it earlier) that my OBs' hands are tied on inducing or c-sections in under 39 weeks.  If I developed pre-e, yes definitely necessary immediately.  PIH, has to wait until 39 weeks.  Not that I'm happy about that either.  I've read PIH should still be taken seriously and I was so annoyed to hear that I'd still have to wait it out even though I know it's not good for LO. And my bp has been very high at some points (160/110) but without the proteinuria, no pre-e and therefore LO and I have to wait it out.  If they diagnose you with PIH instead of pre-e (which is doubtful since you clearly have the proteinuria) make sure they stay on top of testing you, it can quickly change to pre-e and you wouldn't notice a big change in symptoms.

E&RMommy

Just a clarification.  PIH is old school terminology.  Gestational hypertension is BP > 140/90 after 20 weeks without proteinuria.  Pre-E is htn after 20 weeks with proteinuria.  While someone might have only gestational hypertension and not be spilling protein, if their BPs are severe range then most would argue to treat it as pre-e and deliver at 37 weeks.  In fact, 25% of patients with gestational hypertension actually have undiagnosed pre-eclampsia.

To the OP, your 24 hour urine is much more accurate than a dipstick (that's why they even bother doing a 24 hour urine collection in the first place).  You have to spill 5000 mg of protein in a 24 hour period to be classified as severe pre-e (or have symptoms). 

Just rest, rest, rest and hopefully they will keep your lilttle one cooking!!

LittleDucky

Thanks ladies for all of your responses.  Based on the diagnostic criteria (BP 140/90 and protein over 300 in a 24hr urine collection), it looks like I am going to walk away from my OB appointment with a pre-e diagnosis.  I'm not sure what will change since I'm already on bedrest and having twice a week NSTs and weekly OB appts.

Like I said in my original post, my biggest concern is that my platelets will drop from the pre-e, and since I already have low platelets from my blood disorder (ITP - it's an autoimmune disorder) this could be dangerous.  I'm going to talk to my OB about this today.  My platelet count pre-pregnancy ranged between 50-80 (normal is 150-400) but never caused any problems.  During pregnancy my count was 50-60 and was 55 last week when they started me on steroids to get my count up.  After 5 days on steroids my count was up to 81 from 55, so that is good!  I just hope that the steroids can keep working for a week or two to get my counts over 100, which is the magic number where an epidural/spinal is safe.  This is particularly important because if I ended up with a c-section, if my count is under 100, I would need general anesthesia - no thank you!  I just don't want to be on the steroids and have the steroids be working and then have pre-e drop them back down again.  I think if it was just pre-e and I didn't have the ITP issue they'd be willing to just watch closely and keep me on bedrest longer, but because of these two different complications they might want to induce sooner rather than later.

At my OB appointment last week I said something about how I'd like to make it to at least 37 weeks, but the OB said "well, let's just get your platelet count up and go from there," so we'll see what she says today... wish me luck ladies!

mrsbnlmel

My symptoms were exactly like yours at 34 weeks. My pressures were much better lying down, but high when up, protein in my 24 collection but trace with a dipstick, etc. 

What might change at your OB appointment? I would be prepared to be admitted to L&D for bed rest at the least.  I was hypertensive for a couple of months and on strict at home, but as soon as I had protein, I was in the hospital. We still hoped I would make it to 37 weeks, but they wanted me hospital just in case something changed. 3 days later things got severe really fast and I had a baby! I was really glad to already be there.

Good luck with everything! 

LittleDucky

mrsbnlmel:

My symptoms were exactly like yours at 34 weeks. My pressures were much better lying down, but high when up, protein in my 24 collection but trace with a dipstick, etc. 

What might change at your OB appointment? I would be prepared to be admitted to L&D for bed rest at the least.  I was hypertensive for a couple of months and on strict at home, but as soon as I had protein, I was in the hospital. We still hoped I would make it to 37 weeks, but they wanted me hospital just in case something changed. 3 days later things got severe really fast and I had a baby! I was really glad to already be there.

Good luck with everything! 

Thankfully they don't think I need to be in the  hospital at this point at least.  I'm much more comfortable being on my own at home so I'm glad they feel like the preeclampsia can be managed outside of the hospital.  Still on bedrest, still allowed to get up to eat and shower and things, but I'm lying down probably 22 hours a day.  My OB said best case scenario I'll make it to 38 weeks (2 weeks from Friday) but she does not think I will go past then, and it could be much sooner.  I'm still having twice weekly NSTs and once weekly fluid monitoring.  

My hematologist also upped my steroid dose to try to further increase my platelets.  The side effects from the steroids are no fun (crazy insomnia, psychological side effects, extra water retention, ugh!) so hopefully it works.  I'll also have to taper off of the steroids after delivery to prevent steroid withdrawal, so I'll be on these for a while... ugh.  It would be so nice to have a nice uncomplicated pregnancy with no underlying health concerns!

mrsbnlmel

I'm glad you get to be home too! It can be terrible to be trapped in a hospital. I hear you on the uncomplicated pregnancy! People have no idea how great they have it. 

mzpink3

My 24 hr urine was 600's or so, BUT every visit I do not show protein not even trace and my BP seems to jump from 127/70 to as high as 159/96 and I have not been delivered yet, no headaches, spots etc. I am on meds to keep my bp low and last week my OB has me on weekly visits already and now a nurse to set a BP monitor at home and dip sticks to take my protein. I have been induced because of PIH/pre e before once at 34 weeks and the other at 36 and neither time has my child stayed in the NICU and we were both discharged in 2-3 days which is pretty normal. I say just dont panic and let it your OB do whats best for you. If you worry it will only make your bp high. I dont know how many weeks you are but tomorrow share your concerns, it still sounds too early to decide anything now. I was "diagnoised" at 31 weeks and I am her to 34 now and my LO is still cooking. Good Luck (keep us posted, sorry so long)