The Difference Between A Hunch And A Diagnosis
09.03.10: A look at preeclampsia
Wendy is 36 weeks pregnant with her third baby. She writes that she’s had a perfectly normal pregnancy with no excess weight gain, no nausea, “nada.” At her doctor’s office last week though, her blood pressure was a little elevated. Wendy says it was “140 over something normal” and then, after she rested in the office a bit, was “130 over something normal.” At another appointment a few days later her BP was “140 over something normal,” but this time there was a little protein in her urine.
Her doctor told her she might have toxemia (another name for preeclampsia or pregnancy induced hypertension) and he was thinking about doing a c-section. He ordered an ultrasound to make sure the baby was developed enough for delivery. Wendy says, “the baby looked perfect and was making breathing movements on the ultrasound so her lungs are fully developed.” Wendy doesn’t want another c-section (her first was a c-section, her second a VBAC) and wonders if she should be induced instead.
Wendy, there’s not enough information here to know whether or not you need a c-section or induction. What I can tell you is:
- A little more information about blood pressure,
- How preeclampsia is diagnosed,
- What it really takes to tell if your baby’s lungs are developed,
- How other doctors would probably deal with this.
A word about blood pressure: It involves two numbers. The first number, called the systolic pressure (in Wendy’s case, 140 and 130) is the pressure in the arteries when the heart contracts. The second number is called the diastolic pressure (Wendy called it “something normal) in the arteries when the heart relaxes between contractions.
For most pregnant women something around 120/80 is normal (120 over 80). Some run a little higher and some, lower. If it’s 140/90 on several occasions, that’s too high. That’s not enough however, to diagnosis preeclampsia.
When doctors are concerned a patient might be developing preeclampsia, they’ll have her come to the office or even the hospital, to have their blood pressure monitored over a period of time. Then, they run urine and blood tests to look for protein in the urine, and how well the kidneys, liver and blood clotting factors are working. They also look at other things like reflexes, vision, and other physical symptoms.
Wendy’s says her doctor found protein in her urine. What’s not clear is how it was found. Was it a routine dipstick test, like the one they do at every prenatal visit or did she have a 24-hour urine collection tested? The dipstick isn’t accurate enough to diagnose preeclampsia. Wendy needs to pee in the bucket for 24 hours and have the lab screen it thoroughly and count exactly how much protein it contains. Wendy didn’t mention anything about blood tests at all.
Now, about that ultrasound. That’s totally appropriate to make sure her baby is growing properly. One of the bad things about high blood pressure is it can reduce blood flow, nutrition and oxygen through the placenta. Then, babies don’t grow well. Wendy’s baby apparently looked normal and she saw “breathing movements.” While that’s a positive sign, it doesn’t mean her baby’s lungs are mature enough to breathe on their own. She needs an amniocentesis for that.
So far, it sounds like her doctor is going on a hunch she might be heading down the preeclampsia road. A hunch isn’t quite good enough. Wendy should be getting the appropriate lab tests to guide her doctor’s care plan.
I talked to my doctor buddy, Desiree Bley, MD, a Portland Oregon obstetrician who said, “Nuh-unh – that’s not how we handle high blood pressure in pregnancy. You don’t do a c-section unless there’s fetal distress or mom’s in imminent danger. There are so many other things we do for this like bed rest, lab tests, further monitoring and medication if necessary. And you can’t tell if a 36-week baby’s lungs are fully developed based on ultrasound. That’s just practice-breathing to strengthen muscles. It’s like how butterflies beat their wings to get out of the chrysalis. If they don’t do that, they won’t be strong enough to fly. Prenatal breathing movements are exercise so babies will be strong enough to breathe. If a doctor is thinking about delivering a 36-week baby, you need an amniocentesis to back that decision up. Otherwise you risk delivering a baby who will wind up in the NICU on a ventilator.”
Wendy needs more information. You don’t want to mess around with preeclampsia. It’s dangerous stuff; one of three major causes for maternal death. But, based on what Wendy told us, her doctor hasn’t diagnosed preeclampsia yet, hasn’t determined her baby is old enough for delivery and certainly hasn’t made a case for c-section. So far, he’s just worried about a couple of kinda, sorta, a-little-bit-high blood pressures. Worry isn’t enough. Protocols and guidelines are like safety nets that protect patients and doctors alike. While a hunch is a good place to start, it’s not a diagnosis.
This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.