Pre-Eclampsia

[tinabowen]

I got out my Medical records from last year and I found a few things worrysome.
I was dianosed the day my son was born with Pre-Eclampsia(that was 8-13-04 wasn't dianosed with PPCM until 8-19-04) now in my chart it has my Protien only being 2+ and 24-hour Urine 283(right now at almost 30 wks my Protien is 1+ and my 24-hour Urine was 256) which from what I have read does not meet the guidelines fro Pre-E.
I was wondering if they thought it was Pre-E because they didn't know at the time that I had PPCM(didn't find out until the day before I went into heart failure)..


Tina

[JAMESFETT]

I'm sorry not to be able to be helpful. I rely on Ob/Gyn to confirm a diagnosis of pre-eclampsia or toxemia of pregnancy. It is unusual for pre-eclampsia to lead to heart failure. In our experience the two conditions (toxemia and PPCM) may co-exist, but toxemia has only occurred in 15 percent of our 150 PPCM patients. If it is a risk-factor, it is not a strong risk factor, since most of our cases of PPCM occur without toxemia of pregnancy.

JD

[Kimberly Sidden]

Dr. Fett,

You asked if I had toxemia during pregnancy or "simply" hypertension. I did not have toxemia, as my urine and protein were fine during my pregnancy, I had severe swelling and pitting edema. Interestingly, I had a visit with my perinatologist, and learned my cardiologist did NOT diagnose me with PPCM originally, it wasn't until 5 months after delivery when my heart was returning to normal that he diagnosed me with PPCM. (According to his notes that were sent to the perinatologist.) I had been released from care after my visit in August as my heart was "back to normal". However, as I am surprised and blessed to be pregnant again, I have scheduled an appointment with a different cardiologist in the same group, Dr. Tracy Stevens, St. Lukes Hospital, Kansas City, MO, on the 27th of this month. I will ask her about the labs and tests you recommend. My perinatologist also has a birthing center with some other doctors in Haiti. Her name is Dr. Elizabet (Betsy) Wickstrom, do you happen to know her? As my heart had supposedly returned to normal, am I at a reduced risk for having PPCM again, or do we really know? Also, I would like to have a c-section again, but have read that it is not as advisable. What are your thoughts on a c-section? Thank you so much for your thoughts and prayers!! I believe prayer is even more powerful than excellent medical attention, which is obviously very powerful!!

Kimberly

[Anny311]

I think it is possible they thought you had pre-eclampsia before your dx of ppcm.

The reason I say that is when I was re-admitted for ppcm, my ob was talking to the cardiology fellow and the fellow asked if they were "sure" I had Pre-e. My ob said yes, because I had HELLP syndrome (where your liver enzymes and platelets are affected). If I had just appeared with high BP I could see them being confused and thinking it was pre-e without HELLP, which is possible. My BP returned to normal whe I was d/c'd after the delivery but was sky high when I went back to the ER.

I also asked my cardiologist if the pre-e could not have been the cause of my heart damage, and he said that not only is it unusual for pre-e to cause heart failure, but it causes a different kind of heart failure (I know there are different types but I don't remember which ones they are).

Good luck to you.

[JAMESFETT]

Good for Dr. Wickstrom! I don't know her, but I wish I did. Having had PPCM and having recovered left ventricular function already places you in a favorable category so far as later pregnancy goes. Most problems occur for those who have not regained normal. I'm not OB/GYn, so my thoughts about the C-section are not so important; however, normal labor places considerable stress on the heart, and C-section avoids that. Also from the baby's standpoint, it can be safe to do the C-section before labor begins, and safely concluding the pregnancy for you and baby then clears the way for ongoing recovery. Prayers and best wishes,

JD

[tinabowen]

My Cardio said "I will tell your Dr's that you will have a C-Section whether they like it or not" so I will be having a C-Section in the next 5 wks..
I will be in the hospital stating Thursday until the baby is born(could be 5 weeks but I doubt it)..

Dr.Fett the reason that I asked the question is I am affraid that the Dr's will miss any signs of PPCM this time but after talking to the Perinatologist I feel like he knows what he's doing.He wanted me to see my Cardiologist before I was admitted to the hospital for another Echo and is sending a letter to him so he will know I am in there and will need to be checked by him or his partners.


Tina

[SarahsMom]

Tina,

I'm glad your going to the hospital...that's the VERY best place for you guys right now. Please let us know how you're doing....I'm thinking about you guys! Take care.

Love,
Kari

[JAMESFETT]

If your doctors follow your BNP (B-type Natriuretic Peptide) in the blood they will have advance warning of worsening of left ventricular systolic function.
If they don't want to do it weekly, then with the earliest symptoms of heart failure one could be done to confirm the problem and start appropriate treatment early.
JD