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Thread: Preeclampsia?

  1. #1
    Join Date
    Oct 2009

    Default Preeclampsia?

    Dr Cusick,

    After suffering from infertility for several years, my husband and I conceived on our first try with IVF/ICSI. Other than hypothyroidism, I was a healthy 33 year old (turned 34 the day before beta). My hypothyroidism had been controlled for 4 years with levothyroxine. After the positive beta, I continued progesterone supplementation until approximately 10 or 11 weeks and low dose baby aspirin until +/-21 weeks when my OB told me to stop because there were risks to the fetus in the 3rd trimester.

    A few weeks after stopping aspirin, 26 weeks, I was diagnosed with preeclampsia and put on bed rest in the hospital. The u/s showed absent diastolic flow so we started steroids. At 26w4d my baby stopped moving, and I repeatedly told the nurses. The nurse got the Doppler so I could hear the heartbeat and said some mothers just donít feel their babies. To my surprise, the next morning I learned that the nurses never called my doctor to tell him I stopped feeling movement. As soon as the doctor learned I had not felt movement for 24 hours he ordered an u/s which confirmed that my baby wasnít moving and we had an emergency c-section to try to save her. Unfortunately, my daughter passed away approximately 30 minutes after her birth. She weighed 1 lb 7 oz. Path report showed non-descript blood clots on 30% of the placenta. After delivery I was started on 100mg Labetalol 2x/day, which was doubled a few weeks later. It is now 6 months post partum and although my pressures are now under control I have not been weaned off the Labetalol. We are currently doing another IVF cycle and my PCP was concerned the increase in hormones would mess with my BP, so he thought it was safer just to stay on the meds.

    All my doctors assumed I had some type of underlying condition, but when I was tested a few months later for autoimmune or blood clotting disorders. Everything came back normal except one gene mutation for MTHFR A1298C, which Iím told is clinically insignificant. When I met with my OB and MFM to discuss the results and possible future pregnancy, the MFM said I would take low dose aspirin throughout pregnancy with more frequent monitoring. He said he would prescribe heparin if I want to take it, but since there is no underlying condition he doesnít think it will help. And, he wouldnít have his wife take it if she were in a similar situation.

    My MFM has really poor bedside manners. When I told him I was disappointed about the nurses not telling him that I was complaining about lack of movement, he had the audacity to tell me they probably just didnít want to bother him! I plan on finding a new MFM if Iím fortunate enough to get pregnant again, but it is too stressful for me to search for a doctor while undergoing IVF when I know there is a chance I might not get pregnant again. So, in the mean time, Iím hoping you can answer a few of my questionsÖ

    1. My MFM is only recommending treatment with aspirin in a future pregnancy. Iím skeptical that low dose aspirin should be my only treatment because I took in through 21 weeks in my previous pregnancy. Do you think the outcome would have been different had I not stopped taking aspirin 4-5 weeks prior? I really wish I hadnít stopped, but at the same time find it hard to believe that 4-5 weeks more of baby aspirin would have prevented such a severe case of preeclampsia.

    2. Would you recommend treatment with heparin in a subsequent pregnancy? If so, when would you recommend starting injections? Day of transfer? Positive beta? Day cardiac activity is confirmed?

    3. Is it possible for someone to test negative for autoimmune & blood clotting disorders to develop them only when pregnant?

    4. Is the one gene mutation of MTHFR considered a clotting disorder? (Homocystien levels were normal.)

    5. What are your thoughts on recurrence of preeclampsia?

    I want to thank you in advance for you help.

  2. #2
    Join Date
    Oct 2008



    Sorry for your loss- there is little you/we can do for women who develop severe preeclampsia as early as you did- although controversial in some eyes, baby ASA started early in a pregnancy may delay or slow the development of preeclampsia- stopping it at 21 weeks would not have had any impact. in fact the benefits of baby ASA are best realized when the med is started early in pregnancy (does not help when started in the mid-trimester)

    Recurrence risk with a singleton pregnancy is 66%, with a 1/3 of these cases occuring in the 2nd trimester

    There is an association between the blood clotting issue and wome with severe, early preeclampsia- had one been found, the standard recommendation would be to add Heparin to the treatement plan. Other women who might consider Heparin, despite lack of proven value, would be those who have failed baby ASA alone in prior pregnancy or those with a negative work-up but a placenta showing major clotting abnormailities.

    Hope this helps-


  3. #3
    Join Date
    Sep 2009


    Hi Becky-

    I lost my 3rd baby 7 months ago. I have two other boys who were born prematurely at 32 and another at 34 weeks. This last baby was stillborn at 30 weeks exactly. I saw a perinatologist for 2 visits in mid-Dec. and in early Jan. I too had a MTHFR gene and also factor V Leiden. I guess both spell not so great news. It was recommended that I go on a Heparin pump (full blown heparinzation!) at 21 weeks. I was really scared about doing that. I wish that my doc would've had the decency to at least talk with me over the phone when I had questions the next day, but he refused. No one in AZ will talk to you for free over the phone. In CA, it seems like people will bend over backwards (blue state) Just an observation as I've met with a few IVF clinics, surrogacy agencies, and attorneys w/ surrogacy law over the past few months.

    I did a tubal ligation, and I guess I can't reverse it? I'm too high risk to get pregnant again really and the fact that I can't even carry a baby past 34 weeks isn't great. I honestly don't know what I would do. I was on baby aspirin with all (3) pregnancies. With my first, about half way through because I started to enter that pre-eclampsia stage. I took it with my 2nd and 3rd pregnancies right after my first prenatal appointment. I too was told that pre-eclampsia wouldn't necessarily reoccur in the 2nd pregnancy and if it did, perhaps later on in the 3rd trimester.

    Baby aspirin is enough for most folks, but other need Heparin whether it's twice daily injections or the pump. I didn't do it. I ended up with a bloodclot. Did the abruption kill the baby or did i get the clot first and then that caused the abruption? I'll never know. We refused an autopsy. It was such a hard decision to make at the time.

    All I know, is that nurses and docs need to LISTEN to their patients. The nurses should've called that guy and woke him up! I don't care if it's in the middle of the night, do your job, and look after your pregnant patients, that's your job! Went in to the medical field to help people, so let's do that. These people make A LOT of money (more than teachers anyway) and at least they can pick up the phone and call the appropriate people.

    Sorry to vent, but it's been one of those horrible days. I applaud you for trying again. You are a strong and brave woman. I wish you the best of luck with everything. You sound like you know what you're doing. Keep asking those questions, push for answers, and demand the best of service. We are the only advocates for our children. Moms do know what's best



  4. #4
    Join Date
    Jan 2010

    Default Preeclampsia

    I have to say that I did get some flashbacks from your story. I do recall having been told that I had infarcts in (one or more of) my planceta(s). I suffer from PE and (borderline) HELLP.I am trying to find my way. I hear that ther is something that probably floats in our blood that essentially constricts the flow to the planceta when the fetus is recognized (simple explanaion). Supposidely there is research going on on how to divert those chemicals. I am not sure that I can mention othe programs or locations so I will stop here or aviod too much sharing, until I know it is ok to do so. Odly enough, I am not supposed to fit the category of on who gets hellp syndrom (based upon the HELLP Syndrome Society--yet I do; I digress). Good luck. You are still young. I am 43 (and suffering in my own way, yet cannot give up, because I will continue to try until i cannot conceive or I have tried all possible alternatives). I send much.

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