Question re: High Blood Pressure...

  1. This is a general question, and I know that every birth is different, and should be treated as so, but how high does a pt's bp have to go before you start mag?? If you had to induce, would you suggest an epi just in case a c/s is needed? (This is of course assuming the pt is term)

    The reason I ask, is that I was induced on my due date due to high blood pressure, and a trace of protein (wasn't enough to be a concern, but the hbp was) At one point, my BPP went as high as 166/119, and still no mag was started. Reason I wasn't given any, was that I was told it would make me drowsy. Instead, they suggested an epi, and then boosted the pit into me like there was no tomorrow. He was born 6h40m after I arrived to be induced.
    The other part that I'm concerned about, is that he also showed signs of stress major decels and was born with thick meconium that he in turn had swallowed. Not knowing anything about mec, could a high stress birth like this cause him to poop, or was it my body reacting to him being in stressful conditions?? (Sorry, this sounds dumb, lol.. but really, I wonder if either co-relate)
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  2. 2 Comments

  3. by   mother/babyRN
    Most of our docs would have started Mag, but perhaps they were going by the protein result...In any case, a PIH panel would have been drawn first before any decision would have been made...Pushing the pit could surely stress the baby quite a bit and if there was mec, especially thick mec, with your membrane rupture, around here there would have been an amnioinfusion and an attempt to visualize the cords once the baby was born, with tracheal suctioning...
    We don't do epidurals routinely just because someone is getting induced, any more than giving them routinely in someone who is intact and at the beginning of a labor who has to be augmented with pit...Doesn't sound like you got the most of your treatment and hope your baby is feeling wonderful...
  4. by   SmilingBluEyes
    It' s not usually simply a matter of B/P numbers (and it does not take much of a rise to make us worry, usually only a rise of 10-15 mmHg over normal diastolic in different positons and different times and we begin to investigate). We also look for the classic signs/symptoms of pre-eclampsia. Get labs, the usual. The numbers, plus symptoms, will usually prompt MgSo4 tx. Often prior to this though, with elevated B/P's, they will be on labetelol or procardia. If these don't do the trick, then of course, MgSo4 tx is likely indicated. It's considered carefully case-by-case.

    In YOUR case, I would say it is LIKELY you would have been on MgSo4 tx where I work. The epidural would have been YOUR decision to make and yes, your baby could have been stressed for any number of reasons (sometimes placental functioning declines markedly with significant rises in B/P.) Hard to say exactly what happened since I was not there. I hope you are both ok!
    Last edit by SmilingBluEyes on Jan 12, '03

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