preeclampsia ,polyhydramnios, impaired gtt

[lmkrn]

Thanks for any responses in advance. My 35 yr old sister with no previous deliveries is currently in her 32 week.she has fairly significant edema ,a 24 hr protein of 294, polyhydramnios,impaired glucose tolerance, bp has not yet topped 150/100 and fetal heart rate in the 120 - 130 range.estimated fetal weight is 3.6 lbs.What are the implications of these findings .She is now having biweekly office visits and scheduled for a repeat stress (nonstress ?) test next week.Her OB tells her baby looks fine but that if protein goes over 300 the may plan early delivery. Her biggest concern (PANIC) is that combined preeclampsia,polyhydramnios and maternal age indicate 10% risk of downs or neural tube defects (she read it somewhere). Could this be true? I feel that she should trust in what the OB says and that he would inform her if thats what he suspected . I (as a nurse-not ob) recognize there are few absolutes in any condition but I would like to help her with any advice ,knowledge you all may have.

[rdhdnrs]

Has your sister had ultrasounds that show any signs of neural tube defect? Most of the time, there are some signs of that. Did she have an MSAFP blood test? That is just a screening test for downs and ntd. If these were normal, she could rest a little easier.

It sounds like she is probably developing preeclampsia, very common in older first time moms. I think she should speak frankly to her OB about her fears and I think the doc can address them and make her feel much better. It sounds like her care is appropriate.

Let us know how things go.

Lisa

[CA CoCoRN, RN]

Her advanced maternal age (AMA) could have predisposed her to Downs, chromosomal defects, etc. However, at this stage of the pregnancy, all that is water under the bridge. The question was asked: did she have at least an MSAFP?? That would give the first indication of risk during this pregnancy.

As for the edema, proteinuria, elevated blood glucose, poly (which is usually foretold by the GDM she is developing/has), HTN etc: she's pretty much on the verge of a planned induction or, if things get too far out of hand, a C/S. That is because she is coming "within sight" of pre-eclampsia. If her pressures are above the 140/90 mark, she's already hypertensive by definition. Sometimes, OB practitioners will set a mark, and if it's exceeded then they will "officially" label it PIH/Pre-eclampsia. But, regardless, she's getting there.