I am a complication...

Okay, here's what I have... had... yeah... that got me admitted to the ER yesterday afternooon:

A particular condition of pregnancy--a complication--is now called Gestational Hypertension (previously, pregnancy-induced hypertension (PIH), pre-eclampsia, and toxemia) which is quite different from the "chronic" hypertension discussed. Although the exact cause of it is unknown, it seems to be an immunologic rejection of the pregnancy, the baby seen as a hostile tissue-graft reaction. This is a much more dangerous condition than chronic hypertension, because there is much more alteration in the maternal body than just high blood pressure. There's a whole chemical shift of maladaptative reactions that can even lead to seizures and death in the pregnant patient.

Brain swelling is the cause of seizures, lethargy, and visual disturbances. (The visual disturbances are not to be confused with the swelling of your cornea which results in blurred vision, which reverses after birth and is harmless.) The expectant mother's kidneys are especially vulnerable, affecting filtration, worsening the swelling and resulting in the loss of protein in the urine. The blood vessels develop abnormalities of constriction, affecting blood pressure, and the reflexes become hyperactive

The blood pressure changes are only part of the "classical tetrad" of signs. These four noteworthy signs and symptoms are:

• High blood pressure,
• Edema (swelling, more suggestive of gestational hypertension if it is central of the face rather than peripheral of the ankles--peripheral swelling is normal),
• Hyperproteinurea, or spilling protein in the urine, and
• Hyper-reflexia, or exaggerated deep tendon reflexes (the knee-jerk, for instance).

While chronic hypertension, on the one hand and even in pregnancy, is a slow-growing problem that allows plenty of time for managementgeek that seldom interferes with bringing a pregnancy to term, gestational hypertension can progress swiftly to prompt delivery prematurely.

Management of gestational hypertension

If a patient has only mild disease, this can be followed conservatively, but there are those who will argue that there is no such thing as "mild" gestational hypertension and advise delivery as soon as the baby is deemed lung-mature. Bed rest, a low salt diet, and peace and quiet are the treatment before delivery, and this regimen hasn't changed in over a hundred years. Of course close observation with frequent blood pressures, serial 24-hour urine collections, and liver and coagulation studies go with this conservative treatment. That's how we watch the mother. We do non-stress tests and biophysical profiles to watch the baby. As soon as the patient's cervix is inducible near term, induction for delivery is recommended.

Bed rest, check.
Low-sodium, check.
Delivery asap, not so check.

I'm already beginning to dilate. I'm glad I'm still feeling her kicking me.

It can get worse

There are some particularly sinister forms of gestational hypertension. Thrombocytopenia (low platelet count) can appear as a sole problem. Since platelets are part of the blood-clotting system, hemorrhage and strokes can occur if the platelet count gets low enough. HELLP syndrome (low platelets associated with liver disease) is an obstetrical emergency and requires prompt delivery.

My platelet count was fine.

The protein count was fine (as deemed so by both my attending doctor and a conference room full of maternity nurses that my mother in law happened to be meeting with right at the time I had gotten all my tests results back and Josh called her to give an update).

So, they let me leave, ordering me to bed (which is where I wanted to be in the first place), and told me to go in in the morning for check up. Only, Moron Staff didn't have me down for appointment. >.<'

And AGAIN I'm not on the appointment books. I'm getting so fucking frustrated with the staff at this office. If they give me issue about insurance payment on my labs again, I swear....

God damn it. Now they are refusing to see me for the ER follow up.


And they are wondering why I have hyper tension?

FUCK!