Our Senior Moderator, Sara Owens, writes: High-risk does not always mean you have or will develop complications. It does mean that your provider feels you have a higher likelihood of developing a complication then other patients. But even if you are high-risk, you may have a very uncomplicated pregnancy. It just means that your provider is aware of higher potential for complications and should provide appropriate monitoring in case complications do arise. Medically complicated means that you or baby or both have known underlying conditions or problems that may mean some changes to your care. Your doctor may recommend running extra tests for either or both of you, seeing a higher level provider, and/or delivering by a certain point or in a certain way. Should I be considered high-risk after preeclampsia? If my doctor says I am high-risk, does that mean they expect me to have complications again? Yes, if you have had preeclampsia or another hypertensive disorder of pregnancy, you should be considered high-risk in all subsequent pregnancies. Again, you may have a completely uncomplicated pregnancy, and in fact, most women who have had preeclampsia do have uncomplicated pregnancies the next time. If your doctor says you are high-risk, it does not always mean they expect you will have complications, but it should mean they will be prepared in case anything changes. What does a high-risk pregnancy look like? This is going to be very individual. Your provider can review your obstetric history, fetal outcomes, underlying conditions, and so on and give a personalized monitoring and assessment plan for you. They can also decide if they want to refer you to a higher level of provider or hospital, and they can create a plan for delivery. High-risk has a very wide range. For women who deliver at term, where baby and mom recovered quickly, no underlying conditions, high-risk may just mean their regular OBs do the recommended baseline testing and are just aware of their history and ready to act if anything changes. Except for baseline testing and perhaps home BP monitoring, their subsequent pregnancies may not look especially different from a low risk pregnancy. For women who delivered preterm, who lost a baby, and/or who have certain underlying conditions, their subsequent pregnancies may be a little more busy. It is common for those women to have extra visits, sometimes with Maternal Fetal Medicine specialists or other specialists like cardiology. They may also have more ultrasounds, more NSTs, more lab work. This chart is from the US's ACOG. It talks about the recommended monitoring and testing for women with a history of preeclampsia. There is leeway for individual situation, especially in the third trimester. Your plan will look specific to you! Here is our list of preconception questions to ask as well. My doctor said I am not high-risk and they will just proceed "as normal" unless anything changes. This may be a matter of wording choice. As discussed above, you should be considered high-risk, but if your circumstances do not warrant extra tests and such, your pregnancy may not look very different from low risk. Use the above chart to discuss with your doctor how they will ensure that you and baby receive appropriate monitoring and any necessary care. My doctor says I only need some baseline labs and a couple of ultrasounds. I see other women going to MFM, going for NSTs, and so on. Is my doctor doing enough to make sure baby and I are safe? Or My doctor wants me to come in twice a week for two months, wants me to see MFM, etc. That seems like a lot – do I really need all of that? Again, this is going to depend on your situation. Ask your doctor what they feel is appropriate for your clinical situation, as outlined in the chart. Ask your doctor what their concerns are for you and this baby and this pregnancy. Ask them what impact the results of certain tests would or would not have on your care and delivery plan. Informed consent means that you should be able to understand your doctor’s reasoning, and they should be able to understand your concerns, and in the end, you should both be comfortable with the plan and approach. Here are some posts that can help you have a productive conversation with your doctor about how your care should look: This post is about concerns when your doctor doesn't listen. This post is about what good care looks like in the context of preeclampsia. This post has suggestions to help you advocate for yourself. This post explains how to keep mothers safe. This post goes over what is the role of the MFM. I just discussed the plan with my doctor, and that made the fear a little too real, and now I am worried and scared. Hugs – pregnancy after preeclampsia is stressful, for sure. Many of us can relate to how you are feeling, and we are always here to listen and to lend a virtual shoulder. But we also recommend keeping your doctor informed about how you are feeling, emotionally as well as physically. They can help, by discussing pregnancy-safe anxiety meds and when those might be warranted. They can also refer you to a mental health professional who can help you develop some coping techniques for anxious moments. Postpartum.net also has some excellent resources. Specific information for those living in the UK In the UK, as you don't have direct access to either an OB or MFM, your pregnancy will usually be placed on the appropriate pathway when you book in with the community midwife. They will complete a risk assessment and score you on risk, which will include details of past pregnancies, losses and personal data. Your NHS trust will have a specific pathway detailing what your care looks like if you are high-risk, so make sure to ask your midwife. They will provide you with a list of appointments and with whom when booking in. If needed, you will be referred to MFM departments at a larger hospital if your pregnancy becomes medically complicated.

What are the different types of urine protein testing, and what do they mean? Dip Test -- a strip is dipped into a single sample, and the color is compared to a chart; can be done in office Spot Test -- the amount of protein in a single sample is measured in a lab 24 Hour Urine -- you collect all urine for 24 hours, and the lab measures the amount of protein in the full amount of urine Protein Creatinine Ratio (PCR) -- the lab measures the amount of protein in a single urine sample, like with the spot test, but also measures the amount of creatinine in a single urine sample and compares them together to approximate the 24 hour urine. You can read more about lab work associated with preeclampsia in this post.

I've been diagnosed with preeclampsia. Do I need to be admitted to the hospital for the rest of my pregnancy? Can I be monitored from home? Our Admin, Jennifer Hohulin Heiniger, writes: There are a lot of factors that go into the decision of whether to admit someone to the hospital. Doctors look at things like how far along you are, how any previous pregnancies went, how your current pregnancy is going, even how far away you live. Preeclampsia is hard to predict. Sometimes it moves quickly and sometimes slowly. The average time from diagnosis to delivery is around two weeks, but that includes a wide range from those who deliver immediately to those who stay stable for weeks or even months. When severe symptoms start to appear, it can get very bad very quickly. Some of our members have been admitted for the duration of their pregnancies for hospital bed rest. If your doctor recommends it in your case, they should be able to explain why. You can ask what they are watching for that will tell them it is time to deliver. You can ask what tests they will be doing each day, how often you will see them for rounds, etc. You can also ask about hospital resources for long-term patients. They may have a therapist on staff you can talk to, for example. Being in the hospital can be scary and boring. It is natural to feel anxious or depressed. You can also discuss medication options. They may also have activities you can do. You can ask if you are stable enough to walk around or go outside for a short time each day. You can ask about visitor policies, which can change depending on the situation in your community. Can your partner or another support person stay with you all the time? Can you have more than one or two visitors at a time? If you have other children at home, can they visit? You can also work with your nurses to make your stay as good as possible. My night nurses would come in immediately at shift change to do my hour of fetal monitoring. Then I could have a solid 6 hours of sleep before the lab tech came in for my morning blood draw. It helped a lot not to be woken for monitoring at 3am. If you have nurses you like, or nurses you do not like, you can ask to have them put onto or off of your scheduled care. Other members have been able to stay at home after diagnosis with frequent appointments. Your doctor can explain how often you will have appointments and what tests they recommend at each one. They should also give you instructions on symptoms to watch for between appointments and what to do if you notice something. If anything starts to change, do not be afraid to call or go in for evaluation. See some questions and talking points to communicate with your care team here.