Pre-eclampsia and the feeling doctor is not taking it seriously enough.

[fleab123]

I am 29yo female 32 wks pregnant. 247lbs 5' 5". Suffered from chronic hypertension for the last 6 yrs. I was taking ACE inhibitor pre-pregnancy but was switched to Procardia XL 60mg extended release at 4 wks gestation.
My baseline BP is around 135/85. This is my first pregnancy. I am on bed rest.
I have been working with my regular OB as well as perinatologists. I have weekly NST's and BPP's as well as growth level 2 ultrasounds every 4-5 wks. So far, everything is going well. My amniotic fluid has been going down a bit every week and is currently at 8.4 which I am told is the low end of normal.
My situation is this. I tend to have VERY high BP readings at the doctor due to what I believe is a little white coat syndrome. I do monitor at home and up until recently my readings have been fine and close to my baseline. Right now, my pressures are all over the place ranging from 120's/80's to 150's/100's. I keep my readings and bring them to my doctor every week. Recently he added Lebatalol 200mg twice per day on top of the Procardia.
I have no swelling, maybe just a little but in my fingers and I have had anywhere from trace to 1+ protein in my urine. As of now, I have 1+. I have a little pain under my right rib cage but nothing significant. My last 24 hour urine showed 164mg of protein and that was around 28 wks. My OB said that if my protein is still 1+ at my next appt they will do another 24 hour. I also recently(in the last wk) had CMP done and the blood work all came back normal so doctor said I was not pre-eclamptic at this time.
My questions.....
1. i know other pregnant women who's doctors make a HUGE deal and induce them early because THEIR BP gets up to 130/80. Is it because my baseline is higher to begin with that it's considered "ok" if my BP readings get up to 150's/100's with protein in my urine? It scares me to think that the doctor isn't making a correct diagnosis just because I was already hypertensive.
2. how exactly is pre-e diagnosed? I thought it was high BP with protein? if that's the case...why am i not diagnosed with this?
3. should my doctor be doing addl testing at this point or does all seem on track?

[peekawho]

Preeclampsia is diagnosed by several different things.  Generally speaking, if you have high BP's with over a certain amount of protein in a 24 hour urine (not the dipstick done at the doctor) with or without certain lab changes, then you may be diagnosed with preeclampsia.  Often there is swelling of the hands and face and headaches that do not respond to medication.

On the lab work, they typically look at your uric acid level, your platelets, and your AST/ALT in conjunction with your blood pressures and proteinuria on a 24 hour urine.  Most but not all of these tests are included on a CMP.  The platelets would be on a CBC.  

If your pressures were high to begin with, they will often tolerate a slightly higher number than someone who usually is normotensive.  

It sounds as though you are being followed closely, but many, many  doctors would admit someone in your circumstance to the hospital for bedrest and close BP/lab monitoring.  You don't want to deliver this early, but you need very close follow up for this, and you might be best served by hospital observation.