Induction at 37 weeks after questionable diagnosis of PIH?

[marymoonu]

My blood pressure has been borderline at most of my prenatal visits to my OB (~135/85).  

At my 31 week appointment, he ordered a 24-hr urine test which came back normal.  

At 33 weeks, my BP at the visit was 142/92 and he sent me to L&D for a non-stress test, blood tests, and another 24-hr urine.  During the NST, they checked my BP every 15 minutes and I didn't have one elevated result.  All labs were normal.

At 35 weeks, my BP in the office was 150/100 (per manual reading).  I had just taken it at home shortly before the appointment and got 128/75.  My doctor told me that he will be inducing me at 37 weeks.  I was sent to L&D for another NST and more blood tests.  At L&D, all labs and BP were perfect.  

Now the interesting part...  The L&D nurse came to me and told me that I'm not the first patient she has seen from my OB office (multiple doctors) with this issue... Elevated BP at the office and then perfectly fine on the NST.  She doesn't know if they have faulty equipment, poorly trained staff, or if something else is going on.  She reminded me that if the baby is reactive on the NST and he's moving, my BP's are still looking fine and my labs are normal, that I CAN say no to the induction.

My question is how to approach this with my doctor.  At this point, I'm monitoring and recording my BP multiple times a day at home and set up to go for NST's twice weekly.  I have no explanation for the BP reading of 150/100 at the office... I've never seen it that high before and just an hour later at L&D it was fine.  I disagree with his diagnosis of pregnancy-induce hypertension.  He checked my cervix and at this point (35 weeks), it was still thick, high, and posterior.  A fingertip dilated.  I know my cervix is not favorable and I do NOT want to end up with a c-section.  How do I convince my doctor???

[Elaine Brown, MD]

Hi!
Standard of care for pregnancy induced hypertension or pre- eclampsia would be conservative management ( let nature take its course ) UNLESS:
Severe pre-eclampsia is present and there are several criteria needed to make this diagnosis including two blood pressure readings of 160/110 or greater taken more than 6 hours apart.  Concern about the baby would be another reason to induce (poor growth or non-reactive NST).  If you are a first time mom with an unfavorable cervix, your chance of a C-section and possible breathing problems for the baby are quite high.
Make sure that your blood pressures are taken in your right are when you are lying on your left side.  
That might help.
Good luck!
Dr B

[marymoonu]

Update:  My BP this morning was 106/71.  Seriously.  I am NOT hypertensive.  Call it white-coat syndrome if you will, but it's not hypertension.  I'm going today for another NST and will update with those results also.