08 Aug

An Encounter with Severe Pre-eclampsia – Clair’s Story

Like the majority of people who get pregnant, when my husband and I became pregnant with our first child in late 2008, we had no reasons to suspect that we would have anything other than a totally normal pregnancy, hopefully a natural birth and a bouncing beautiful baby to take home.

The first half of the pregnancy was totally normal apart from the baby measuring much smaller than expected at the 12 and 20 week scans – not an unusual occurrence in itself, but a source of some concern for me since I thought I knew my dates almost down to the day, however, I accepted that I must have been wrong and readjusted my due dates accordingly. As all first time mothers do, I kept all my antenatal appointments on time and despite my blood pressure being slightly high, it was always well within the normal range of measurements for me.

Like most of the people who attend their regular antenatal appointments with the midwife, I never expected that anything significant would come out of them. Blood pressure (BP) check, urine check, listen to the babies heartbeat, etc, etc. My mother had suffered from gradually increasing high blood pressure throughout all of her 3 pregnancies so I fully expected my blood pressure to rise slightly towards the end of the pregnancy and was on the look-out for it. I also knew the full significance of the urine and BP checks as well – one of the first signs of pre-eclampsia is a rise in blood pressure and an increase in proteinuria (the presence of increased protein in your urine). This, as well as urine infections and gestational diabetes, is a key reason why your urine and BP is checked at each antenatal appointment.

By about week 25, my feet had started to swell and soon I was unable to wear my regular work shoes and was wearing trainers to work. I told my midwife about the swelling and was assured that swelling was normal in pregnancy and it probably wasn’t anything unless it was severe and sudden; pre-eclampsia was unlikely to occur so early in a pregnancy and not to worry. My blood pressure was normal, though, and so I resigned myself to having massive feet for weeks on end.

At the beginning of week 27, I had my first appointment with the healthcare doctor at my work. Almost as an aside, I mentioned my concerns about my swelling feet again to her since they had now started to ache and she immediately advised me to seek a doctor’s appointment as soon as possible, since severe oedema (swollen face, hands or feet) can be a sign of pre-eclampsia (see explanation below). I fully credit that woman for giving me the confidence to take my symptoms seriously.

I made an appointment with my doctor that Friday where he noted some concern about my blood pressure rising slightly and a slight increase (1+) in my proteinuria. Since I had a scheduled antenatal appointment at the Royal Berks for an unrelated issue the next Tuesday, he wrote a note asking them to check my blood pressure there, but he didn’t feel it was an urgent issue at the time.

I had no problems over the weekend and felt fine. By the time I was in hospital on the Tuesday for my appointment, I had convinced myself that I probably had a bit of a urine infection and would be given antibiotics and sent home. My first indication that things were maybe not quite right was after my initial booking in appointment to check my BP and urine. I was sent into the consultants room almost immediately after (unheard of!) where they checked my BP again. I was still blissfully unaware of the issue and it wasn’t till they started talking about hospital beds and admission that I started to get slightly concerned, but still not overly worried. After all, my mother had spent weeks in hospital and still delivered naturally at 35+ weeks.

It was only when I talked about going home to get some bits and pieces and they refused to even let me drive the car since it would increase my blood pressure too much that I started to get an inkling of the seriousness of the condition. My husband still fondly recalls the moment I phoned him to say they wouldn’t let me leave the hospital… “Um, we have a bit of a problem – they won’t let me leave the hospital…”. A bit of a problem – understatement of the century…! Even then, though, I was still only thinking of a few nights in hospital to get my BP under control before I was discharged again.

I was admitted to the high risk antenatal ward at 11am and my BP checked every hour. By the evening, though, concern was rising significantly (as was my blood pressure and proteinuria!). My husband had left earlier in the evening and unknown to him, around 11pm, I was admitted down to the delivery suite for constant supervision. My blood pressure was being taken every 15 minutes; despite increasing my BP medications, the diastolic (lower measurement and the more reliable indicator of BP problems) was almost constantly above 100 (90 is considered high) and the protein in my urine had rocketed up to 3+. My blood tests were showing signs of my kidneys beginning to struggle, and at one point, my BP was as high as 180/130 – a point where strokes are a real concern.

Despite the staff trying to get me to rest through the night, I found it impossible to sleep and spent the night chatting with anyone and everyone. It was clear to them that I was developing severe pre-eclampsia but I felt absolutely fine and actually felt a bit of a fraud being pushed everywhere in a wheelchair. In fact, apart from raised BP, oedema and proteinuria symptoms, I didn’t show many of the symptoms you’re warned about – headaches, vision problems, stomach pain… I hadn’t realised, though, just how much I’d swollen all over and how much – prior to the surgery, I could hardly get my wedding ring off. Since I’d had a lot of morning sickness throughout the pregnancy, I’d actually lost a lot of weight, but water retention had replaced the weight so I looked the same. On coming home, I found I’d lost over 2 stone and was a stone lighter than I had been before I got pregnant – most of it due to water retention.

The staff regularly asked me through the night if I wanted to contact my husband to get him to come in, but I was aware that he was working and needed his sleep, and bizarrely enough, I still hadn’t quite got the point of how serious the problem was, so I kept refusing to phone him. By 5am, though, they asked me once again. My answer this time was, “You keep asking – do I need to phone him?” Their response shook me significantly, “If you don’t phone him now, he’s in serious danger of missing your baby being born.” Suddenly, it dawned on me that they were seriously preparing for my baby to be born at just 28 weeks and 1 day. I found out later on that they had made the first enquiry about a Special Care Baby Unit (SCBU) bed for a very premature baby at 2am. I phoned my husband and told him to get there ASAP. He’s never had such a fast journey from bed to hospital and was in by 5:45am.

By the time he got there, I was starting to feel more of the effects of all the drugs they’d pumped into me in an attempt to reduce my blood pressure and was complaining of a throbbing headache in one specific place on my forehead. The one major advantage of that whole night is the ability to now know when a headache is BP-related!

Unknown to me, they had taken my husband aside when he came in and warned him that my condition was serious enough that at any point, he might lose either the baby, me or in the worst case, both of us at any time. Bless him – despite knowing that, he never once let on to me just how serious everything once and kept my spirits high with lots of joking and laughing with the staff. Just having him by my side made everything suddenly seem much more bearable and ever since, whenever we have ever encountered problems in pregnancy, he is called first and foremost! He is the most effective way of reducing my blood pressure that we have found yet (and we’ve tried quite a few).

At around 9am the consultant came round and recommended an immediate ultrasound – we were taken down for a scan around 10am and it was determined that our baby was very small for its dates (even accounting for the two weeks we had deducted after the 12 week scan), the placenta was constricted and blood was not flowing properly to the baby. An immediate emergency caesarean was ordered and by 11am we were being prepped in surgery.

Whenever a very premature baby is delivered, a team of specialists from the SCBU comes down to take immediate care of the baby. At one point, with a staff change over, I think we counted 26 people in theatre! K was born around midday at 28+1 weeks weighing just 860g (1lb 14oz). She was so tiny, I wasn’t allowed to hold her or even see her (I asked to see the placenta instead!) – she was put straight into a ziploc-type plastic bag (believe it or not, one of the greatest innovations in recent years to increase the survival rates of very premature babies is to help them maintain their body heat by putting their bodies straight into a plastic bag) and whisked straight up to the SCBU unit to be stabilised.

I was so knackered after being awake over 30-odd hours and so doped up with drugs that I practically fell asleep in the theatre and was asleep for a good 24-36 hours afterwards, only occasionally waking long enough to grin inanely at my long suffering spouse before dropping off again. He was so bored waiting for me to gain some sensibility that the next day he bought work into the delivery suite! It was over 6 hours before he was even allowed to go and see K.

After being monitored constantly on the Delivery Suite for almost 2 days, I was eventually returned to the high risk postnatal ward for further monitoring where my blood pressure continued to fluctuate for several days. I was in hospital for 10 days and on high levels of blood pressure medications for a couple of months afterwards but otherwise made a full recovery. To cut a long story short, K fought for life on SCBU for 6 weeks but eventually died of premature-birth related complications. We were obviously devastated but with the support of the hospital, tried again and 6 months later were delighted (albeit very nervous) to become pregnant again. If you have had pre-eclampsia once, it is highly likely that you will get it again, but you can reduce the risks and time of onset by keeping the same partner, reducing the time between pregnancies and taking certain drugs to reduce blood pressure.

This time, I was put on drugs immediately to prevent/delay the onset of pre-eclampsia and after a very worried pregnancy, taking maternity leave from 28 weeks, I sailed through to 38 weeks with absolutely no blood pressure problems. H was born happy and healthy by elective caesarean at a healthy 7lb2oz in June 2010. She is now a very sturdy 3 years old and tests my patience every day, but is without doubt the most important person in my life and so precious.

I am amazed by how many people (and mothers!) I speak to who don’t know the symptoms of pre-eclampsia and don’t recognise the importance of regular monitoring and check-ups. Pre-eclampsia is one of the most dangerous pregnancy related conditions and knowing its signs are vital to your health and that of your baby. Most of the time it is a mild condition, usually from the second trimester onwards, treatable with drugs and easily controlled. Sometimes it requires hospital treatment and monitoring until the baby is born, and in more severe cases, like mine, it can come on very quickly and requires immediate treatment, monitoring and most likely, early delivery.

Identification of risk factors can contribute to identifying its likely onset and once identified, it can sometimes be controlled with just drugs but it is a condition that is usually only fully resolved with delivery of the baby. If pre-eclampsia is not controlled, it can lead to full blown eclampsia, or in very rare cases, a condition known as HELLP, both of which are extremely serious and can even lead to death. Luckily, improvements in monitoring (and increased awareness among mothers) about the warning signs of pre-eclampsia during pregnancy means that such cases are very rare.

After a totally normal second pregnancy with no BP concerns, all the health professionals assured me pre-eclampsia was highly unlikely to occur again, but in our third pregnancy, I identified the signs of severe oedema again, this time at 28 weeks. By warning our healthcare professionals and raising the alarm, we had several scans in advance and we managed to identify the warning signs and predict the onset of pre-eclampsia 2 weeks before it actually happened, which allowed us to manage the condition in a much more relaxed manner and keep the baby in as long as possible before delivery.

The aim of this article is not to scare you but to inform you – yes, pre-eclampsia is common but your regular antenatal checkups are designed to hopefully identify any signs of it well in advance. Cases like mine are not commonplace, but if, in between check-ups you are concerned by consistent severe swelling, headaches, severe pain just below your ribs and/or visual disturbances in pregnancy (or indeed, any one of these symptoms), it may well be (and probably is!) nothing, but get it checked out by your GP – whatever stage of pregnancy you’re at. As always, trust your own instincts and I guarantee you that any GP or midwife worth their while will take you seriously.

For more information about pre-eclampsia, please go to:

http://www.tommys.org/pre-eclampsia

http://www.nhs.uk/conditions/Pre-eclampsia/Pages/Introduction.aspx

Some facts about pre-eclampsia

What causes Pre-eclampsia?

The cause of pre-eclampsia is not fully understood. There are two schools of thought. One is that it is an auto-immune response caused by the mother’s reaction to the baby (or vice-versa). The other is that it is thought that the placenta does not develop properly because of a problem with the blood vessels supplying it. The effects are the same. The placenta is the organ that links the mother’s blood supply to her unborn baby’s blood supply. Food and oxygen pass through the placenta from mother to baby. Waste products can pass from the baby back into the mother.

To support the growing baby, the placenta needs a large and constant supply of blood from the mother. In pre-eclampsia, the placenta does not get enough blood. The problem with the placenta means that the blood supply between mother and baby is disrupted. Signals from the damaged placenta affect the mother’s blood vessels, causing high blood pressure (hypertension) and affecting her kidney function. Waste products that should be removed from the mother’s blood and passed out in her urine remain in her blood. At the same time, valuable proteins that should remain in her blood are leaked into her urine, causing proteinuria (protein in the urine).

What are the symptoms of Pre-eclampsia?
(Bear in mind that, as with any medical condition, not all the symptoms may occur at the same time).

  • High Blood Pressure
  • Proteinuria
  • Swelling of ankles, feet, hands or face
  • Severe headaches
  • Vision problems, such as blurring or seeing flashing lights
  • Pain in the upper abdomen (just below the ribs)
  • Vomiting
  • Excessive weight gain due to fluid retention
  • Feeling generally unwell