Pre-eclampsia and high blood pressure in pregnancy

Kate

Female
Age at interview: 35
Age at diagnosis: 34

Brief outline: Kate’s pregnancy had gone very smoothly until she reached 36 weeks. She developed pains which she thought were indigestion, but soon became more severe. She had high blood pressure and doctors soon diagnosed HELLP syndrome. Her son was born by emergency caesarean and was fine although small.

Background: Kate is a teacher. This was her first pregnancy. She lives with her partner and son. White British.

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This was Kate’s first pregnancy. It was a “model” pregnancy until 36 weeks when she developed high blood pressure and severe pains in her chest, which came on very quickly. She texted the midwives overseeing her care but received no reply and after calling NHS Direct she went to her local hospital. 

Kate arrived in hospital at 9pm in the evening and was soon told that her blood pressure was dangerously high and that they were going to have to deliver her baby by emergency caesarean immediately. She was conscious when her son was born at 3am in the morning, and was able to hold him for 10-15 minutes. However her condition deteriorated and she was rushed to another hospital where they had an intensive care unit (ICU) to stabilise her blood pressure, liver and kidney function. She had developed HELLP syndrome.

Her baby was fine but transferred to a neo-natal ward in the original hospital as he was small and needed naso-gastric feeding. Kate was 2 days in ICU and 2 days in a high dependency unit (HDU) before she was allowed back to the original hospital to be reunited with her son. She then spent a further 5 days on the post-natal ward until her blood pressure had stabilised. She describes feeling very distressed and angry, and being in a great deal of pain during her stay. She was not allowed visitors, apart from her partner, so friends and family (who had travelled hours to see her) were turned away, despite the seriousness of her condition. 

Kate was distressed at the delayed bonding she felt she had with her son, and at not being able to establish breastfeeding as they had been separated for so many days at the start. At the time of the interview her baby was 14 weeks old and both mother and baby are doing well. But Kate was clearly traumatised by her near-miss experiences and the fear of being in ICU/HDU and the hospital generally. She described the hospital as a prison and herself as an inmate. 

Her GP has been supportive, although the follow up midwife care was poor. She was discharged by the community midwives without them noting down either her medication or the fact that she had had HELLP. Her follow up with the consultant took place at 10 weeks, and was helpful. He advised her to wait at least a year before thinking about another pregnancy, and that the next pregnancy would be under his care, and classed as high-risk. The consultant did not discuss with her the likelihood of HELLP developing again even though she has a higher risk of developing it in future pregnancies.

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