Pre-eclampsia and high blood pressure in pregnancy

Monitoring during hospital stays for pre-eclampsia

Women we interviewed who stayed in hospital because of pre-eclampsia or HELLP syndrome regularly saw doctors and midwives and had their health closely monitored with different tests and checks. 

Most women had been on wards with other patients, many of whom were also being monitored. A few people said talking to the other pregnant women in the shared room was good and helped pass the time. Some even made lasting friendships. Women were closely monitored, especially if they were very poorly and doctors were worried that the situation could become more serious quickly. Paige remembered having one-to-one care where a midwife or doctor stayed in the hospital room with her all the time – “even when they were on break I had to have somebody else come in the room; I wasn’t allowed to be left alone”.
Ongoing checks

Doctors and midwives ran different tests and checks. Monitoring helps give a better idea of how serious the situation is and how it is or isn’t changing. Josie stayed in hospital for two weeks and, during this time, she had her blood pressure measured every three hours throughout the day and night, blood tests every two days and ultrasound scans every three or four days.
Women described various tests:
  • Checking blood pressure
All the women we spoke to previously had their blood pressure checked at routine antenatal appointments and some had also been self-monitoring at home. Blood pressure was also frequently monitored in hospital so that a fuller picture could be built up of the readings and any worrying readings could be acted on quickly. However, the frequency of blood pressure tests could be exhausting, especially if they were run all day and night. Aileen said the constant monitoring was reassuring but also tiring: “obviously I didn’t get a good night's sleep or a good day's sleep”.
  • Testing blood samples
Blood samples were usually taken and tested. Kay remembered having her blood tests taken at 6am every morning in the hospital. It was blood tests that revealed Helen X’s liver was not functioning very well and she was told she had HELLP syndrome.
  • Testing urine samples and measuring urine output
Urine samples and sometimes urine output (i.e. how much urine a person produces compared to the quantity of liquids they drink) were closely monitored too. Kay had to do both – her “first morning sample” was tested for protein levels and she had a “big tub […] to pour my daily amount” of urine which was measured as well as tested. Some women had restrictions on how much liquids they were allowed to drink each day.
  • Ultrasound scans and using a Doppler device
Some checks looked more directly at the health of the unborn babies. These tests including trace monitoring (also known as CTG or cardiotocography) which measures the unborn baby’s heartbeat. This usually involves a kind of belt being strapped around the pregnant woman’s bump, although Angela had one with “prongs” placed on her bump around the baby’s head which she said gave a very accurate reading. In some instances the midwife or doctor used a Doppler, a device moved over a pregnant woman’s bump to check the unborn baby’s heartbeat and the placental blood flow.
Frequent monitoring could be reassuring, but it could also feel like a chore. Kay remembered finding it annoying having nurses check on her all the time, but also realised it showed that they were doing their job well. Julie didn’t like the feeling of being “strapped to the bed” by all the monitoring equipment.
 
Monitoring guided the next steps taken in hospital for women with pre-eclampsia, such as taking medicines. You can also find out more about women’s experiences of being informed and included in decision-making in hospital here.

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