Pre-eclampsia and high blood pressure in pregnancy

Munirah

Female
Age at interview: 27
Age at diagnosis: 27

Brief outline: I developed severe pre-eclampsia 5 months (25 weeks) into my first pregnancy. Scans showed that my unborn baby had a brain haemorrhage and he had stopped growing. The doctors advised me and my husband to terminate the pregnancy, and our baby was subsequently stillborn.

Background: My name is Munirah, I am 27 years old and an administrator. I am married. Our son died before birth following severe complications from pre-eclampsia. I identify as being Asian.

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Being diagnosed with a high blood pressure problem

I developed severe pre-eclampsia 5 months (25 weeks) into my pregnancy. I had some pain above my bump and, when the discomfort continued, I went to hospital. My blood pressure was quite high and I was initially told I would be admitted to hospital. However, I was then told it was probably a urinary tract infection and so I could go home as long as I returned the next day for a check-up. Although I felt a bit unwell and had been sick, the pain-relief I had been prescribed helped. I felt reassured that there was nothing to worry about. I went back to the hospital next day – my blood pressure was still high and there was protein in a sample of my urine, so I was admitted to hospital. I remember being told that I would stay in hospital until my baby was born. Although I knew my baby would be born earlier than expected, I thought that everything would be OK. I started taking medicines to lower my blood pressure and had steroid injections to help my unborn baby’s lungs develop.

Finding out my baby was very poorly

Later that day, I had an ultrasound scan and a consultant explained that the situation was more serious than they had expected. The scan showed some white patches on my baby’s brain which suggested a bleed on his brain (a brain haemorrhage). My unborn baby’s growth had stopped and he was nearly half the size that he should have been at 5 months (25 weeks). I was told that I would be transferred to another hospital with the resources to deliver babies born earlier than 28 weeks. I was transferred the following day and saw a consultant paediatrician who explained the sad news that the outlook for my baby was poor. I had another ultrasound scan and the white spots on the brain had grown bigger, suggesting that the haemorrhage was getting worse. The doctors said that ending the pregnancy (a termination) would be the best option – my own health was getting worse, with my kidneys not working properly and I had very high blood pressure, and my baby was unlikely to survive birth. My husband and I felt we had no choice but to proceed with a termination. An injection was given to stop our baby’s heartbeat. I was induced and gave birth to my baby about two hours after the contractions started. I was exhausted and unwell after giving birth, and I collapsed when I first tried to get up. When we were ready, my husband and I spent some time with our baby in a separate room. This gave us an opportunity to talk to our baby and support each another.

Decisions after my baby died

It was important to my husband and I that no one else knew about the termination. We’re Muslims and our families hold traditional religious beliefs. They wouldn’t be able to accept the termination. Instead, we told our parents that the ultrasound scan showed the baby had no heartbeat. My husband and I agreed a post-mortem should be carried out on our baby in case it could some answers on what happened and the chances of it affecting future pregnancies. The post-mortem was also a decision that we felt our families would disapprove of. The hospital arranged for the post-mortem to be carried out within two weeks. We wanted it to happen quickly so that we could bury our baby as soon as possible, to be more in line with religious customs of immediate burial. The hospital was understanding and they accommodated our requests, such as arranging for our baby to be wrapped in a white cotton cloth for a cemetery burial.

I was discharged from hospital several days after giving birth. My blood pressure was still high and I needed to keep taking medicines, including a daily injection to prevent blood clots. I had regular check-ups and also monitored my blood pressure at home. My GP said I could stop taking the medicines after two weeks. It took about three months for my blood pressure to fully return to normal. I should have had a follow-up appointment six weeks after being discharged, but this was not arranged by the hospital. Instead, I had to pursue the appointment through PALS (Patient Advice Liaison Service). At the meeting, I was told that the post-mortem results showed that my baby’s health problems were entirely related to pre-eclampsia. They said that, if I became pregnant again, I would need to take aspirin and be closely monitored from 20 weeks onwards.

Emotional impact

The emotional impact of losing my baby as a result of pre-eclampsia has been huge. The circumstances of terminating the pregnancy make it particularly difficult to talk about. Soon afterwards, I tried to spend lots of time with family and friends because I didn’t want to be on my own. Other distractions, such as moving home and returning to work, helped me keep busy. I saw a bereavement midwife who signposted me to a national organisation with local support groups. I didn’t feel that meeting others in person was right for me then, but I did find some online discussion forums helpful. Reading about the experiences of other people helped me feel less alone.

Messages to others

Medical professionals should ask about family histories of high blood pressure problems in pregnancy at appointments. I told my midwife at my booking appointment that I have a family history of high blood pressure in pregnancy – my mother had been in hospital with problems when she was pregnant. However, nothing more was said about family history being a risk factor. The name pre-eclampsia was not mentioned in any of my antenatal appointments until I was diagnosed with it at 5 months (25 weeks). Yet I know that other women are more closely monitored because of their family histories of high blood pressure. This extra support should be consistently offered. Doctors and midwives should also let pregnant women know of symptoms to look out for. Looking back, I had some headaches and swelling during my pregnancy but I thought these were normal at the time. It was only after everything happened that I put all the pieces together about pre-eclampsia. It is important that pregnant women can see doctors and midwives if they are at all worried about their health.

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