Pre-eclampsia and high blood pressure in pregnancy

Treatment in hospital for pre-eclampsia

Of the women we interviewed, there had been different ways that their pre-eclampsia had been managed and treated in hospital. 
 
Medicines and treatment in hospital for pre-eclampsia
 
Some women were already taking medicines before they were admitted. Aileen had a history of high blood pressure (chronic hypertension) and took tablets for this whilst she was pregnant. Other women were given medicines and treatments while in hospital. 
 
Those who had medicines described different types and treatments, such as:
  • Medicines to lower blood pressure
Most women took tablets, containing either a drug called labetalol or one called nifedipine. Josie took both labetalol and nifedipine, as this combination proved more effective in managing her blood pressure. But the nifedipine made her feel “light-headed and a bit woozy”. The doses of medicines to lower blood pressure were adjusted, depending on the readings from being monitored in hospital. Aileen found it worrying when her blood pressure kept spiking as she had a pre-existing high blood pressure condition and knew she was already on the maximum level of the medicines. Although the medicines sometimes helped, others found their high blood pressure was very difficult to lower and stabilise. Kay was sceptical about whether the medicines she took worked properly as her blood pressure readings were still very high.
Medicines to prevent a fit (eclamptic seizure)
 
If high blood pressure can’t be controlled with medicines, one major health risk is that the pregnant woman may have an eclamptic seizure – this can be very dangerous for both her and her unborn baby. The main medicine women had been given was magnesium sulphate, administered through a drip in the arm. Having magnesium sulphate can be painful and several women said it “burnt” as it went into their veins. Dominie is a midwife but her own experience was the first time she realised the infusions burnt. Lyndsey was pre-warned it would burn and she said the infusion was “probably one of the worst parts” of being hospitalised for pre-eclampsia.
  • Medicines to stop blood clots
Because high blood pressure can cause blood clots, some women were given injections to reduce the chances of blood clots forming. Kate remembered being given Clexane (enoxaparin). However, there were sometimes implications from these medicines. Josie and Aileen both said that having quite recently had anti-clotting injections meant delays when they needed emergency caesarean sections. Doctors don't usually operate when the blood is thin as it can lead to uncontrolled bleeding. Hanna wore pressure socks to reduce the chances of developing blood clots, but she found these very uncomfortable and “horrendous” to wear.
  • Medicines to develop the unborn baby’s lungs
Some women had steroid injections to help speed up the development of their unborn baby’s lungs. Doing this could give the baby a better chance of survival and long-term health. Munirah was given steroid injections when she was admitted to hospital at 25 weeks pregnant. Tests later showed that her baby was very unwell and, although the outlook was poor, she requested a second set of steroid injections: “I just wanted to hold on to any small hope”.
  • Pain-relief
Some women had pain-relief medicines. Claire had paracetamol to help with headaches. Kate had HELLP syndrome and took paracetamol for the pain between her ribs. She didn’t want stronger pain-relief; instead, she found it useful to have the pain as “something to concentrate on” and distract her from worrying about her baby needing to be born early.
  • Other medicines
A few people took antibiotics because their doctors thought they might also have an infection. Emma continued taking tablets for morning sickness and Nicola took her epilepsy medicines.
 
The different types of medicines taken in hospital could be confusing. Kate said she wasn’t necessarily aware of all the medicines she took at the time or since then: “I took an orange pill and I took a white pill, but I can’t remember what they were”. A few women found that the nurses sometimes forgot about giving them their tablets to lower blood pressure when the ward was very busy and so they needed to remind them.
 
Decisions about taking medicines
 
Some women had worried about taking medicines in pregnancy. But most of the women we spoke to said they felt okay taking medicine if it could help them get better and keep their baby safe. They trusted their doctors that the medicine was safe for them to take in pregnancy. Claire saw being in hospital and taking medicine as “doing my Mum job and I was protecting my baby”.
While a few people described side-effects, others said it would have been hard to notice these because they were already feeling very unwell. Lyndsey didn’t worry much about possible side-effects of medicines on her baby “because you naturally assume that the healthcare professionals know what they’re doing on that front”. Sometimes the risks of not taking a medicine were highlighted as more serious than possible side-effects from medicine. Dominie explained: “you have to have it [magnesium sulphate] to stop you from fitting […] If I don’t have it because I don’t want it to go over to him, I could fit and die”.
 
You can read more here about women's experiences about other decisions about their health and their relationships with midwives and doctors whilst staying in hospital for high blood pressure problems in pregnancy.
 
Rest in hospital
 
Although not a treatment as such, some women thought being monitored in hospital gave them an opportunity to rest more than they would at home, and they hoped that this might lower their blood pressure. It could be boring being ‘cooped up’ in bed day-in and day-out. When women felt relatively well, it was frustrating if doctors refused to let them go for even a short walk and change of scenery nearby. Mairi remembered being “so bored” – she was allowed to go down to the hospital canteen once with her husband but was warned she must come back to the ward immediately if she started to feel unwell in any way. Some women didn’t see monitoring and rest as an effective way to manage their high blood pressure problem and felt that medicine would have been a better option.
Chatting to the midwives/nurses and other pregnant patients on their ward helped pass the time. Talking to other patients with high blood pressure problems could be helpful, but it could also be frightening. Emma was upset after seeing a woman on her ward have an eclamptic seizure. Some were put on wards with women in very different situations to their own, and this could be hard.
For some, the ward environment was quite stressful and so rest wasn’t always very easy to achieve. Emma said it was “really noisy all the time and chaotic” on her ward – it wasn’t a very private or relaxing environment. Josie explained “there were some days when the ward was empty except for me and other days where it was really full and people coming in constantly, in and out”. A few women said their wards had been very hot and stuffy. This had been off-putting for Samantha Y who dreaded being re-admitted to hospital a second time; when she was sent to hospital again, she took a fan to help cool her down. One complication Kay had from her pre-eclampsia was that her kidneys were not working very well which made her feel very hot. She shared a room with four other pregnant women so it wasn’t always ideal to have the windows open in winter to cool down.

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