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Pre-eclampsia and high blood pressure in pregnancy

High blood pressure problems shortly after birth and late onset pre-eclampsia

Pre-eclampsia can still be a concern for several weeks after birth. Women can still have high blood pressure or go on to develop pre-eclampsia up to eight weeks after giving birth. For those who were ill during pregnancy, it can take a while for their health to return to normal and their blood pressure may need to be controlled by medication for some time. Women are monitored whilst recovering in hospital after giving birth, and usually have health checks after discharge. It is advised by doctors that women who have had pre-eclampsia see their GP on a yearly basis for health checks (see also section on future health).

Not everyone we interviewed was told about the risks of high blood pressure problems and pre-eclampsia after birth, and it could come as a shock. Some thought it should be flagged more clearly. Paige found out about the risks from a family friend who had experienced it herself. For Angela, the possibility got “stuck in my head” and made her anxious.
 

Paige was readmitted to hospital for high blood pressure problems after she gave birth. She was given more information the second time she was discharged.

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Age at interview: 20
Sex: Female
Age at diagnosis: 19
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But the first time it seemed very rushed. Like they were quite… they just wanted to get rid of me sort of thing. In their eyes I'd had a section; I was going to the toilet on my own and I was walking round, so they were quite happy for me to go. I don’t know whether they got me confused with another patient because, like I said I was… my mum was in complete and utter shock that I was being discharged after 48 hours after having pre-eclampsia and a section. But I hate hospitals and if the midwife said I could go home I was going home. The only thing you think of is your own bed, your own comforts; that’s what you're looking for. If I pushed it now would I have ended up back in – I don’t know; you're never going to know. But the second time they did seem to go through everything a lot more in detail. They were… had the OK from two different doctors, rather than a midwife just discharging me. I was discharged a lot later in the afternoon, rather than in the morning and I don’t know they just seemed more reassuring. "Obviously if you’ve got any problems ring us back straight away," and stuff like that. Whereas the first time it was sort of like, "Right, you're fine you can go. Just come back and see us once a day so we can check your blood pressure," sort of thing, whereas the second time I got discharged it was a lot different. Whether it was because it was a different midwife, or whether it was because they got to know me a bit more because I was in for so long, I don’t know but… or they were scared of me ending up back in again, I don’t know. But the second time was completely different; they were just more empathetic, made sure I had the medication, because when I was discharged the first time she'd given me this bag and was like, "This is your discharge bag; it's got your notes in." And actually went to bed… oh and some painkillers because I'd had a section, and I was actually in bed and my mum come to wake me up and she goes like, "What are these?" I was like, "I don’t know." She said, "What does it say?" She's like, "You're meant… when are you meant to take them; it just says take two?" And it was actually my blood pressure tablets that I had no idea I had to take.

So, I took them, whereas the second time I got discharged, they were like, "Right if you this now, these are these, these are these and this is when you need to take them," sort of thing. So they were a lot more reassuring. They were going through a lot more thoroughly and I think that helped me feel like I was ready to go home.
 

Dr Khan describes when women tend to get pre-eclampsia.

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Sex: Male
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Most women who are affected by high blood pressure are affected during the latter stages of the pregnancy. The majority of women are therefore affected in what we call the third trimester, which is the last one third of the pregnancy, and sometimes for the first to few days to weeks after they give birth to their child. In a minority of patients, they might be affected earlier but in a lot of these patients it turns out that, actually, they’ve had a blood pressure problem possibly from even before the pregnancy’s beginning.
 
There is a risk of pre-eclampsia after a woman gives birth. Although many women develop evidence of pre-eclampsia before they give birth, in some women pre-eclampsia only comes to light after the delivery but pre-eclampsia remains a condition of pregnancy and soon afterwards. It isn’t a permanent condition and it’s always the case that pre-eclampsia will get better if enough time is given. However, some women continue to need monitoring and treatment for a number of weeks after the birth of their baby.  
Returning to hospital

Some of the women we spoke to needed to go back into hospital because of high blood pressure and pre-eclampsia after giving birth and being discharged home. Vicki was re-admitted after she began to feel unwell. Although she thought it was scary for her husband being told to “just follow the ambulance with the new baby” when she was taken into hospital, the stay helped get her blood pressure back under control: “it kept going down when I was there [… partly because] when you are in hospital, you have got your feet up and you are doing nothing”.
 

Vicki had high blood pressure a few days after giving birth and returning home with her baby.

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Age at interview: 36
Sex: Female
Age at diagnosis: 36
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So he was delivered at 38 weeks, he was big enough, no no problems there. I came home a couple of days later, everything seemed to be fine and then I think it was on day five, he had actually developed a little rash and I think, you know, first time mum, really quite worried about it, thought we will pop down to, our midwives do a drop in clinic. So I popped down there and I had a splitting headache, which I’d had for two days but, as I mentioned, you know, as a migraine sufferer, that’s quite normal for me and I thought it was the stress of having a new baby, trying to breastfeed, everything like that and that’s what I put the headache down to. And, while I was sitting in the waiting room, I had to rush off and be sick and that’s when I thought, you know, oh dear, this is this is quite normal with a migraine as well, to be sick.

And then I went and saw the midwife and she said, “Are you okay?” And I said, “No, I haven’t been feeling well.” And when she took my blood pressure, it was the highest that she’d ever taken and I think it was up in the 210s, 150, or 130 or something like that. And so she was, you know, instantly, “You need to lie down. You need to get on your left side. We need to call an ambulance.” And I was rushed back into the [hospital] again. So yeah, and then, you know, they just monitored me. They put me on labetalol and more blood pressure medication, that kind of thing.
 

Kate developed some pains by her ribs just before she was discharged from hospital. She was reluctant about being readmitted.

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Age at interview: 35
Sex: Female
Age at diagnosis: 34
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I got home [small laugh]. I remember sitting at this very table, eating toast and drinking tea and just crying, with sheer relief. And I cried all the way home [laughs]. And my partner finally laughed at me, and he said, “What are you crying about?” “So I don’t know. I am just so happy to be alive, and be here.” Because I hadn’t been outside for eight days. And it was weird because it was, the world is still going on, and you think but it can’t. I’ve been stuck away in this prison. But anyway got home, got through it. Slept, actually did sleep luckily my baby was an angel. I think he knew that he just had to be, because [laughs] and then I woke up in the morning with a dreadful pain on my right hand side again. And I could hardly breathe. And I thought, oh what’s happening now? So I called NHS Direct and I explained and he said, “Right I’m sending an ambulance for you now.” And I said, “No, don’t, please don’t. I can’t bear it.” I couldn’t go back to hospital. I didn’t want to be an inmate again. And I thought if I go back in to A & E I’m going to have to explain my whole story again and I said, “No, honestly. I know you’re going to think I’m completely crazy, but I’ll got to the hospital myself and I’ll explain.” Because I had to go back in to get the injections anyway. So I went back in and I was very fortunate, because the two midwives who’d been there on my admission, it was their shift again, and I said, “Oh I’m here to get my Clexane injections and by the way I’ve got a bit of a pain here.” Now they said, “You shouldn’t have come here, you should have gone to A & E.” And I said, “I know.” But they also knew me thank goodness. So I was given an ECG to rule out any heart problems, and they suspected it was my liver which was distended because of the HELLP syndrome. So they gave me some co-codamol for the pain, but there’s basically nothing you can do for the liver, because its self healing. So I assumed I couldn’t have a drink or anything, and I didn’t get my Clexane injections because the fax hadn’t been sent [small laugh]. I thought no this can’t be happening. So I had to go in and get the Clexane the next day and I thought well my first two days out of hospital I’ve gone back into hospital. And the midwife the next day said, “You know, you should talk to the doctor about your problems.” And I thought, I can’t wait around for a doctor. I want to go home, because my family were coming. I hadn’t seen my family. And I thought, no I’ve waited long enough. I’m going to go home and spend time with the people who haven’t seen me and our baby.
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