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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.
 

Dominie took nifedipine tablets as she is asthmatic and labetalol wouldn’t have been suitable.

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Age at interview: 25
Sex: Female
Age at diagnosis: 24
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So, initially they just… they checked my urine, they put a cannula in and took some bloods, and they do kind of blood pressures ten minutes apart; so you get three blood pressures, then they get you an average blood pressure over that time just so you’ve got an idea of whether it's fluctuating or whether it's true high blood pressure and it remains high. So, I think my average was 200 over a 120. So, they couldn’t give me labetalol which is the drug that they regularly use round here. To drop your blood pressure, because I was asthmatic.

And I have had a few asthma attacks, so I think if you’ve got minor asthma you can have Labetalol, but not how severe mine is. So they gave me Adalat retard so some nifedipine, and I had… I think I had two or maybe three lots of dose, and in that time my blood pressure went higher.

So, it wasn’t actually doing anything. So, my mum lives in [city] about ten minutes away from the hospital, so I'd phoned once I'd got in there, but by the time that she arrived I was already up on labour ward because they just… my blood pressure was just wasn’t going down how they thought it should be. And the next drug they had to give me was an IV drug that they have to monitor me on so yeah.
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.
 

Josie’s doctors decided she needed an emergency caesarean section. She had quite recently had an injection to prevent blood clots, which meant waiting longer until she could be operated on.

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Age at interview: 45
Sex: Female
Age at diagnosis: 39
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The CTG (Cardiotocography), for it seemed like hours and hours and hours, and there were some very drastic decelerations, and I'd have doctors come and go and come and go and come and go, and say you know, "We may have to deliver," and … ah I'm trying to think of the actual process because this was all going on from about eight or nine at night till, you know till the early hours of the next morning. So there was… some were saying it was OK and others were saying, "Well we're going to have to deliver." But and then was an issue of the fact that there was no…there were no operating theatres available you know, so I was kind… I felt that it really did feel that night that we were up against it. And I had a Doppler scan and there was a real clear sound of the dip in the heartbeat going much, much slower, and so I'd also only just, a few hours beforehand, had the injection for thinning my blood, so they said, "Well we can't do anything until, you know until you get over that anyway; until your blood starts to thicken up again." So, anyway this all went on for, you know most of the night until about four in the morning where they rushed me, or I rushed, I ran, to a… into an operating theatre and he was… yeah he was delivered in about four minutes.
  • 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”.
 

Paige had tests and various medicines, including some to lower her blood pressure and to help her baby’s lungs develop, when she was admitted to hospital.

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Age at interview: 20
Sex: Female
Age at diagnosis: 19
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I went in at 26 weeks. I had… what did they do? Urine test to see what was in there. They done blood pressure and they managed the baby's movements and baby's heartbeat. When I went in at 32 weeks they said my blood pressure was through the roof. At one point it went to 205 over 130. So, as soon as I went in it was steroids for the baby and then I had to take two lots of pills straight away. Blood pressure was being taken every two minutes – that wasn’t bringing it down, so they tried something else and then there are a lot of pills. Again that wasn’t bringing it down so they tried IVs; I was just having bloods like… look at my arms and it was just bruises all down my arms where they were just sticking stuff in, pulling blood out to try and find out… try and make sure it was coming down.

And then again through all this baby was being monitored. Eventually they managed to get the IVs and it had come down, stayed stable overnight. Had another lot of steroids then for her and they were just like, "Look now you’ve had your steroids." I wasn’t outputting any water; I had to drink 85 mls of water every hour. I was lucky to output 20 [mls]. So they knew my kidneys and everything else were, aren't-, failing. And then they were like, "No, you need to get… we need to have this baby out because although your blood pressure it's not just that that’s the issue, it's everything else that’s coming with it now as well." 
  • 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”.
 

Claire was in hospital for four days when she was 33 weeks pregnant. She describes the aims of her staying in hospital and having medicines, such as steroid injections.

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Age at interview: 39
Sex: Female
Age at diagnosis: 39
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To give her more of a chance, to keep her in as long as we possibly could. To be born at 34 weeks is, you know it had to be done, it had to be done, but yeah if we could have kept her in longer everything gives her… at 34 weeks there's that teetering point isn't it where her lungs and her developmental things, it's everything happens so quickly then. Yeah it was to try and keep her safe and give her the growing time if she needed it. By that point as well they'd given her steroids, so it was a case of I knew that, at least the 24 to 48 hour period to give the steroids the chance to, to really work.
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.
 

Olivia stayed in hospital for a week. She wasn’t given any medicines but she thought rest helped her blood pressure lower. She was discharged but returned to the hospital only a few hours later.

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Age at interview: 32
Sex: Female
Age at diagnosis: 28
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I was in for the week that week. So, 37+5 to 38+5 I was in. And every day I was saying, "So, what are you going to do with me?" and they said, "We're just going to monitor you." I was like, "OK." One of the consultants came round and he was like, "Most of the women in this hospital are because of pre-eclampsia, you know everybody on this ward right now, they're only here because of pre-eclampsia," and I was like, "Oh right OK," and he's like, "That’s what you’ve got," and I know, you know I know [laughs]; I diagnosed that myself months, you know months ago, I know I've got pre-eclampsia. And he said, "Yeah, that’s pretty much all we can do to make sure you don’t do anything." He was like, you know "We don’t want you going further than the bathroom; we just want you to stay still, don’t move and just wait to go into labour," and I was like, "Oh right OK." I had responded to lying still; my blood pressure came right down – I think it was around a 133 – it stayed high for a couple of days and then it came down to about a 133 and this was at 38+5, and he said, "You can go home if you want today." I said, "OK yeah, I'll go home now," and I said, "Do I just continue bedrest?" He said, "Yeah, bed rest until you deliver." Alright fine. 
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.
 

Aileen had to stay on some wards which weren’t appropriate to her situation. Whilst still pregnant, she spent time on a postnatal ward and a labour ward.

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Age at interview: 40
Sex: Female
Age at diagnosis: 35
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I was in a ward; I was… there was one time I was in a postnatal ward and there's obviously mums there whose had a baby, with their babies. And I don’t think it's a good experience for parents who are scared that their baby come out early or might be well, mixed with mums whose had a well baby, healthy baby and thinking, 'That might not happen to me.'

Or being mixed with mums whose in labour and shouting and screaming and it was…that was…I think that terrified me having a normal delivery.

I heard all the swear words and all the screaming and shouting and I thought, 'I don’t want that,' yeah.
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.
 

Nicola was admitted to hospital with suspected pre-eclampsia. She didn’t like the ward environment, but was told she had to stay on one because she has epilepsy and so doctors thought she was at greater risk of having a fit.

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Age at interview: 33
Sex: Female
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The risks - my blood pressure was actually fine, but the pre-eclampsia - what they thought was pre-eclampsia starting was in the, was the protein in my urine, which had reached four, which is apparently incredibly high. All these things you discover. And he said, "I want you to go home and be back by 3.30 to book - you know, to - and you're not going anywhere, and we'll see how you are when we deliver the baby.” So gone were all thoughts of how I'm going to have this baby. I was sort of, "Oh my God, the nursery's not ready. I haven't bought the sheets and" you know. So I go home and teach my husband how to work the washing machine.

Was he with you?

Yes. Which was actually not - because we went so often, and he works, you know, a reasonable distance away, he was with me because we thought we were going to go and see an anaesthetist and things, whereas a lot of them I'd been to on my own, or my mum had taken me to a couple, and you know. So that was a fluke, really. And we went out and had a nice lunch, came home, packed, and in I went and cried my eyes out. But the reason they were worried about the pre-eclampsia - I missed that bit - was because pre-eclampsia can trigger seizures. And that is the, that is what happens, if it gets very, very bad. And with my tendency to seizures anyway, they were worried about the two, which was why the professor said, "You're staying in", and the registrar had thought we might think about it for a while. And so I arrive, and they can't put you in a room on your own, which a lot of the, you know, people on this special floor were in, because I might have a seizure. So you can never be on your own, so you have to be in a ward with four of you. So, which, you know, is fine, but I was distraught, just beside myself. And it was horrible in there, just ghastly. And it was sweltering, absolutely sweltering. And we were - the one godsend was that the hospital has beautiful gardens, and every night my husband came with dinner. So he'd go to work, come home, cook dinner, put it in the car and bring it up, and we'd have a picnic every night.
 
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Josie asked to be put in a quiet side room as she expected to be in for a long time, but she was told she had to stay on the bigger and busier ward.

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Age at interview: 45
Sex: Female
Age at diagnosis: 39
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Because another thing that happened that was quite bizarre was that I was on a ward and even though there were private rooms, they wouldn’t put me in one of the private rooms. I asked several times; I said, “I'll be here for a long time”. They said, “No, no, we need you there”. So, I was on a ward with other women coming and going and it was a-, you know, it was-, a lot of women were in for inductions and so on. So, you know, every day I was kind of witnessing all these women having inductions and so on. You know, some women were in with medical complications but a lot were just in for induction and things like that. So, it was, yeah it was, you know, I just felt I was sort of surrounded by it all and by all this information. I always said I'd probably be able to qualify as a midwife after over-hearing these conversations all the time; it seems like I picked up so much and learned so much, you know, from kind of just being there on the wards and seeing what was going on.
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