Pre-Eclampsia Stories - Denise Lawrence's Story

My story starts at 25 weeks with my doctor giving me the all clear and asking me to make 3 appointments, one for 31 weeks, 34 weeks and 36 weeks. My BP was 130/80 and my urine was clear of proteine.

I started to notice swelling in my legs and hands at 27 weeks. By 29 weeks my total weight gain was only 4 kilos. During the next 2 weeks I gained another 3 kilos even though my diet did not alter.

At my 31 week check up my BP was up 140/90 (borderline high normal) and I told my doctor of my sudden jump in weight during the last two weeks. He was concerned and told me to come back in two weeks rather than three weeks as originally planned.

By 33 weeks my weight had gone up another 3 kilos and I was definitely starting to look puffy. My BP was now 150/95 and I was told I could work only one more week. I was also to see my doctor at the end of that week.

The next night (Saturday) I went to bed early as I had a headache and was feeling nauseous. I woke the next morning unable to move and decided to seek advice from the hospital. They suggested I come in for a check up. It took me 3 hours to get mobile and make my way to the hospital as I was feeling very ill.

Once at the hospital I had to wait for 45 minutes before someone was available to look after me. (The real reason, which I learnt later on that evening, was that I looked so awful when I arrived they wanted me to rest before they moved me to a room). I was taken to a semi private room where by BP was checked and the sister left. She returned shortly with a CTG (foetal monitor) and also asked me for a urine sample. After about an hour my BP was checked again and the CTG output examined. The sister left only to return 10 minutes later, to tell me I was not going home. My BP was 170/110 on admission and still 170/105 after one hour. It was Mother's Day. I was 33 weeks pregnant and it had been only 2 days since I last saw my doctor.

On Monday, after a one night stay in the hospital, my BP had stabilised at 165/90 and I was allowed to go home. I was prescribed Aldomet for my BP and was to return to the doctor on Friday. I spent five days at home resting but that didn't stop my BP from going up 170/110. My doctor readmitted me to hospital where I spent the next two days. I was again allowed to go home on the Monday but had to return to the hospital on Tuesday for a CTG, BP check up and urine test. Everything was fine. The next day, Wednesday, I had to get my BP checked again as well as go for an ultrasound. The utrasound showed good blood flow to the baby.

That night I developed upper abdominal pain and a severe headache. A few hours later I started vomiting. Finally at midnight I phoned the hospital, their advice was to take some panadol and call back if the symptoms persisted. I finally fell asleep around 1.30am and woke the next morning at 9.00am. The headache and upper abdominal pain had gone and the baby was moving around a lot so I didn't feel the need to contact the hospital again. By 3.00pm that day the baby hadn't moved again, so I called the Doctor. My appointment was for the next day but they suggested I come in as arranged. They rang later to say to go to the hospital instead because I would have to go there after I saw my doctor anyway. When I arrived at the hospital, I was taken to have a CTG, BP check and urine test. This time things were not so good. My BP had gone up to 180/115 and the baby was in foetal distress. The doctor was called and he headed straight over from his rooms. They called my husband and told him I was probably going to have a Caesarean that night and to come to the hospital. When the doctor arrived he checked the CTG and decided to cancel the Caesarean because the baby had settled down. He felt it would be in everyone's best interest to let the pregnancy continue as long as possible.

Friday came and went with the usual round of tests, BP, CTG and urine. Saturday was to be a bad day. I woke with upper abdominal pain, a headache and nausea. Unfortunately the doctor was off for the weekend and his stand-in didn't really want to intervene unless things became critical because I wasn't his patient. He did however order blood tests and more frequent CTG's, BP, and urine tests. Sunday came and went much like Friday except that I was allowed to go home for a few hours to get some more things. My doctor returned on Monday to inquire how the weekend went. .I told him about Saturday again. He decided to do an internal the next day to see if I was ready to be induced and if I was he would induce me on the Friday. At last an end to all the abdominal pain.

Well I never made it to the scheduled internal exam for the next morning. I started to get sick again at about 6.00pm on the Monday evening. By BP went up and my urine, which previously had shown no protein had suddenly shown 3+ protein. My doctor was notified, BP machines were hooked up and ran constantly. At 3.00am I started to vomit, not an easy thing to do with all those machines around and the intense abdominal pain. By 4.00am I was asking for pethidine because the pain was so intense. The doctor arrived at 5.00am to find me continually getting sick. he examined me and found I was already 3cm dilated, and decided to go ahead and induce labour. The pros and cons of vaginal delivery vs. Caesarean section were explained in great detail before I made any decision to go either way. Because it was felt that I would probably end up with HELLP Syndrome, it was decided that vaginal delivery was probably the safest choice. (HELLP stands for haemolysis, elevated liver functions and low platelets).

I was taken into the labour ward and my waters were broken at 6.00am. Contractions started right away and were 5 minutes apart. The pain of the contractions coupled with the upper abdominal pain I had for the past 12 hours were too much to bear. I told the sister to tell the doctor I had changed my mind and I wanted a Caesarean. He said that was fine but I would have to wait for an anesthetist until 7.30am so I could have an epidural. The epidural was worth the wait and I fell asleep until 9.00am when my doctor returned to see if I still wanted to have a Caesarean. I said I did not and he left saying
he would return at 12.00pm to see how things were going and that a Caesarean was still a possibility. I slept off and on until 11.30am at which time I woke because I could feel something brushing my leg. I thought it was my catheter falling out but it turned out to be the foetal monitor which was attached to the baby's head. The doctor was called and arrived at 12.15pm, we were all now just awaiting for the arrival of the Pediatrician. He came in at 12.35pm and Stephanie was born at 12.39pm after only two pushes. She had an apgar score of 9 at 5 minutes and weighed 4lbs 10oz. She was a picture of health. Unfortunately I was not so lucky.

Once the epidural started to wear off, my BP started to go up and the vomiting started again. I was given Nifedipine to bring down my BP and also an injection of Pethidine to relieve the pain in my abdomen due to my liver swelling. I was moved onto the ward at 5.00pm and positioned in a room directly opposite the sister's station so I could be closely monitored. The abdominal pain was so severe I was getting Pethidine injections every 2 hours and spent most of the night either crying from the pain or in a daze from the Pethidine. My urine output for the first night was 10 litres.

The next morning I was allowed out of bed to go to the nursery to see Stephanie. I had walked about 4 metres when I felt a gush of blood, I had started to hemorrhage. Fortunately it didn't last very long so 1was able to get back to the nursery later that day.

The results of my blood tests came back at 4.00pm, there was evidence of haemolysis on my blood film, my platelet count was 41 and my LFT's were elevated. My platelet count the day before I had Stephanie was 205, and my pre-pregnancy platelet count 450. It's no wonder I had a bleed when I got out of bed.

On the Thursday I developed jaundice, petechia (small pin pricks of bleeding under the skin) and my nose bled every time I touched it. My abdomen was still very tender but I was managing to get around. I did not have another blood test until the following Monday. It showed that my platelet had returned to my normal value of 450 but my liver function tests were still becoming more abnormal. By the Thursday I was able to be discharged. I had been in hospital for 15 days. I was also referred to a Physician for management of my liver and blood pressure. Stephanie was to remain in hospital for another 10 days until I was confident that we had established a good breastfeeding routine.

Prior to the birth of Stephanie, I had worked in pathology as a Medical Scientist at the hospital where I chose to have my baby. Neither pathology nor the midwifery staff had seen a patient with HELLP Syndrome before, I was their first. Because of my training I had a fair idea but it didn't make it any easier to actually go through the process.

Finally, I would like to add that my blood pressure only returned to 110/70 just in the last few months (it took 2 years) and my liver functions took 6 months to return to normal. I also cut alcohol out of my diet entirely for about 12 months and even now when I do drink I only have at the most 2 glasses of wine per week. And yes, Stephanie is happy and healthy, but still small compared to other children.