Pre-Eclampsia Isn’t Always Over with Delivery. What You Need to Know and Do Post Partum

September 7th, 2010

Pregnancy complications don’t always spontaneously resolve with delivery. Case in Point:

I just got an e-mail request from a mom’s group that I am a part of requesting prayer requests for one of our members. She just had a baby a couple of weeks ago and ever since she has had severely high blood pressure. She has been experiencing “migraine” headaches at home and her husband has taken her back to the hospital several times because of her high blood pressure and headaches. She was diagnosed with post partum eclampsia, excessive high blood pressure that occurred after pregnancy, and was sent home to rest with her baby. My friend’s husband has been monitoring her blood pressure at home and making note of her headaches. When her blood pressure soared again yesterday, he again took her back to the hospital. This time she had a CT scan and MRI scan. The scans detected a small blood vessel that had burst. This likely occurred around the time of her delivery and has been the cause of her high blood pressure and headaches.

Ladies, many pregnancy complications don’t spontaneously resolve with delivery and high blood pressure or pre-eclampsia is one of them. I don’t know if my friend had high blood pressure during her pregnancy and I don’t recall her being on bed rest, but I am reasonably sure that she did have high blood pressure before she left the hospital. Pre/Post Partum Eclampsia can quickly become a medical emergency and my friend could have died in the time that it took doctors to diagnose her condition.

As explained in a previous post on pre-eclampsia, the condition is characterized by high blood pressure, protein in the urine and swelling (especially of the hands, feet and face). These symptoms together create a toxic intrauterine environment for the baby as well as a dangerous physical condition for mama, so when the symptoms become uncontrollable, the baby is emergently delivered either via labor induction or via cesarean section.

In many instances, delivery is enough to quell the symptoms of pre-eclampsia and to restore stable health to both mama and baby, but it’s not always curative.  Some women, like my friend, have persistent symptoms or, which may have been her case, develop symptoms after delivery. It is highly likely that her blood pressure was elevated at discharge, so the question becomes, why was she sent home? Hypertension is defined as blood pressure over 140/90, but as was also pointed out in the blog post on pre-eclampsia, if a woman normally has low blood pressure, say 110/60 and her blood pressure shoots up to 130/80, even though she does not have “clinically high blood pressure”, the fact that she has jumped 20 points on both her upper and lower numbers is cause for alarm. The more prudent course, regardless of which type of hypertension she had, would have been to keep her in the hospital for at least another 24 hours, to closely monitor her blood pressure at frequent intervals and at each vital sign check, to evaluate her for swelling and to ask if she is experiencing any headaches.

The other question that comes to mind is does my friend know what her blood pressure is when she is not pregnant? This is critical information. If she knew that her blood pressure is regularly 110/60 when she is not pregnant, if her blood pressure did not begin moving in that direction after delivery and most certainly if it steadily crept up, she could have quickly relayed that information.

Here is where I think we women falter. Did my friend ever ask the nurse what her blood pressure was? Dr. Linda Burke-Galloway in her book, The Smart Mother’s Guide to a Better Pregnancy* (read our bookreview, and listen to our podcast interview), encourages women to be keepers of their own health records. She advises (as I do!), Whenever you visit your health care provider or while you are in the hospital, ask what your vital signs are and keep your own little log. You’ll know if you are gaining too much weight too quickly or if your blood pressure is creeping up. You will be able to notice trends in your own health and  quickly notify your provider if there is something out of the ordinary. If we women are to be partners in our health care, we must share in the responsibility of caring for ourselves and that includes doing what we can to keep track of our health, noting and reporting changes. You know you best and in an emergency, may be your best lifesaver.

As for the headaches…Headaches in a person with high blood pressure are NEVER a good sign, and almost always indicate that the blood pressure is dangerously high (even if not clinically “hypertension”) for that person. Given that my friend was immediately post partum and having headaches and high blood pressure, I am again surprised and concerned that she was discharged and that it took about 3 weeks for her to be readmitted. Pregnancy itself creates a state of increased fluid volume throughout the body. This in part contributes to high blood pressure. The additional fluid pressure creates increased pressure on blood vessels that could lead to rupture. Additionally, the extra hormones of pregnancy put women at increased risk for developing blood clots. So between the increased pressure on the blood vessels, especially the micro-vessels in the brain, as well as the increased for blood clots, pregnant women are at increased risk of both hemorrhagic (bleeding) stroke and occlusive (blockage due to a blood clot) stroke. I am not sure if my friend was diagnosed with a stroke, but she did have a bleed in her brain, what they seem to regarding as a “small rupture of the blood vessel” (more like a leakage) that doctors feel competent they can treat. Treatment is great, but the question is, could this have been avoided if she had remained in the hospital and been monitored or have been admitted at one of her earlier presentations to the emergency room??

I am happy to say that my friend is doing much better. The doctors are tending to her blood pressure and to her leaking blood vessel and I will continue to pray for her full recovery. But this could have easily become a really bad situation. If her leaking blood vessel had gone undetected, it is very likely that my friend would have had a full on stroke, with potentially cognitive and physical deficits. How awful that would be for a mother with 3 small children, one a newborn infant. Even worse, she could have died leaving her husband a widower with 3 young children to raise.

Ladies, please be active partners in your health care. It’s okay to have faith in your obstetrician or midwife, but know for what is going on with your pregnancy, ask questions and give input. Remember, you know you better than anyone else and if something is not feeling quite right, talk with your health care provider immediately! Make them listen to your concerns and don’t stop talking, asking and if necessary demanding until all of your questions and concerns are addressed to your satisfaction.

Update 9/8/2010

Just got word that my friend’s blood pressure is down, the brain bleed has been treated and she is resting at home comfortably. Let’s hope it’s for good this time!

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