Until the beginning of her third trimester, Mrs. C, 26 and having her first baby, would have said her pregnancy was pretty normal. Things were progressing smoothly and she was busily preparing her home for her soon-to-be-born son.
Then, at the 30th week of pregnancy, she noticed a sudden weight gain; both her legs were swollen too. She gave me a call that day and promptly came to see me.
She looked anxious and was very concerned. Her face was puffy and her ankles were swollen from water retention. She told me that her shoe size had increased since her last appointment three weeks ago, and she was a larger size now. Even those felt a little tight on her.
I checked her blood pressure and it was alarmingly high at 200/100mm Hg. Her usual blood pressure was normal at 120/70mmHg. A large amount of protein was also found in her urine.
A routine ultrasound scan to chart the baby’s growth showed that he was small, with all his growth parameters below average. I told Mrs. C she had preeclampsia and that she should admitted to hospital at once for her surveillance and also that her baby. We began anti-hypertensive therapy straight away.
Hypertensive disorder in pregnancy (often referred to as preeclampsia) is a fairly common condition. It affects about 10 per cent of first pregnancies and can be very dangerous to both mother and baby even if the mother does not feel sick. Severe hypertension, as in Mrs. C’s case, can lead to maternal death and foetal demise.
The causes of preeclampsia are still unknown. Certain medical conditions such as chronic hypertension, chronic kidney disease and diabetes are associated with higher risk of developing preeclampsia.
It is also more likely to develop in women who are pregnant with their first child, those who are younger than 20 and older than 40, those with multiple pregnancy and those who have had preeclampsia during a previous pregnancy.
Symptoms include persistent headache, blurring of vision, nausea or abdominal pain, and swelling of the hands, face and legs and reduced volume of urine. If the blood pressure is too high, the mother can die from epileptic type of fits, coma, stroke, and heart, kidney and liver failure.
The baby may die from premature birth or premature separation from the placenta. There is usually restriction in the growth of the baby from malfunction of the placenta as in the case of Mrs. C.
She was started on medication and her blood pressure was monitored closely. Mrs. C required maximal dosages of oral medication, some of which made her sick. She was lying in bed most of the time and got up only to have her meals or to use the toilet. Even so, her blood pressure remained very unstable and difficult to control. Sometimes, she would get bad headaches and nausea. Her blood tests also showed that her kidneys were affected by the blood pressure.
I had frequent discussions with her and her husband. They were alerted that if the blood pressure was too high and threatened the mother’s life; the baby would have to be delivered regardless of his chances of survival.
The optimal outcome would be to deliver a healthy baby. In this situation, the obstetrician is like an acrobat walking a tight rope and this can be distressing to him.
Meanwhile, Mrs. C’s baby had frequent and regular ultrasound scans to monitor his growth. His heat beat was measured electronically by cardiotocograms (CTG) to ensure adequate oxygen supply. Malfunction of the placenta can cause sudden death to the baby. Steriod injections were also given to the mother to help improve the baby’s lung function.
At the 32nd week of her pregnancy, all the parameters indicated that the oxygen supply to the baby was diminishing. It was decided that the baby would benefit from medical support at the neonatal intensive care unit rather than the womb’s “hostile” environment. The baby, weighing 1.28kg, was delivered by caesarean section and immediately admitted to the intensive care ward.
When Mrs. C awoke from the anaesthesia, her husband told her how painful it was to see the baby hooked up with so many tubes and wires. It was a wrenching sight as the baby was no bigger than a kitten. They prayed that the baby he would pull through. And pull through he did – he is now a bubbly, feisty four-year-old boy