Pre Eclampsia support

For Women & their families who have suffered with Pre Eclampsia, Eclampsia, HELLP syndrome, Pregnancy induced hypertension (PIH) and related conditions.
 
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 reading your medical notes

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*Carole*
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PostSubject: reading your medical notes   Wed 13 Jan 2010, 2:52 pm

This is a really shortened version of my story, I will write a full one eventually, but i wanted to put into context what happen in relation to my questions.

I was seen on the DAU every 2 days for a week with high BP before being admitted to the ward with high BP(high 90's and a couple of 101,103 etc) that wasn't stablising despite methlydopa at it's highest dose. All the time I remember being asked if I had headaches, visual disturbance but I felt well and I had no protien. I was discharged home after 5 days because (I feel) the consultant was convinced that my high BP recordings were as a result of me being anxious and being in hospital. it's like they couldn't believe that i had PE because i didn't tick all the boxes. I was lucky that a midwife was suitably worried to ask the doctor to prescribe the steriod injections whilst I was there 'just in case my baby came early'. eventually they said come back to the DAU in 1 week; i didn't even make 12 hours at home. In the early hours of the morning I woke with terrible pain in my chest and back and thought i was having a panic attack. i had swollen up like balloon and thought I was dying. I arrived at the delivery suit at 3.30am and luke was delivered at 5.49am at 31+5 weeks.

as part of my coming to terms with what happened during my pregnancy and luke's early delivery I obtained my birth notes. I read through them and although it wasn't a big revelation, i was interested to read that my BP was 199/114 and 197/120 in the delivery suite with protein 3+++, clonus> 3 beats. i presumme that this is bad? During theatre my BP peaked agian to 203/121.

i was also interested to read that i had a spinal. I always presummed that I was given an epidural as all I remember was trying to be still, shaking and being sick whilst they put the needle in my back, all the time I was howling with pain in my chest and back from my liver. Spinals are quicker to administer?

there were a few things that I'm not sure about.

* when I was admitted from the DAU to to the ward for BP monitoring part of the plan proposed was for a doppler scan, yet i didn't have one of these, despite being an inpatient for 5 days. would the doppler have helped predict how my PE would develop and that Luke was small for dates?

*I remember being given an IV drug straight away when I was at my worst and the doctor saying that it may make me feel hot. I could feel it travelling through my body and it made me delirious and I felt like I was on fire. i then proceeded to wet myself and throw up over my husbands shoes. in my notes it says I was given bolus doses of hyrailazine and mag. which of these would have made me react like this?

* the nurse records my -c-section as an SOS 5, what does this mean?

*My c-section notes state that the placenta had seattered infacts, is this an indication that it wasn't functioning properly?

*my blood loss was 500mls, is this about average?

* why was I put on a syntocin drip post c-section, I thought that was a hormone for induction?

* I know that I become worst post delivery with HELLPs and my blood results sheet is full of arrows indicating high levels of things. AST is recorded as 828, with a comparison of 20 on the ward a few days earlier. do you know what is the normal range? and that my platelets dropped that evening to 111. what is LDH? this was red marked at 2360. this was all around the time when they considered moving me to ICU.

* what role does uric acid play in PE, my levels seemed to be consistently rising whilst I was being seen on the DAU and the ward.

I know i can't change the past but I'm interested to understand a bit the disease that robbed me of a healthy pregnancy.

thanks so much
Carole
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Bell
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PostSubject: Re: reading your medical notes   Thu 14 Jan 2010, 5:19 pm

Hi Carole,

The drug that would have made you feel warm all over was the IV Magnesium. It makes you feel warm from head to toe, dries your mouth and can give you a feeling of impending doom. I felt the very same when i was given it.

My pathology results from my placenta showed that i had multiple infarcts on it. This reduced the blood flow thus reducing oxygen to my baby.

Bell.x
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*Carole*
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PostSubject: Re: reading your medical notes   Fri 15 Jan 2010, 1:29 am

thanks bell and alison, it's nice to get things clearer in my head. Although I was very fortunate to have the spinal and not GA I don't have much recollection of the delivery other than feeling very frightened. I think as soon as i was given the cannulas and mag sulphate I closed my eyes and went a bit loopy, it must have been the drugs and my reaction to a stressful situation. It's interesting to know that the mag makes you feel warm all over generally as I know from reading my notes that as well as the bolus dose I was on a mag drip post delivery and i kept complaining that I felt hot. My husband was concerned and the nurse was taking my temp regularly but it's recorded as within normal range.

I think I must have developed Hellps, but it was my liver that took the biggest hit. My only post delivery advice was if we wanted another child to wait at least a year due to the c-section and I could try for a VBAC, not a very comprehensive chat. It was so good to find this forum, thanks Liz.
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*Carole*
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PostSubject: Re: reading your medical notes   Sat 16 Jan 2010, 8:19 pm

I just wondered if Liz or anyone else could add anything else.
Thanks so much
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Liz Pidgley
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PostSubject: Re: reading your medical notes   Mon 18 Jan 2010, 2:51 pm

Hi Carole,

Im sorry, I seem to have missed this thread till now.

Im sorry too, to hear you had such a rotten time with this horrid condition.

I think the ladies have done a good job in answering some of your questions but here is what I think!

The IV drip was magnesium sulphate. It is given primarily to help lower blood pressure & prevent an eclamptic fit.
Until recently (Last 10 years or so) it was assumed that conventional anticonvulsants, particularly diazepam and phenytoin, were the best agents for controlling eclampsia and preventing further convulsions. But a landmark multinational trial (the MAGPIE trial) has now demonstrated that magnesium sulphate - the drug of choice in the US for many years - is better than either at preventing further convulsions, and may also save more lives .
The drug is thought to work by improving blood flow to the brain, which suggests that impaired cerebral blood flow is the main cause of eclampsia. When these results were published in the summer of 1995, only 2-3 per cent of UK obstetricians were known to use magnesium sulphate, but this is likely to change in future. The drug is given by injection and is relatively straightforward to use.

However, there is no suggestion that magnesium sulphate has any effect on the underlying pre-eclamptic disorder, and a woman who recovers from eclampsia may still be at risk from other complications of the condition. There is evidence to suggest that magnesium sulphate may prevent eclamptic convulsions in women with pre-eclampsia, but as yet it is not possible to identify those who would benefit most from treatment.

The only thing is with this medicine is that is feels horrible going in. From personal experience I remember feeling hot, short of breath & also incontinent! There is evidence to show that women who have had prolonged use of magnesium can have problems with lactation when the body is trying to get rid of it all a few months down the line. However, lactation can be supported with medicines like domperidone. (...I alway want to say Dom Perignon when I talk about that drug...I wish heh?!) The hydralizine was simply to lower your blood pressure.

I dont know why your MW chose such an insensitive phrase, but I suspect she meant emergency C section scheduled in 5...minutes, hours?

The placenta showing scattered infarcts was clinical evidence proving you did have PE. The infarcts (a posh term for the death of tissue) meant that for whatever reason, most likely blood clots in the uterine arteries, you placenta just did not get enough blood supply through it & it started to fail. Thats why you became so poorly too, it was the proof to say we made the right decision to get the placenta out as that was the root of the problem. Of course you cant deliver the placenta with out delivering the baby.

500mls of blood loss is around average for women who have PE or HELLP and the Syntocinon injection contains a synthetic version of the naturally-occurring hormone oxytocin. It works in the same way as the natural hormone.
After the baby has been born, Syntocinon may be given to stimulate contractions that help prevent heavy bleeding.

The doppler may well have given some good indications of how efficiently the placenta was working & perhaps almost certainly showed bilateral notching. However, as with all scans they are subjective in their reading & may not have changed the outcome, perhaps they way the out come happened. Having said that some women show absolutley nothing until the last moment. The word eclampsia itself is a Greek word for bolt from the blue.

Uric acid can be qute useful as a marker. If you were for example 27 weeks pregnant, you would expect to have a uric acid level of around 27 and so on.
If your uric acid is 40 & you are 27 weeks pregnant, it can be a marker that your liver is not working as well as it should be. This would perhaps explain your high LDH level too. LDH is an enzyme that is only released into the body when there is significant tissue damage. Originating from the liver, this enzyme is a marker of the extent of tissue damage.
I strongly suspect the cause of this was the infarcts in the placenta than anything more sinister but without the full picture perhaps the move to ICU was to safeguard you incase it wasnt just the placenta that was effected.
A platelet level of 111 is not unreasonable but would be nice if it had been higher.

What this all shows Carole, is that you were a poorly lady but that you & your baby have done triumphed over this horrid condition. You were strong enough to not let it rob you of all that it would have liked.

I know this is going to make tough reading, sometimes seeing things in 'black & white about yourself can make the whole time seem to flit between real & surreal. But, as you quite rightly said, by trying to understand is regaining the control & understanding at the time will help the healing process.

I hope this helps Carole, Im sorry, Ive gone on a bit.

Warm wishes to you & your baby boy Luke.

Liz

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*Carole*
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PostSubject: Re: reading your medical notes   Sun 24 Jan 2010, 8:05 am

a belated thank you for replying to my post Liz.

You are a very wise woman. Thank you for giving me such detailed responses. I like the way you come across as being very calm and factual. Smile

No doubt I'll be posting more questions in the months to come.
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Liz Pidgley
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PostSubject: Re: reading your medical notes   Mon 25 Jan 2010, 7:54 pm

Hi Carole,

Im glad you found my post helpful, as always if you have more questions...ask!

Knowledge is the power againt this condition.

Best Wishes
Liz

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