Pre-eclampsia mentalling thread

[Fishandjam]

A place to come and kvetch/worry/chill for anyone at risk of developing pre-eclampsia in their pregnancy. We have buckets for those still feeling sick, cushions for those who are just plain knackered, and crisps and ginger beer for everyone else. Come and say hi!

Read that link chelseymarie , hope your pregnancy is OK, it must be a worrying time. Please don't worry at any point about getting checked out, if it comes to nothing, that is for the good, and you're not wasting anyone's time.

I know the sense of impending doom is a symptom now, just was surprised at how dismissed I was when I kept complaining. The post-natal midwives who looked after me were nothing short of a disgrace though (not the ones who looked after me in HDU, they were fab).

Just wanted to say hi. I am 21 weeks pregnant with DS2 after having severe PE last time. Like others, my symptoms were non specific - severe swollen ankles, epigastric pains and exhaustion. By the time I developed slightly high bp at 34 weeks and had a scan, DS had developed severe IUGR and abnormal blood flow in his brain. I had an emergency section at 35 weeks.

The things I am worried about this time are the mode of delivery. I had assumed I would have a section at around 37 weeks if I get that far but my consultant thinks I should try for a VBAC and would be happy for me to go to 41+ weeks. Since the PE can come on so quickly I'd be keen to deliver as soon as I reach term at 37 weeks. Also worried about labour causing eclampsia.
I also had the impending doom thing about a couple of hours post delivery when my bp was 210/130. The nurse didn't seem overly concerned and gave a tablet which caused it to return to normal. But I have always felt I was very close to having a stroke or something, but maybe I'm wrong!

I was told that if I get pregnant again that I can have a EMCS at 39 weeks. I would insist to be honest because it was only when I was overdue and my placenta was failing that I got PE. I realise it may not happen a second time but there is no way I'm taking the risk. I won't be getting in any arguments about vbac or no vbac. It won't be an option. I also wouldn't want to be induced at 39 weeks.

I mean a planned cs.

I wouldn't want to go over 40 weeks either, was told after birth that women with high BP should be induced at 37 weeks, so can't see why you should go overdue! Also after having a CS, no way should you be induced.

I had a major PPH after being induced (sorry to scare anyone, just what happened to me) and no way I could go through another induction. Was told I could have a CS if I wanted one, and I didn't even have one first time around.

My advice would be read up on all the guidelines and go back to your consultant and/or ask for a new one. Hope you get what you need, you don't need the extra stress, not after everything that happened first time.

Titan, I agree with happygilmore. You need to be firm that you want a cs and the guidelines as I understand it have changed now so that they can't refuse you anyway. Out of interest has your consultant read your notes from your last pregnancy?

I had a birth debrief with a senior midwife a few months ago when I was first considering ttc again (3 years later but it did help). She told me that I would automatically be a high risk pregnancy and consultant led. I could also request my consultant to be the same one that dealt with my emergency situation last time - is this an option for you?

That's exactly what I thought. Even if it hasn't manifested by 39 weeks it can happen so suddenly and severely I wouldn't want to risk it. My consultant won't discuss mode of delivery any further until 36 weeks. I think even if I don't have signs of PE I'll say I would like a section at that appointment.

I have read the VBAC guidelines and, even aside from the PE issue, having had a preterm caesarian, and an interval of less than 2 years between deliveries are both indicators of failure of VBAC. I guess I didn't want to be seen as pushy and demanding a section which isn't needed but my gut feeling is that all the odds are stacked against going for a VBAC at 40 weeks plus. I think you can't have induction after a section due to increased risk of uterine rupture.

I would feel a bit more chilled now though if it had all been agreed to and I had a fixed plan. I guess there's still quite a long time to go though, and anything could happen.

Sorry cross posted! Yes I have the same consultant as before and I like him. I have only seen him once, at 9 weeks when he said he thought VBAC was a good option if the pregnancy went well. Then he said he wouldn't discuss again until 36 weeks. Since that I have seen the midwife at 12 and 16 weeks and the registrar at 20 weeks. My next appointments are at 28 and 32 weeks. I thought maybe I would ask to see the consultant personally at 32 weeks as that's nearly 36 and maybe he'll agree to have the discussion early!

Does anyone know if there are any guidlines or evidence suggesting delivery by 39 weeks or avoiding a VBAC with a history of severe PE? I have googled but didn't find anything.

I've just googled the NICE guidelines and had a read - definitely read these if you are pregnant/planning a pregnancy. Have skim read and found some of these recommendations

If you are currently pregnant, have you been prescribed aspirin from 12 weeks?

Additional ultrasound and doppler scans should also be undertaken.

Sorry they're here:
www.nice.org.uk/nicemedia/live/13098/50418/50418.pdf

I have also googled this point to death Titan and not found anything. I think consultants tend to view each case on it's own merits. In your case they will probably monitor you very closely from 36 weeks (I would be asking for daily protein checks) and deliver at 39 weeks. In my case I'd want similar.

When I first thought about ttc again I went to see my GP to ask if I'd definitely get a cs next time round. The first GP wasn't at all understanding and looked at me like I was too posh to push and too old (at 38) to consider the risk was implied. The second GP was a lot more helpful and even though he wasn't very clued up about PE (in 17 years I was the only patient he'd met who'd had it) he said he would ring the consultants at the maternity unit and ask them. The reply was that basically until I was sat in their office with a baby in my tummy their hands were tied and they couldn't be sure I'd get one. Followed very quickly by the fact they are encouraging VBACS as much as possible nowadays. Not very helpful really

After that I found out about the debriefing service at my local hospital where they go through what happened with you in great detail with a senior midwife. I got up to 1.5 hours to ask any questions I wanted. I decided to raise the question about VBAC as I wanted to be very clear in my mind about what would happen to allow me to make an informed decision. She said 100% in MY case I would get a planned section. She was very reassuring of that fact. However I do realise it's not her decision but it was on this reassurance that we've started ttc. I think she has a better idea working with the consultants on a day to day basis what their advice would be.

Wow, I am so glad I started this thread! It's been great (though scary!) to read everyone else's experiences - makes me realise I got off relatively lightly. And as various posters have said, it's interesting (and also scary) to see how many of us didn't have the classic PE symptoms of high BP and proteinuria. I agree that this is something pregnant women should all be better educated about, and that there are far too many threads on MN which mention PE and where posters dismiss the OP's concerns. Maybe we need to form a flashmob and go onto each and every such thread to point out the dangers?

The other thing that struck me is how relatively rare severe PE is, despite all our stories. Most of the midwives on the post-natal ward hadn't seen a case like mine. Which might explain why it so often goes undiagnosed until the last minute. My consultant told me frankly that I'd given them such a scare with my first pregnancy, there was no way I'd go under the radar this time!

gecko, I forgot to say - ask your midwife/consultant about low-dose (75mg) aspirin from 12 weeks' gestation. There's some evidence that it can reduce the risk of PE.

WRT being induced versus CS, I was induced at 38 weeks but only because my cervix was favourable - I'd have had a CS if it hadn't been. It was OK, though I was so exhausted I couldn't cope with the pain and so bottled it for an epidural. I didn't haemorrage much but then I didn't have HELLP - I had the EL but not the H or the LP (iyswim). My understanding is that if you have HELLP, vaginal birth is not to be recommended due to the risk of PPH (due to the haemolysis and platelet problems).

A very helpful thread I agree, thanks for sharing your stories ladies

After I had DS, I did a lot of Googling about PE - including trying to get my head around some medical papers. One phrase really stuck in my head, from this article: emedicine.medscape.com/article/1476919-overview "Although its pathogenesis is incompletely understood, it is a major cause of maternal and neonatal morbidity and mortality."

I remember thinking WTF? It kills mothers and babies but we don't understand it properly? Why is that? The feminist in me wonders if it's because it's ONLY a problem for women and the anticapitalist in me wonders if it's because the major drug companies don't see easy cash in flogging a pill to cure it .

At least there are outfits like APEC trying to do something about it.

I had it explained to me that severe PE is rare - so if 10% of pregnancies have PE, and then 1-10% of them go on to have severe form, that might be only 1 or 2 people at a hospital a year. Easy to see then how a midwife might never see someone with it, esp say on the post natal ward. Still not good enough though.

Yes APEC are doing a great job.

I do think midwives need educating more about it. When I was in intensive care I remember a consultant bollocking a midwife for leaving a light on in my room as I had to get plenty of rest. Unfortunately two days later I was slung out onto a post labour ward with a load of chavs who kept me awake all night shouting, swearing and intimidating everyone. I hadn't even met my baby at that point and was distraught

happygilmore - thanks for posting that link to the NICE guidelines. Really useful. I'm living overseas now, just to complicate matters, and it's good to know what the basic UK guidelines are so that I can (as a minimum) try to ensure that I get care in line with those. Hoping the obstetrician I see is clued up on all the latest recommendations, but good to have my own back-up just in case.

Fishandjam - will definitely ask about the aspirin from 12 weeks. Thanks!

I reckon, for all preg women who had PE in their previous pregnancy but who are concerned their GP/community midwife isn't taking it all seriously enough, they should print off the APEC PRECOG community guidelines and give a copy to their GP/midwife.

I agree

Definitely agree with fishjam.

And also regarding people saying on here, and in real life "it'll be OK" when people have symptoms of PE. It's a syndrome, there are varying symptoms and few people are "classic" cases. It's a serious and life-threatening illness.

And it is so important (I now know!) to be educated and not expect everyone involved in your pre and post natal care to be fully educated on the gold standard for managing PE, because they're not and I'm clearly not alone judging by this thread!

Everyone should read the guidelines and make sure their care is inline with them.

Good advice I saw from someone was, don't see that you are causing a fuss by getting checked out, view it as if your baby was already here and you are getting treatment/care for them. They cannot do it themselves and you are simply keeping them safe, same as after they are born. I know I'm not expressing that very well at all, but hopefully it makes sense.

This has been really helpful to hear other people's experiences so I don't feel like I have no idea what could happen. I am also overseas, redexpat, and I mentioned the protein to my mum, but didn't really tell her the rest, as I don't want to worry her when she can't really do anything. Turns out she had high BP in late pregnancy with me and was on bed rest for 3 weeks, so maybe it is a genetic thing.

I'm feeling quite lucky about the level of care I have here, and although it will be a pain going into the doctors 3 times a week from 32 weeks I am going to look at it like I'm making sure she is OK, and if nothing else, I can have a half hour to sit quietly and read.

I would quite like a debriefing with someone. After my section I was put on the labour ward. A nurse was checking me but I wasn't seen by a doctor for about 12 hours. When my bp went sky high and I had neurological symptoms the nurse did telephone the doctor but I felt I should have been checked more frequently. Maybe this is normal practice and maybe my perception is worse than I actually was. I don't know how to bring it up without seeming like I'm criticising.

Having a woman in labour in bed the next to me wasn't great. Even worse was the next morning when the woman in the next bed was having people come to help her breastfeed her baby when nobody was available to show me how to express colostrum for DS who was on NICU.

WRT aspirin, I have been taking it since 12 weeks as per the NICE guidlines. The evidence suggests it should be started by 12 weeks and there is no evidence of benefit if started after 14. I was subsequently told that it would have been even better to start it at conception as there is no evidence it is harmful and starting earlier means it is in the system as the placenta implants. I think different obstetricians differ in what they recommend. I did agonise over starting it as soon as I got a positive test but was scared of bleeding and the NICE guidelines say to start at 12 weeks.

titan, I got my GP to arrange an appointment with a consultant at the hospital (who turns out to be the consultant that's looking after me now). I explained that I wanted to know what had gone on and the risks of getting pregnant again. I also took advantage of the "birth afterthoughts" service, wihch admittedly is done by a senior midwife not a consultant, but going through my notes (and seeing all the doctors' comments about what they were finding) was really informative.

Sounds like you had a grim time though. Hope you're OK now?

I found a debrief very helpful