My Tryst with Preeclampsia, Again!

Dr. Mona Nongmeikapam *

What is Pre-eclampsia, exactly?

o Pre-eclampsia- also known as Toxaemia of Pregnancy develops after 20th weeks of pregnancy.
o It is characterized by high blood pressure and signs of damage to the liver, kidneys, etc.
o Left untreated, preeclampsia can be FATAL for both the mother and baby.
o Despite of all the science and its advances, the only fool-proof treatment is delivery of the baby.
o Even after delivering the baby, it takes a while or in some unfortunate mothers, a lifetime for the high blood pressure to subside.
o It is a fine balancing act between how much more time the baby needs to mature and how bad the complications are.
o So not just for the family, it is a challenging task for the unlucky treating Obstetricians, especially in a hostile society like ours, where knocking out a tooth or two of your physician or even better, burning their houses down (even though it may be shared family property) is quite common scene!
o Rarely, preeclampsia develops after delivery of a baby, a condition known as postpartum preeclampsia.

Some scary facts:

o Preeclampsia affects roughly 5 percent of pregnancies.
o The exact causes of preeclampsia are not known but are likely to involve blood vessels in the placenta. These blood vessels do not develop or function properly limiting the amount of blood flow.
o Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly or have a sudden onset.
o Other signs and symptoms: excess protein in urine, severe headaches, changes in vision, abdominal pain, nausea or vomiting, decreased urine output, decreased platelets, impaired liver or kidney function tests, fluid in lungs leading to shortness of breath, sudden weight gain and swelling.
o Risk factors: history of preeclampsia- personal or in the family, Hypertension, first pregnancy, new paternity, extreme age-groups, obesity, multiple pregnancy, IVF.
o Complications of preeclampsia: Foetal growth restriction, Preterm birth, Placental abruption, HELLP syndrome- haemolysis, elevated liver enzymes and low level of platelet count —a more severe form of preeclampsia that can rapidly become life-threatening for both, Eclampsia (preeclampsia plus seizures), cardiovascular disease etc.

Myths and facts:

o Eating less salt, changing activities, restricting calories, or consuming garlic or fish oil, intake of vitamins C and E doesn't reduce risk.
o Antihypertensive medications are used to lower blood pressure, anticonvulsants like magnesium sulphate in severe cases are used to prevent seizures and corticosteroids are added to improve platelet, liver functioning and prolong the pregnancy.
o Low-dose aspirin, Vitamin D and Calcium supplements have shown some efficacy.

My personal experience:

I was in my 35th week of an uneventful pregnancy. Regular antenatal check-ups? Check. Baby shower? Check. I had my routine check on a Friday and was given an ‘All Clear’ with an appointment to come back in two weeks. Throughout the entire time, my BP ranged between 120/70 to 130/80.

And then on the coming Monday a routine check of BP and subsequent Urine routine test landed me in the hospital to be quarantined until delivery and post-partum recovery. My BP had been pulsating at a mind-boggling 200/120 and I had a proteinuria of +++ (quite impressive as well). Symptoms? Absolutely nothing. Not even a headache or vague discomfort. Mine was the asymptomatic form, as I discovered later.

Why share?

If this could happen to me, a medical person who had the entire department of OBG of the medical college I worked in on my speed dial, how vulnerable does it make a lay-person who has absolutely no clue or no way of knowing?

My two bits as a Mental Health Professional:

Meditation, mindfulness, breathing and relaxation techniques, journaling, pursuing a hobby, to even continuing to work till most part of the pregnancy have been recommended, in contrast to the earlier absolute bedrest. The idea is to be vigilant but not go crazy with facts, figures, monitoring and tests. The recommended minimum 34-37 weeks for safe delivery is a long haul and if not cautious, one has a high risk of developing medically-induced Hypochondriasis!

Gratitude makes the world go round!

o I cannot thank my cousin Dr. Indrajit, whose casually checking my BP while I was savouring parathas made by his wife and prompt presence of mind saved my life! Filmy, but Bro I owe you this life and the next one too, for my first-born!
o A good rapport and communication with the treating team is a must. Tough decisions need to be made, no choice is fool-proof and risks and benefits need to be weighed. Monitoring is the operative word. Trust and respect plays a huge role. Blame-gaming and burden-sharing need to be balanced. I have been extremely fortunate in both my two occasions.
o In my earlier case, Dr. Tomba and his excellent team of Maipakpi Hospital did offer the option of prompt delivery but on my request, allowed me to stay in the hospital for 9 days under strict round-the-clock monitoring until the delivery so that the baby could mature a little more.
o A special mention has to be made of Dr. Subodha and the efficient team at Shija Hospital, with their constant reassurance, counselling, recommendations for rest, round-the-clock BP monitoring, DVT (Deep Vein Thrombosis) massager, epidural anaesthesia etc. made Pre-eclampsia feel almost like a luxury vacation!

Take home, please!!!

No joking matter, Preeclampsia is a lethal illness that can in one careless moment cost two lives and affect several others in its aftermath. I am not a subject expert and would request you to harass your respective obstetricians till you absolutely know the dos, donts, know-hows and what-nots. After all, forewarned is forearmed!