Patients do not come in neat little packages with straight forward pregnancies nor are their complications obvious. Some pregnancies are complicated not only by health issues but social issues as well. Take Karen* for example. She was considered mentally “slow”. Her parents gave her up at the age of eight and she subsequently grew up in group homes.
Karen had an innocence that made everyone want to protect her and I was at the top of the list. She had a friend name Shirley* who was also pregnant and they eventually became roommates. I was not Shirley’s physician, but I wish I had been. Both Karen and Shirley made plans for the birth of their babies and assumed they would grow up together.
Two weeks before Shirley’s due date, she began bleeding bright red blood but was hesitant to go to the hospital. When she finally arrived, her baby was dead from a premature separation of the placenta; a condition known as placental abruption. Shirley most likely had pre-eclampsia, a disease that sometimes goes unrecognized.
The day before Karen’s due date, her blood pressure became elevated, there was protein in her urine and her feet were swollen. I referred her to the hospital with a diagnosis of pre-eclampsia. Karen brought home a healthy baby. Shirley left the hospital with empty arms.
Here are three important things every pregnant mom needs to know about pre-eclampsia:
- If you are over 20 weeks pregnant and your feet are swollen someone needs to check your blood pressure
- If your blood pressure is “normal” but you have protein in the urine, the urine needs to be sent for a 24-hour specimen AND you need to be given the results
- If there is more than 300 gram of protein in the urine, you may have pre-eclampsia and a decision needs to be made whether your baby should be delivered
Sometimes the diagnosis of pre-eclampsia is missed because a patient doesn’t have the usual presentation of extremely high blood pressure. Karen was Caucasian; Shirley was African American. Both had the same illness that ended with very different outcomes.
If Shirley ever becomes pregnant again, I’d be honored to be her physician. Every pregnancy deserves to have a happy ending.
*Names have been changed