Two Times Severe Preeclampsia

Post On Friday, April 11, 2014 By Chelsea

Two Times Severe Preeclampsia

My husband and I were married in June 2009. I had just graduated from college and had a vague plan of returning to school in 2010 to work on my master's. We found out we were pregnant in October 2009; this was not a planned pregnancy, but while we were both extrememly nervous, we knew it was a blessing and were very excited. With a due date of June 21st, we were off to a normal start. The morning sickness set in right at 8 weeks-it was daily and it was awful, but my mother with whom I shared an office at the time assured me it was normal. I ate constantly trying to curb the nausea and gained about 7 pounds by my 12th week.

As my first trimester ended and my second began the sickness was still around but with less intensity and frequency. However, the swelling began right at 20 weeks. I remember noticing my ankles swelling on and off right at the start of February-my Mom commented that it seemed rather early for this to be happening. I experienced chronic headaches throughout my pregnancy as well. By my 24 week check-up, I had gained 28 more pounds. My urine was clear of protein, my BP had not budged from my typical 120/70's range. My doctor commented that I was gaining quite a bit of weight and asked if I was eating excessively-even though my legs and feet were extremely swollen and it was obviously water weight. He said everything looked good and not to worry and attributed my headaches to hormones. No other tests were done, no blood work, no 24 urine samples.

Everyone at church, my family and my friends were concerned about the massive amount of fluid I was retaining in my feet and legs. I went barefoot most of the time, wearing flip flops and house slippers to drive. I work in an office where 80% of my day is spent at a desk. At that time, my evenings were spent teaching voice and piano lessons until 8pm; after lessons I would go home and lay down with my feet up, but there was absolutely no relief. My husband and I were both leading worship at our church on a weekly basis as well. During my 27th week of pregnancy, I was scheduled to play synthesizer for the High School musical-my husband was playing drums. Opening night, Thursday March 25th, 2010, I was beating myself up for ever agreeing to take part in the musical. I was exhausted, had experienced a terrible headache all day and wanted to be at home in the bed! I had also been experiencing a resurrection of morning sickness. However, I followed through with the commitment-I noticed about halfway through the evening that I was having trouble focusing on the music in front of me, seeing spots; my head was still hurting-I just attributed all of this to fatigue. Once we were home, I cried myself to sleep-I felt so exhausted.

Friday at work, everyone kept telling me I looked terrible and kept asking how I was feeling. I had a headache, felt enormous and uncomfortable, and I was dreading playing the musical all weekend. That evening, I remember feeling a bit better-probably just because it was Friday and I knew I got to sleep in the next day. Saturday, we dropped by my folks' house on our way to a birthday party for one of my friend's little girls. My feet looked and felt better than they had in several days-I had no headache! My brother and sister-in-law were in town and they, along with my parents looked concerned when they saw me that morning. The birthday party was fun and relaxing-it was nice to do something different. We went about the rest of our day, and attended the musical that evening. We were home and in bed by about 11pm-which was late considering the fact that we needed to be at church early the next morning.

At about 2am Sunday morning, I woke up with an excruciating headache. I was nauseous and had to throw up. I took some medicine and went back to bed-after about an hour, I had managed to get back to sleep in spite of the relentless headache. By about 5am, I was up again-still hurting and sick again. I went ahead and took a shower, thinking it may help and laid back down-only to get sick again around 6am. This pattern continued-with more frequent trips to the restroom as the morning progressed. My head was not getting better-I couldn't keep anything down.

We left for church and tried to stop and get a pop and a biscuit-however, my husband insisted I go back home when I got sick on the way there. We thought it was a stomach bug. He went on to church and I stayed home attempting to nurse my headache and keep any nutrition down. From 8am to 12pm, my headache worsened and I was sick about every 20 minutes. I noticed around 9am that I was having trouble focusing on anything-I had received a few texts and couldn't read them. I assumed this was just due to my headache. I tried to sleep. I tried pressing on the painful areas on my head to make it stop hurting, but it would just start hurting somewhere else. Around 10:30am I took a shower and let the massage setting hit my head until the hot water was gone. No relief. I laid back down.

At 12:00pm, I noticed that I was completely unable to see. So, I located my phone and clicked what I thought was the "2" to speed dial my husband and told him to come home-I thought I should go the hospital. Upon arriving at the local hospital, we sat in the waiting room for about 5 minutes when they took me back to check my vitals. No one told me what my blood pressure was, but i was wheeled down the hallway, placed in a room, hooked up to machines and given magnesium through an IV. After about 15 minutes, my husband and I were both expected at the matinee performance of the musical-he called my parents and told them that I was in the hospital and that he had to leave me for a little bit. They drove over expecting that I was being monitored for high blood pressure. My mom entered the room and spoke, and I asked "where's Daddy?"-she said "he's right beside me, honey..." My husband had not informed my mother that I could not see.

She told me later that upon entering the room my BP was reading 190/190's. She had evidently spoken to my OB out in the hall who told her "she's in God's hands"... They planned to transfer me to UK Chandler Hospital in Lexington, KY. It was about 45 minutes away. I was transported by ambulance-I remember being EXTREMELY thirsty and begging for something to drink. My parents waited on my husband to meet them before following the ambulance. Upon arriving at UK, I was asked to fill out some paperwork-which was comical, since I couldn't see. They noticed that my IV was upside down-so they had to attempt to find another vein in my extremely swollen body to start another one. They hooked me up to monitors to check my BP every few minutes. They searched for several minutes for the baby's hearbeat-she had flipped over...but, they found her and she was looking okay at that time. I was given a catheter. They went ahead and gave me a shot of steroids for her lungs. I was asked about 1,000 times what my pain level was, what my name was, what my birthday was...if i needed anything...I kept telling them that my head hurt and that I needed some water-they would only give me ice; I was still getting sick every few minutes.

Every little bit my Mom would wave her hand around in front of my face to see if I would blink-she was really concerned about the whole vision loss thing. The doctors assured us that it was most likely due to the extreme edema. However, they could not rule out stroke or retinal detachment at that time. The OB people were itching to deliver the baby. They explained that I had severe preeclampsia-that my head would not stop hurting and that my BP would not go down until they delivered Sophie-who was 27 weeks and 6 days gestational age. As the day progressed, it became obvious that the Pediatricians were trying to hold on to every minute they could give Sophie. The ultrasound indicated that she would weigh around 1lb 14oz-and that my condition was starting to cut off her supply of nutrients and oxygen. Sometime in the evening, Sophie's doctor came in to run down all of the things we would need to expect and be prepared for with delivering a preemie.

During the entire day, I think I was mostly in shock... the pain combined with the drugs and just the utter surprise of the situation... it was all overwhelming. I had not read about C-Sections, as I did not plan to have one. I had not read much about preeclampsia because my BP had been normal. I had not read about preemies because I had not considered the possibility that Sophie would be born that early. We were completely unprepared. Through it all, I had a peace that I know came from God-that He would provide. That did not change the heaviness of the situation, though. By 9 pm, they decided they were going to go ahead and operate. They took me in to the OR and I could not stop shaking. They finally were able to do the epidural to administer anesthesia. The operation went very quickly and Sophie Gale entered the world at a whopping 2lb 1oz-all I could hear was her huge cry-her lungs were working! They immediately gave me medicine to help me sleep.

When I woke up-my headache was gone. I still could not see, but the pain was gone. My husband and my parents explained that Sophie was the cutest baby ever-that she was healthy-just little. She had been taken to the NICU. I spent another day on magnesium and started blood pressure meds (lebetalol and nephedipine). On Tuesday they removed the catheter and took out my IV-I was allowed to go see Sophie. Although my vision had not improved much, I was able to at least hold her tiny hand and sit beside her for a little while. I was in the hospital until Friday-went home on BP meds and the typical pain meds and iron supplements. My BP returned to normal about 2 months following Sophie's delivery. We were so blessed.

Looking back, I feel so stupid-while my doctors assured me that the illness was not my fault, it seems obvious that I was trying to do too much-that I was not allowing my body the rest it needed. Whether it could have been prevented or not, if I had let a few things go and rested, I think we could have lessened the severity of the whole situation. My OB at UK told me I would not be considered high risk if I were to have another pregnancy as preeclampsia rarely occurs a second time. Sophie was in the NICU for 8 weeks. She was on room air through a nasal canula for about 2 weeks. She had one blood transfusion due to anemia at about the 4th week. She was a "feeder/grower"-with very few issues-we were so lucky!

She came home on May 25th, 2010 at 37 weeks gestation weighing 4lb 14oz. She is 4 now-she is still very small, but she is on track developmentally-ahead of the game in verbal skills and is rotten as can be. I found out I was pregnant with baby #2 in August 2012. I obviously went with a different OB with this pregnancy. I was classified as high risk from the beginning due to my last pregnancy. Everything was normal and great until 28 weeks. No morning sickness at all-however the heartburn with this pregnancy was absolutely unbearable! My doctor decided to run baseline labs and a 24-hour urine at 24 weeks, just so we would have something to compare things to, if this pregnancy started heading the way things did last time.

The swelling started around 20 or so weeks, but not nearly as severe this time as the first-and it always went down at night. I was still working the same job, but rather than 28 piano/voice lessons a week, I was only teaching 5-we were still very involved with praise team at church, though. The day of my 28 week appointment, I was extremely swollen. My BP which was normally 120/70s was reading 130/80s-which wasn't super concerning, but still notable. The baseline labs were performed again and a 24-hour urine ordered. I was scheduled for a follow up in 2 weeks. That afternoon, I received a phone call that my potassium level was critical (2.6) and that I needed to get checked in to the hospital for the weekend. They stated that this was completely unrelated to preeclampsia, but that it was still something that needed to be built back up for the risk of heart issues. I was given 3 K bags that evening; they tried running them at 50, but I was unable to tolerate the pain so we ran them at 25.

I managed through the night to get some sleep, but not much. They drew blood in the morning and my potassium level had not budged. They started another round of K bags-but this time, the pain was worse. The on-call Doctor stopped by to visit and he said it was unnecessary for me to be that uncomfortable-so he said we would switch to supplements instead. After an afternoon and night full of supplements, they took more blood and my potassium was back up to a 3.0. As the morning progressed, I developed an extremely terrible headache and nausea. I had noticed that my BP was high all through the night and morning; neither the doctor nor the nurse saw these as points of concern and sent me home that afternoon. I rested the entire day and my headache subsided.

Monday morning I returned to the doctor with my 24-hour urine specimen. They took some blood and prescribed a potassium supplement twice daily. My BP was 156/94 at my visit-my doctor decided it was time for me to begin seeing them twice a week, so a follow up visit was scheduled for Friday. Friday, they informed me that my 24 hour urine had come back showing Protein; with my BP staying around 140/90 and protein in my urine, I was officially diagnosed with mild preeclampsia, a "ticking time bomb." They took more blood to check on the potassium issue and sent me home with another 24-hour urine. My potassium came back Monday as a 3.0, and the urine sample showed less protein than the previous week, so I was told I was "stable" and could go back to weekly visits. Monday my BP was still stable-although it is fluctuating up to some pretty high numbers throughout the day, it was not consistently high. My potassium was at a 3.5 so I got to stop taking the supplements.

After the hospital stay, I went ahead and cancelled my lessons indefinitely and stepped down from my responsibilities at church. Rest and reduced stress level greatly improved the edema. Over the course of the next few weeks, my BP continued to rise gradually. At 35 weeks, it had started to fluctuate up to the 170s/90s at night, and the edema was becoming very uncomfortable. The swelling was moving to my face and hands and the weight gain, which had been next to nothing prior to 28 weeks was becoming more apparent daily. I knew things were shaping up to a similar outcome as my first pregancy when my swelling stopped going down-I was extremely uncomfortable and not sleeping well at all. At my 36 week appointment, my BP was 165/95, and I had gained over 5 pounds in one week.

My doctor admitted me to the hospital for observation and to await the results of my last 24 urine sample. The proteinuria level had gone from the 230's to 470's-although, the regular stick test did not indicate any protein in my urine. My C-Section was scheduled for 37 weeks, but with my history and current condition, the decided to go ahead and deliver the baby at 36 weeks. Brody Daniel was born April 9, 2013 weighing 6lb 10oz...he had a little issue with his blood sugar the first day, but other than that he was perfectly healthy, and beautiful! I felt like a million bucks, aside from the normal C-Section pain. The plan was for us to go home on Friday. Thursday evening, my BP began to rise. Each time they checked it, they said "turn on your left side and we will come back in a few minutes" would always go down when I did this; however, my nurse was concerned.

Throughout the day Friday, my pressures kept reading higher; they knew I wanted to go home, so I was sent home on lebetalol. Sophie ended up coming down with a double ear infection-so when we returned home, it was not a restful night. Brody was to go to the pediatrician on Saturday as well as Sunday morning for a weight check. What should have been a relaxing weekend, turned in to a 100 yard dash. I checked my BP every 4 hours or so...the lebetalol was not helping. By Sunday morning, I was feeling awful. My chest was tight, my Blood Pressure was 160s over 90s and I just generally did not feel well. That afternoon, I laid down and slept for 3 hours. When I woke, my chest was rattling and my Blood Pressure was 170 over 105. My husband and I left the babies with my parents and drove to the ER. I received magnesium and lebetalol through an IV; my Blood Pressure continued to rise. I had to have an EKG as well as a CT Scan prior to being admitted back to the Post Partum ward. By the way, my edema had returned with friends by Sunday-I looked like a balloon ready to pop. The nurses came in to see my clonus. I was hooked up to magnesium for the night, given a sleeping pill and a catheter. I was also placed on Oxygen, due to low saturation. The next morning the High Risk OB came to see me and explained that the Preeclampsia had worsened and I had what appeared to be Congestive Heart Failure, or Pulmonary Edema.

The Cardiologist came to see me and did an ultrasound on my heart to verify the CHF-she put me on a low sodium diet and started me on Lasix to flush the fluid out of my body. She felt that my Potassium was too low and would continue to drop with the Lasix, so they also hooked me up to some K bags throughout the day. They decided to give Procardia a try with reducing my Blood Pressure, as the Lebetalol was not helping. They moved me down to the regular floor as they felt I should be pretty easy to deal with. That afternoon, they gave me several concentrated doses of the Procardia to try and figure out how much it would take to move my BP. Monday night, the headache set in. Although I was still recovering from a C-Section, less than a week prior...they were very hesitant to give me pain medicine. The headache was awful, not as bad as I had with Sophie, but similar. There was thought that it could be related to the Procardia, but the Doctors also felt it could just have been the Preeclampsia. Regardless, my Blood Pressures were not dropping...and did not drop much-even with medicine-throughout the morning on Tuesday. My head continued to hurt. They moved me back to the other floor so I could get more attention. Eventually the fluid started coming off and I started feeling a little better. I was taken off of the IV fluids and given the pill form Lasix, BP medicine, Potassium, Nausea meds, Pain Meds.

I was able to start getting up and going to the restroom on my own and such on Tuesday afternoon...then, I was finally able to take a shower on Wednesday morning-it was heavenly. I was weaned from the Oxygen by Thursday morning. They were able to sort out my BP was still inconsistent, but my average BP's began to read much lower. I was sent home on Thursday afternoon. It was only about 3 weeks before I was taken off the BP medicine and back to normal. Ultimately, I felt like I should share my story here to simply warn other women to trust their body and to know that pregnancy is not a walk in the park for everybody. I never quite fit the mold with the symptoms (specifically the proteinuria) and ended up with severe preeclampsia with both pregnancies. I am blessed and lucky to have two sweet and healthy children-there is great value in educating yourself and making healthy choices during pregnancy-and most importantly, trusting your instincts and communicating clearly to your physician.

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