Sunday, February 25, 2007

How I met Pre-Eclampsia

I got pregnant with my first daughter at 24. She was very much planned. DH and I had gotten married when I was in college. When I graduated, we left and moved overseas. Dh and I had been married for three years when we got pregnant. We decided that we should go ahead and try. Much to my surprise we got pregnant the very first try. OMG. I didn't really think it would happen that quick but it did. While in the 2 ww, I noticed that I was exhausted. An acquaintance who was a nurse said maybe you are pregnant. I said nahhhhh. But yep, I was pregnant. It was funny, I had a terrible fear of needles an would pass out when my blood would get taken. They couldn't even take blood at the base hospital because I passed out. Little did I know that I would become a pro at giving blood. The base that we were at did not have any inpatient services. So they assigned you a military dr and then you had a foreign dr at the foreign hospital. The military dr's job was to answer any questions and to make sure that the proper tests were being done. The foreign dr was the one that ran your ob care.

I had a normal pregnancy up to 24 weeks. At that point my bp started to go up and I started to have a trace of protein in my urine. My foreign dr was NOT concerned in the least. My military dr was very concerned. She suggested me cutting back at work. I didn't bother. At 26 weeks due to the military dr's urging, my foreign dr put me on bp meds. She put me Visken, which if you have asthma, you CAN NOT take. Asthmatics need as much as their airways open and beta blockers shut them down. My military dr was very upset that I had been put on Visken and had patient services call the foreign dr and change it to Aldomet. I had appts every 2 weeks with foreign dr. She never once checked my blood for anything but toxoplasmosis. I don't own a cat. She never did a 24 hr urine. She never adjusted the aldomet that I was on (750mg). I did get an ultrasound at each visit but that is standard there. Meanwhile, my military dr was getting very concerned. At 29 weeks, I lost sight in my left eye for an hour. Freaked I went to the military dr and she immediately sent me to the hospital. The oncall dr at the foreign hospital ran a NST. Baby passed. She sent me home on bedrest, which I did not do. I had visits each week with the military dr because she was so concerned. By this point, I had pitting edema, stars/spots, headaches. But I blew these off as being normal in pregnancy. Sure pregnant women swell. Sure pregnant women get headaches. So what if I had a little high bp.

The military dr also tested my urine with a dipstick. She wasn't supposed to for some stupid military reason. So she couldn't record the results. But it was ranging from trace to 2+. Each time she sent me back to the foreign hospital for a NST and montoring. She was very upset that I would not bedrest. I did not understand how serious this was. I would find that out later on. My mother had "Toxemia" with all three of her babies. So I didn't think it was bad. Apparently for my mother, it wasn't severe. One day I came into the military dr's office and she was so upset with me. She took off my shoes and socks. She started poking at my ankles. Look at this, this is bad. It is pitting edema. I have pregnant women that come into my office every day and beg me to take them out of work. They are having normal pregnancies and don't need it. You are not having a normal pregnancy. You are high risk. WHY WON'T YOU GO ON BEDREST. She even sent occupational health after me claiming my job was hazzardous to my health. If I had been military, she could have ordered me to bed. As a civilian, she couldn't.

Still, my foreign dr was unconcerned and did no tests. I would say the military dr says I have PE. She would say no you don't. At 34 weeks, I developed what I thought was the stomach flu. I felt nauseated. I had upper right quandrant pain that came and went but hurt really bad when it was there. I couldn't get comfortable. I went to the base's acute care clinic. It was US run, but had foreign drs on staff. I will never forget. I saw a Turkish Air Force Colonel. He said she has indigestion. Give her the cocktail of malox mixed with Lidocaine. In all fairness, to him, even obgyn drs miss the signs of HELLP syndrome. The nurse said, Dr you realize that she IS pregnant right?? He said yes, it will be ok. He was sooooo wrong. I drank the cocktail. I felt a little better. But it didn't go away. The regular military dr that I saw was TDY. At 35 weeks 5 days, I had an appointment with the foreign dr. She didn't even ask me how I was doing. She told me to get up on the table because she wanted my bp. UH OH. It was 160/120. She said you need to be admitted. Well I now know why she was so upset, I had +4 protein on the urine dipstick. I was so innocent. How long am I going to be in the hospital? This was on a Wednesday morning. She said till Monday for observation. She was wrong, I already had a 2 day old baby by Monday. I asked to go home and pack a bag. She said my dh could do that for me, I needed to be admitted now. I said no I have things to take care of. I will be back in a couple of hours. I asked if she would be there when I got back. I wasn't particularly fond of her, but she was the only doc I had seen at that hospital. She said that she would be. I agreed to be back by 3pm. I had still been working. So I needed to let work know and pack a bag.

I came back at 3 and my dr was no where to be found. She had dumped me and left me in the hospital to rot. I was greeted by a midwife who did a full exam. I was admitted into the antepartum area. I immediately had an iv inserted to start bp meds and fluids. At 9pm, they took me for an emergency US that lasted over an hour. I later found out that they were checking out K's lungs and size. The next morning the base liasion called. She said PE Mommy, I don't know why your dr had told you you are there for observation. You are there till you have your baby. You are very sick. I don't feel sick. Well you are. Oh and you are having your baby next week. WHAT?????? No one said anything about having a baby. Ok, well I was told by the military dr that I would deliver early. But I thought early was a week or two early. I still had a whole month to go. I did a 24 hr urine (the only one done the entire time I was pregnant). They drew a ton of blood. I had to document everything that I drank.

The next day (Friday), the base liason called and said I have bad news. You are very sick. You are having your baby on Monday. Your liver enzymes are extremely high and your bp is bad. You have over 5000mg of protein in your urine. Umm ok. I called dh and said we are having a baby on Monday. This was at 1130am. At 230pm, a dr that could speak english came in and said "we are terminating your pregnancy tomorrow". What do you mean terminating? I'm not terminating anything. You are very sick. We are moving you to L&D. You need to call your dh. An hour later I was moved to L&D. They ran more bloodwork. At 8pm, they inserted the progestin gel. It was an excruciating exam because the midwife had horrible long nails. My cervix was very unripe and very posterior and high up. At 9pm, they told dh that he needed to leave. That he could come back at 6am the next day to start the labor. They turned out the lights and told me to get some sleep. Sleep is something that did not happen. At 12am, I got the worst headache ever. I hit the call button and the nurse came in. I told her my head hurt really bad. Could I please have some Tylenol. She looked at me kind of funny. The next thing I know, my room was swarmed with drs, nurses, and midwives. My room was filled and people surrounded my bed. One wass taking a bp, one was drawing blood, one was tapping my knee. Ithought it kind of wierd that my reflexes were so exaggerated that I kicked the dr. Then they all left my room for about 10 minutes. Then the dr and a couple of nurses came back in, with another iv pole pump. The dr said I am very sorry but we have to put another IV in. I said ok, put it in the same arm as the other. He said no. We have to put it in the other arm. What? TWO ivs??? We have to. You are sick. He didn't tell me he was going to mag me. He also told me that I HAD to have an epidural the next day before they started labor because they couldn't chance my bp going up higher. Sounded good to me. I was all for the epidural to begin with.

They again turned out all of the lights and a nurse sat in my room that night through the next night. They also kept taking blood every hour. At 3am, the midwife with the long fingernails came in and checked me. It was excruciating and she wasn't very nice. They did another round of gel. My room was kept quiet and dark. At 6am, Dh came in. I immediately burst into tears. I was swollen up like the michelin man. I had bruises everywhere. I was very pale. I had ivs and wires everywhere. I looked horrendous. DH was very upset that I had one iv in and looked fine when he left and not even 9 hours later, looked very ill. At 9 am Saturday they came in and checked again. No change still. At that point, I was exhausted. I told dh if it was so important to get her out today, then just do a csection. I was too tired and sick to go on at this point. He went and talked with someone. The chief of OB came in to talk with me. He told me I had severe PE. That my liver and kidneys were bad. He also said my platelets were low. That they couldn't do a csection because if they did I would either have a seizure/stroke and/or bleed out/hemmorage on the OR table. He said that they had to deliver vaginally. It was the best way. They had one more thing that they could do. That the baby was stable but I was very sick. If it didn't work, if I declined more, if the baby became distressed that they could do an in emergency csection and have her out in less than 5 minutes.

The last thing that they could do was a manual cervical ripening. OMG. That was the worst pain that I have ever felt in my entire life. Worst than labor and delivery. It left me screaming in the procedure room and dh having to leave the floor. I begged them to stop. It involves a foley catheter being used to force the cervix to ripen and dialate to 3cms. When the cervix is ripened and dialated to three cms, then the bulb falls out. I cried and cried after that. They gave me drugs (stadol and fentanyl) for the pain. I slept after that. At 4pm, they came in to check me. I was now able to start pit. The anesthesiologist came in. Gave me an epidural and stayed with me the rest of the night. She was British and spoke perfect English. She was awesome!!!!! I threw up throughout labor. Fortunately, it went quickly. The mag just made me feel so sick and out of it. Mag is truly awful if you have been on it. At 10:30 pm, they came in and checked me. The nurse asked if she could break my water. I told her she could. I was 5cms. As soon as she broke my water, and removed her hand, I felt K right there. I told the nurse she was right there. The nurse waved me off and said impossible. We argued for several minutes. I finally told her if she didn't check me again, she was going to be delivering a baby. She checked and freaked out. I went from 5cms to 10cms in ONE contraction. Then they made me wait. They had to assemble a team from the NICU, get drs, and nurses. Then they moved me to a larger room because my room was too small. When the NICU team got there, I was allowed to push. K came out didn't cry at first, but then started crying. She was perfectly healthy but small. 5lbs 1oz at 36 weeks on the nose. The NICU team took off with her with dh in pursuit. Dh came back with her and said she was fine. They cleaned me up. Moved me back to the L&D room I had started in. Then K was placed in an incubator with the two holes in it for hands. Then they took her away after an hour. I don't know where she went. I think she went to the nurses station as foreign hospital didn't have newborn nurseries. It was expected that you room in with your baby. If mom was too ill, someone was expected to come and take care of thebaby for you. I spent the next three days in different L&D rooms on the L&D floor. I wasn't moved to Maternity till Tuesday. I stayed on mag till Monday night at 11pm, 48 hours after her birth.

I looked like death warmed over and refused visitors till I got to maternity. The mag makes you feel so sick. Blood was taken constantly. So much so that I had to have it taken from my hands and feet because my veins had collapsed in my arms. The morning after K was born, they tried to take blood. The dr got mad and came in and did it himself. Still no sign of my dr. I was passed from oncall doc to oncall doc. This would later give me a fear of obgyns. K was determined to be perfectly heathy but small.

We were supposed to be discharged on that Friday, but on Thursday the ped and my ob (yeah she finally decided to check on me, mainly because I tossed the ped out of my room) came in and said we needed to stay. K needed to stay till she was 7lbs. I needed to stay till Monday. I called the base. Spoke with the liason. At this point, all ivs were out. I was taken care of K fully. I told her that I didn't care who she needed to contact but I was leaving the hospital with my baby. I would bring K into the base clinic for care. She called the hospital and arranged it. The Commander of the base arranged for the base ped to come in on a Sat to check out K and I followed up with the base's high risk dr.

K was fine, but small. We did weight and temp checks for a long time. My bp was followed. I had been released on Aldomet from the hospital. I didn't take it as my bp at its highest was 140/90. The base clinic followed my bp, and it returned to normal within 6 weeks. I also had gotten a nasty bladder infection from the catheter that took two months to get rid of and I was diagnosed with a uterine infection before I left the hospital. K's birth left me with a distrust of hospitals and drs. So much so that I refused to have any of those women exams for 5 years. I still get upset if I feel like I am not getting enough information from drs. They have to tell me everything, show me lab results, and be prepared to answer questions. I have an awesome obgyn and pcp now, but it took a long time for me to get comfortable with them again. But more on that later. K's birth left some residual problems but not bad and it wasn't long before I was back to normal. The military dr said he would have just done an emergency csection and transfused me while doing it that Friday. But different drs do different things. I also had a very big fear of mag. I also would never ever have a normal pregnancy again.

I'll post about S's birth later. I have a plane to catch!

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