Pre-eclampsia and high blood pressure in pregnancy

Monitoring during hospital stays for pre-eclampsia

Women we interviewed who stayed in hospital because of pre-eclampsia or HELLP syndrome regularly saw doctors and midwives and had their health closely monitored with different tests and checks.

Most women had been on wards with other patients, many of whom were also being monitored. A few people said talking to the other pregnant women in the shared room was good and helped pass the time. Some even made lasting friendships. Women were closely monitored, especially if they were very poorly and doctors were worried that the situation could become more serious quickly. Paige remembered having one-to-one care where a midwife or doctor stayed in the hospital room with her all the time – “even when they were on break I had to have somebody else come in the room; I wasn’t allowed to be left alone”.

Olivia stayed in hospital for a week. She wasn’t given any medicines but she thought rest helped her blood pressure lower. She was discharged but returned to the hospital only a few hours later.

View full profile

Age at interview: 32

Sex: Female

Age at diagnosis: 28

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

I was in for the week that week. So, 37+5 to 38+5 I was in. And every day I was saying, "So, what are you going to do with me?" and they said, "We're just going to monitor you." I was like, "OK." One of the consultants came round and he was like, "Most of the women in this hospital are because of pre-eclampsia, you know everybody on this ward right now, they're only here because of pre-eclampsia," and I was like, "Oh right OK," and he's like, "That’s what you’ve got," and I know, you know I know [laughs]; I diagnosed that myself months, you know months ago, I know I've got pre-eclampsia. And he said, "Yeah, that’s pretty much all we can do to make sure you don’t do anything." He was like, you know "We don’t want you going further than the bathroom; we just want you to stay still, don’t move and just wait to go into labour," and I was like, "Oh right OK." I had responded to lying still; my blood pressure came right down – I think it was around a 133 – it stayed high for a couple of days and then it came down to about a 133 and this was at 38+5, and he said, "You can go home if you want today." I said, "OK yeah, I'll go home now," and I said, "Do I just continue bedrest?" He said, "Yeah, bed rest until you deliver." Alright fine.

Aileen had experience of being on a ward with other patients and in a High Dependency Unit (HDU).

View full profile

Age at interview: 40

Sex: Female

Age at diagnosis: 35

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

I was in hospital for two weeks again.

But during the two weeks' time I was in and out of HDU. There was a point when they can't control my blood pressure – took me to HDU for one night. They kept an eye on me a bit more on HDU, there's one to one, and then I think the next day blood pressure was stable, they decided me to… decided for me to go back to the ward. So there's a few scares that I had to go back down to HDU and thinking, 'This is it, this is it.'

But then blood pressure got controlled, went back to the ward , and then a couple of days later I had to go back down to HDU and yeah.

Mm. And what was the difference between the ward and HDU – why are they different?

Ward is obviously… it's a bigger ward. There's one midwife looks after six mums, whilst in HDU there's one to one midwifery care.

OK. And so you would reach HDU and what would happen during that time?

It'll be in one room I get connected to the… a proper monitoring instead of they're monitoring me every… I'm all continuously being monitored. I'm continuously on CTG monitoring as well.

Ongoing checks

Doctors and midwives ran different tests and checks. Monitoring helps give a better idea of how serious the situation is and how it is or isn’t changing. Josie stayed in hospital for two weeks and, during this time, she had her blood pressure measured every three hours throughout the day and night, blood tests every two days and ultrasound scans every three or four days.

Paige had tests and various medicines, including some to lower her blood pressure and to help her baby’s lungs develop, when she was admitted to hospital.

View full profile

Age at interview: 20

Sex: Female

Age at diagnosis: 19

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

I went in at 26 weeks. I had… what did they do? Urine test to see what was in there. They done blood pressure and they managed the baby's movements and baby's heartbeat. When I went in at 32 weeks they said my blood pressure was through the roof. At one point it went to 205 over 130. So, as soon as I went in it was steroids for the baby and then I had to take two lots of pills straight away. Blood pressure was being taken every two minutes – that wasn’t bringing it down, so they tried something else and then there are a lot of pills. Again that wasn’t bringing it down so they tried IVs; I was just having bloods like… look at my arms and it was just bruises all down my arms where they were just sticking stuff in, pulling blood out to try and find out… try and make sure it was coming down.

And then again through all this baby was being monitored. Eventually they managed to get the IVs and it had come down, stayed stable overnight. Had another lot of steroids then for her and they were just like, "Look now you’ve had your steroids." I wasn’t outputting any water; I had to drink 85 mls of water every hour. I was lucky to output 20 [mls]. So they knew my kidneys and everything else were, aren't-, failing. And then they were like, "No, you need to get… we need to have this baby out because although your blood pressure it's not just that that’s the issue, it's everything else that’s coming with it now as well."

Hanna was monitored overnight in hospital. She didn’t feel ill but was told by doctors that she was very unwell. She had an ultrasound to check on her baby.

View full profile

Age at interview: 39

Sex: Female

Age at diagnosis: 37

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

So the next morning, that was the panic time. Throughout the night they were taking my blood pressure and, because I was so anxious to go home, I kept checking as well but wasn’t coming down, at that point. It was still doing, it didn’t cause me much panic and I slept really soundly that night but they kept waking me to check my blood pressure, to put the monitor on the baby, everything. It was the following morning, after breakfast, when the doctors were doing the rounds, I had a female consultant with her entourage of her students and she said, “We’re not happy. How do you feel?” And I explained that I feel fine. “Have you had any pains whatsoever?’ And I did explain that I had a dull, aching pain and I’d had it for a while, at that point, over two months I would say and I said, told the midwife about that and the GP, just a dull pain on my right rib, just underneath the breast area, the rib cage, on the right hand side, had that for a while and I did tell her about that but, other than that, there is nothing. I felt well and she said, “Well, the way your blood pressure is, I am, we are rather surprised that you actually feel well and able to walk. So, therefore, we’d like to keep you in until your blood pressure returns to normal or we’ll have to do further tests as well before we can decide what the other options are.” And I said to her, “What other options?” She said, “We have to think about the baby and it’s not good for the baby for your blood pressure to be that high and for you to have that dull ache in your rib area, we’re going to do some more tests just to find out what the problem there is and send you for a scan, the baby as well, to make sure it’s developing fine.” So they sent me down to, the porter came, they took me to the scan area. It was fine. The baby was fine.

Having tests and checks was part of the daily routine in hospital for Emma.

View full profile

Age at interview: 38

Sex: Female

Age at diagnosis: 34

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

So, I remember being woken up, well having blood pressure tested every four hours I think.

OK

And then in the mornings having-, going on the trace monitoring for about an hour. And then quite often blood-, had blood samples taken in the morning quite often.

And often saw doctors or the consultants would come round then as well. And then obviously it was sort of lunch-time, and then it seemed to be quieter in the afternoon and visitors were allowed in in the afternoon so, and again, you know it was just the regular monitoring really.

I remember being very tired because obviously the later stage of the pregnancy you don’t sleep brilliantly, and then because you're being woken up all the time, yeh. I remember thinking, 'I'm pretty shattered and I haven’t even had the baby yet,' and yeah so, yeah I mean it-, being in hospital is horrible anyway because the food's not great and your being given the same food all the time and if you don’t feel very well it's-, yeah it's, it's difficult but.

Women described various tests:

Checking blood pressure

All the women we spoke to previously had their blood pressure checked at routine antenatal appointments and some had also been self-monitoring at home. Blood pressure was also frequently monitored in hospital so that a fuller picture could be built up of the readings and any worrying readings could be acted on quickly. However, the frequency of blood pressure tests could be exhausting, especially if they were run all day and night. Aileen said the constant monitoring was reassuring but also tiring: “obviously I didn’t get a good night's sleep or a good day's sleep”.

Testing blood samples

Blood samples were usually taken and tested. Kay remembered having her blood tests taken at 6am every morning in the hospital. It was blood tests that revealed Helen X’s liver was not functioning very well and she was told she had HELLP syndrome.

Testing urine samples and measuring urine output

Urine samples and sometimes urine output (i.e. how much urine a person produces compared to the quantity of liquids they drink) were closely monitored too. Kay had to do both – her “first morning sample” was tested for protein levels and she had a “big tub […] to pour my daily amount” of urine which was measured as well as tested. Some women had restrictions on how much liquids they were allowed to drink each day.

Dominie had her urine output monitored in hospital. She had a catheter fitted at first which she didn’t like and also had her water intake restricted.

View full profile

Age at interview: 25

Sex: Female

Age at diagnosis: 24

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

I also at one point had to have a catheter much to my annoyance. Because I was…basically as I got in there I was probably drinking about six litres a day and I was probably going to the toilet at least every hour.

I was weeing a heck of a lot. So, I…we… the registrar and I – we know each other – and we had a bit of a kind of, "Oh I don’t want it in." "Well, you need to have it in." Because I was on like the high dependency they needed to keep monitoring my fluid input and output. So I did have it in for one night but the next night I lost all kind of… I think because I'd been awake, I had this headache, I had to hold on to this monitor, I had this horrible burning in my arm, and a catheter, again never realised the pain but that for me was so uncomfortable.

Every time you moved you felt like your whole bladder was just being tugged. So, they did take it out and I had to get up every hour and go for a wee, which I was very happy to do. And the other thing was they then reduced…I was only allowed to have 80 mls of water an hour. So, for someone that…in pregnancy my craving was ice and water, so to only have 80 mls – it doesn’t sound that bad, but when you're drinking so much, like your whole mouth is like, you know and that wasn’t very pleasant.

And just give us an idea about how much 80 mls an hour is.

I think it was something like that in the cup.

Yeah

It was like…it was like a swill on the mouth. And some hours I would just be almost in tears because I just needed something to wet my mouth because I was just so dry yeah.

Ultrasound scans and using a Doppler device

Some checks looked more directly at the health of the unborn babies. These tests including trace monitoring (also known as CTG or cardiotocography) which measures the unborn baby’s heartbeat. This usually involves a kind of belt being strapped around the pregnant woman’s bump, although Angela had one with “prongs” placed on her bump around the baby’s head which she said gave a very accurate reading. In some instances the midwife or doctor used a Doppler, a device moved over a pregnant woman’s bump to check the unborn baby’s heartbeat and the placental blood flow.

Kay had Doppler checks and ultrasounds. It was very worrying that her unborn baby was so small, but she found some comments made by her consultant reassuring.

View full profile

Age at interview: 42

Sex: Female

Age at diagnosis: 38

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

And they do a lot of other scans with you where they measure the blood flow through the placenta, and my consultant told me, "Your baby is going to be very small." He knew that you know. And I said to him, "I'm worried, you know she's going to be this small," and obviously as time went on I knew I wasn’t going to go forever, I knew it. And he said to me the sweetest thing, he said, "Don’t worry about her size because the ones that are bigger they're lazy and they come out and everything's fine, but they're lazy. But your little one's in there now and she knows things aren't right, and that baby's getting ready for a fight. She knows she's coming out for a fight." And I was like, "Really?" And again I don’t know if that’s true or not but it did make me feel better, and he was right. She came out and she hit the ground, well bang, and she was fighting; she was pulling tubes out, the ventilator came out. She was sedated to calm her down do you know what I mean? So, maybe that is the truth.

Munirah was admitted to stay in hospital 25 weeks into her pregnancy. Ultrasound scans showed that her unborn baby was very ill and her own health was deteriorating rapidly, so the decision was made to terminate her pregnancy.

View full profile

Age at interview: 27

Sex: Female

Age at diagnosis: 27

See full profile

SHOW TEXT VERSION

PRINT TRANSCRIPT

Later on in the day, they suggested I have another ultrasound scan just to see how the baby is. They kept checking the heartbeat and the heartbeat was completely fine. They did a scan and they were-, they became quite concerned about what they could see on the scan. There was, there was a problem with the baby's bladder which I was told was nothing to do with the pre-eclampsia, and they said there was some white patches on the brain, and when I saw the scan myself I knew there was something wrong because I didn’t see the same patches when I went to the other scans, especially his 21 week scan, none of that was there. So they said, "Actually this is a lot more serious than we'd imagined; it might be starting to affect the baby." Then one of the consultants came and told me that cos I was 25 weeks and the hospital, my local maternity unit, could only deliver the baby at 28 weeks. They said, "We’re going to transfer you," so they actually transferred me to the hospital-, to-, well a more specialist hospital, and they said, "What we're going to do is we're going to try and get you ready to deliver the baby." So I was given some steroid injections and they said that would help my son breathe once he's out. And I was transferred to the hospital and the next day and we saw a consultant paediatrician; we saw-, we just saw so many people, so many consultants and doctors, and the paediatrician said, "Having looked at the-" because I was-, had more scans then, and the paediatrician said, “The outcome for a baby this size is really poor”. Because with my son, he wasn’t 25 weeks; the weight they would have expected him to be at 25 weeks; he wasn’t, he was 23 weeks and his, I think they said his weight was half of what it should have been. So, he hadn’t put on any weight in a couple of weeks. And they said if they delivered, they wouldn’t be able to resuscitate him because he was under 500 gram. They said that if he did survive, he would have most likely have cerebral palsy and he wouldn’t live for very long. If they were being really optimistic, he would make it to about 13 with kind of disabilities till that age, and he'd need round the care… just around the clock care. And it kind of started to sink in just how serious things were. And at that point we just didn’t want to think about it.

We were told we need to have a baby MRI scan, that my blood pressure was just so high they couldn’t bring it down. My blood pressure kept creeping at this point and they couldn’t do anything so-. They were trying to give me medication but it wasn’t working and they said it wasn’t safe for me to go for this MRI scan, so I didn’t have that. So, then I had to have more ultrasounds; another ultrasound scan and a couple of these while I was in the hospital and this brain haemorrhage on my son was getting worse. They suggested we terminate the pregnancy, and that’s the hardest decision we had to make.

Frequent monitoring could be reassuring, but it could also feel like a chore. Kay remembered finding it annoying having nurses check on her all the time, but also realised it showed that they were doing their job well. Julie didn’t like the feeling of being “strapped to the bed” by all the monitoring equipment.

Monitoring guided the next steps taken in hospital for women with pre-eclampsia, such as taking medicines. You can also find out more about women’s experiences of being informed and included in decision-making in hospital here.