Tara's story

I went for a routine 24 week check-up Thursday June 12 1997. We'd just returned from an overseas holiday so I wasn't too perturbed by some ankle swelling and significant weight gain. The night before the appointment I had a brief severe headache that subsided. The day of the appointment my vision was impaired but since I was already near sighted I didn't worry. I also experienced flashing lights the day prior. Thinking I was getting a migraine (which I'd suffered from as a child) I was relieved when a migraine didn't eventuate.

Upon presenting to the OB he noted I'd gained 11 lbs in 4 weeks and 20 lbs in total. My urine showed +++ of protein, the BP was 180/110 and I had very brisk reflexes.

I was admitted to the high dependency unit in the labour ward & informed by the OB our baby would have to be delivered within 48-72 hrs.

Steroid injections were administered to optimise the baby's lung function and overall survival. An indwelling catheter was inserted and multiple IV lines including magnesium, hydration and hydralazine (for BP control) were commenced. The room was kept very dark to reduce the risk of seizures. A CTG was performed to assess the baby's heart rate - she seemed to be stable at that point.

Over the subsequent 24 hrs the BP escalated and I experienced intermittent flashing lights and was given valium to reduce the risk of seizures. I developed left upper quadrant pain that radiated to my shoulder; this appeared to be related to the pre-eclampsia. I had one bout of vomiting on the Saturday night. My liver and renal function tests remained within normal limits. At no stage did my platelet count drop, nor did I develop coagulopathy (bleeding tendency). My uric acid level remained normal.

I was induced (with premature rupture of the membranes, prostaglandin and oxytocin) early Sunday morning and given an epidural shortly afterwards to help control the BP. I had a vaginal delivery. Our baby girl (Jasmine) was born alive at 3.20am with an apgar score of 1 and died shortly after delivery. We held her for a short time but it is never long enough and I wished we'd held her more.

After Jasmine was born, initially my condition remained unchanged. The high BP continued, the urine output decreased intermittently, the edema persisted and I developed a mild fever. My muscles were aching and twitching all over from the magnesium. I felt like I was on fire.

The following Tuesday the IV lines, urinary catheter and epidural line were removed and I was discharged home Wednesday with oral BP medication and advised to wait 12 mths before trying to conceive again.

10 mths later my urinary protein improved but remained 3 times higher than normal and the hypertension continued requiring ongoing oral medication. Multiple tests were undertaken; essentially all came back normal. I was diagnosed with chronic hypertension and it is questionable still whether I have some underlying renal disease.

With pregnancy #2 I was placed on modified bedrest at 20 weeks after the BP started to increase. I did yoga & went on gentle walks but generally rested (on my left side). I took baby dose aspirin (75mg), magnesium and calcium supplements. 24 hr urinary protein collections were performed 2 weekly and I monitored my BP 3 times daily at home.

At 34 weeks the BP started to escalate again (180/110), this time it did not decrease with rest. I noticed some slight edema in my face, though this was not as severe as in the first pregnancy. Following admission to hospital the same day I was found to already have HELLP syndrome (a progression of severe pre-eclampsia) as evidenced by decreased platelets and elevated liver enzymes. Within 12 hrs of admission, a C-section was performed and our baby boy (Noah) was delivered weighing a hefty 5 lbs 9 oz. He required mechanical ventilation for 24 hrs & 6 days in NICU but recovered very well. I was placed on magnesium sulfate and recommenced atenolol that I'd been taking pre-pregnancy and was discharged from hospital in 4 days. Currently my BP continues to be elevated requiring high doses of medication though my renal function is better than ever.

The stress associated with being pregnant is well worth the bundle of joy at the end. We are having the time of our lives with Noah. I encourage other women placed in similar situations to persevere, stay informed and assume responsibility for ones own health by monitoring your vital signs and constantly assessing for warning symptoms. Pre-eclampsia can develop within hrs with little warning but if detected early the risks can be reduced and positive outcomes for mother and baby (and husbands/significant others) can be achieved.

Tara