Pressure cooker
Pre-eclampsia can creep up with little warning and, if undiagnosed, can be a threat to both mom and baby – as this first-time mother found out when 38 weeks pregnant.
People always say you should expect the unexpected when it comes to children and childbirth. They're right. One minute I was loading poles onto the back of my bakkie for our little vineyard, and the next I was standing at the doctor's rooms being told to pack my bags for hospital and 24 hours observation – and the possibility of an emergency Caesar. The problem: high levels of protein in my urine – an indication of pre-eclampsia.

The thing about being from good Voortrekker stock is that toughing it out goes with the territory. So, when I started feeling grim towards the end of my pregnancy, I assumed it was just part of the deal. After all, everyone gets puffy and uncomfortable, don't they? But, when I look back at photos taken towards the end of my pregnancy, I can't believe I didn't notice how shocking I looked.

My face was hugely puffy and grey, my feet were swollen and my thighs started to rub together – an awful experience in the heat of the Cape summer. I also had an intense pain in my solar plexus, which I assumed was that bloody awful heartburn that everybody complains about. But other than that, according to me, everything was just hunky dory. Except it wasn't.

Twenty-four excruciatingly boring hours in hospital and meticulous urine collection confirmed that I had pre-eclampsia, a syndrome that occurs in around 6% of pregnancies, and can be fatal to both baby and mom.

What it is
Dr Janet Cole, an obstetrician and gynaecologist at Constantiaberg Medi-Clinic in Cape Town, regularly sees women with the syndrome. "Pre-eclampsia is a Greek word," she explains, "and means a 'bolt from the blue'. This refers to the convulsions or fits that women can experience if pre-eclampsia goes untreated." Pre-eclampsia, also known as toxaemia or pregnancy-induced hypertension, is a cluster of signs and symptoms. Amongst other things, these include: raised blood pressure; protein in the urine; severe swelling; visual disturbances and abdominal pain. The worrying thing is that preeclampsia can develop without you ever feeling particularly sick, and women are often caught off-guard.

"You're most at risk in your first pregnancy and if you're carrying more than one child," Dr Cole explains. "Also at heightened risk are teenagers and women who are having their first baby when they're over 40."

Cole goes on to say that, "pre-eclampsia can prevent the placenta from getting a good enough blood supply and this will ultimately put the baby at risk. And if left undiagnosed, may eventually develop into eclampsia or seizures caused by toxaemia. These are extremely distressing to witness, and in the past I've had to use my full weight to hold women down as they convulse. This usually only happens in public health settings, where women present late in pregnancy at the clinic or hospital without having regular pre-natal check-ups, which is when the condition would usually be picked up."

But why?
Although the signs and symptoms of pre-eclampsia are well documented, just what causes the condition continues to confound and frustrate the experts. A number of theories exist. Although high blood pressure is a possible explanation, it's hard to know whether this is the cause or result of the syndrome. One possible explanation is a placenta that is not embedded sufficiently, which affects the bloodflow between mother and child; or an overactive immune system, which regards the developing foetus as a foreign body or a suppressed blood-clotting mechanism. All these possible causes result in changes within the blood vessels – causing blood to leak into the surrounding tissues, which explains why you end up swelling so rapidly.

Kidney tissue is also affected and protein leaks into the urine. In a recent issue of The New York Times, an article entitled During Pregnancy, A Silent Struggle by Carl Zimmer describes the work of Dr David Haig, an evolutionary biologist at Harvard University in the US. Dr Haig describes pregnancy as a tug of war between a woman’s body and the needs of her foetus. Pre-eclampsia was one of the conditions that came under his spotlight. He suggests that the foetus somehow raises its mother's blood pressure "to drive more blood into the relatively low-pressure placenta," thereby ensuring maximum nutrition. Key to this mechanism may be a protein called soluble fms-like tyrosine kinase 1. It's this protein, Haig believes, that foetuses inject into their mother's bloodstreams, and it's this which prevents repair to blood vessels. "As the damage builds up," Zimmer writes, "so does her blood pressure". And, according to Haig, the protein that's detected in urine belongs to the foetus rather than the mother.

What to do
As yet, there's still no proven treatment for pre-eclampsia. If your doctor suspects you might be at risk, the first thing you'll be asked to do is produce a 24-hour urine sample so they have an accurate idea of how much protein is flooding your kidneys. Bedrest will be suggested, and you'll be asked to spend most of your time lying on your left-hand-side to help increase blood flow to the placenta and baby. But, if the protein levels are too high, the only way to stop pre-eclampsia spiralling out of control is to deliver the baby as quickly as possible.

For me, this meant an emergency Caesarean early one morning two weeks before my baby's due date. Sofia clocked in at a healthy 3,19kg – a tiny, blue little being with a shock of dark hair and a rosebud mouth. The first night after she was born, they drained eight litres of fluid from me, and each day after that I continued to shrink. I lost 11kgs in 11 days! And while I know most of it is liquid rather than fat, it still feels fantastic that my body has started to return to normal. From one day to the next I can get into my prepregnancy clothes, and while lack of sleep makes my world fuzzy, I feel so much better than I did in my last few weeks of pregnancy.

Apparently my blood pressure will take a while to normalise and at times I feel a bit weird, but who's to tell if that's just how all new moms feel or as a result of pre-eclampsia.

What else do I feel?
Incredibly lucky I was diagnosed so quickly and that both of us are fine. Who knows what would have happened if I didn't just happen to have a check-up on a Monday at lunchtime when I would rather have been loading poles into my bakkie?

Did you or do you suffer from pre-eclampsia? Tell us your story in the comment box below.

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