May 30, 2012
- 1st Pregnancy
- Age; young teens and women over 35 are at greater risk
- History of diabetes
- History of hypertension
- Family history (mother, sister, aunt) of preeclampsia
The typical preeclamptic patient has a blood pressure of 140/90 or greater with protein in the urine and swollen ankles in the late 3rd trimester. She may often complain about a headache. This patient is fairly straightforward, but what happens if these symptoms present in a patient who is only 31 weeks? Or 27 weeks? Some healthcare providers will try to “buy time” and “treat the patient with bed rest or blood pressure meds” and she ends up having a seizure or a stroke. The only treatment for preeclampsia is delivery of the baby because it is the placenta that’s causing the problem. There’s something in the placenta that causes the blood vessels to squeeze and increase the blood pressure. Once the placenta is delivered, the blood pressure usually comes down but a woman can have preeclampsia and the risk of having a seizure for 96 hours after birth.
A patient may have a blood pressure of 120/80 with a measurement of 3+ protein in the urine. Her normal blood pressure is usually 90/60 and she has gained 5 pounds in one week. Yet her physician or midwife thinks this is normal. It’s not. They have been lulled into a false sense of security because her blood pressure is 120/80 and not 140/90. This patient should have her blood pressure repeated 2 more times within a 6 hour period and if it remains high, the diagnosis of preeclampsia is made. She should also have her urine collected for 24 hours to determine if there’s significant protein.
Why is preeclampsia often misdiagnosed? Because healthcare providers view the abnormal signs of pregnancy as “normal” variants. They’re not. A headache that doesn’t go away, a sudden increase in weight gain, swollen feet or ankles needs further evaluation as well as significant protein in the urine. If you think you have preeclampsia but your healthcare provider disagrees, by all means, call your insurance company and request a second opinion.
Remember, a healthy pregnancy doesn’t just happen it takes a smart mother who knows what to do.
May 28, 2012
As a young girl growing up in a small Long Island town called Amityville, Memorial Day was a huge holiday filled with parades and barbeques. I would inevitably end up at my friend Diane’s backyard eating a hotdog along with the rest of the kids on our block. It was also a day when we made our annual trip to the cemetery to place American flags on the graves of veterans and flowers on the graves of the deceased. Well, today, in honor of both Memorial Day and Preeclampsia Awareness Week, I’d like to take time to remember all mothers and their babies who died during childbirth, especially from preeclampsia.
What is preeclampsia and why is it so deadly? Preeclampsia is a condition of pregnancy in which there is high blood pressure; swelling of the ankles, feet, or face; protein in the urine; and abnormal kidney function. This condition requires the delivery of the baby in order to preserve the mother’s life and prevent seizures and strokes. The old fashioned term for preeclampsia was toxemia and it affects 1 out of 12 pregnancies each year. Approximately 76,000 women die annually from this disease and most people know of at least someone that it has affected during pregnancy.
When I think about preeclampsia, a woman name Dawn Fleming comes to mind. Dawn was 31 years old, a member of my sorority, Delta Sigma Theta and a popular radio personality in Orlando. Although I did not know her personally, she was from my former hometown of Queens. She was gregarious, a community activist who died unexpectedly from a preeclampsia related stroke. She had recently married and delivered a baby girl 6 days before her untimely birth. Her daughter is now approximately 8 years old and will never know her mother. When I attended Dawn’s wake, I was both angry and sad. I suspected someone had inevitably missed the diagnosis and by the time she was given treatment, it was too late. Such is the case of the vast majority of preeclampsia victims. By the time a diagnosis is made, the damage is already done. In her book, You Have No Idea, celebrity Vanessa Williams and her mother, Helen, discusses preeclampsia as the reason for her paternal grandmother’s death.
In my next blog, I will describe the signs, symptoms and treatment for preeclampsia that is also described in The Smart Mother’s Guide to a Better Pregnancy. But in the meantime, I urge all of us to take a few moments to remember all the moms and babies who are no longer with us and pray that a cure for preeclampsia will one day be found.
July 12, 2010
Every time I want to retreat from medicine, stories Like Angela Burgin Logan’s give me reasons to press on. Angela almost died having a baby because her physician was too careless to listen. Stories like Angela’s is what inspired me to write The Smart Mother’s Guide to a Better Pregnancy. I saw too many “near-miss” and “near-death” occurrences among pregnant women and decided to do something about it because most of them are preventable.
Angela is a 30-something year old African American alumnus of Syracuse University who has extensive business experience as a marketing executive for celebrities and is also married to one. She had an uneventful pregnancy up until her late second trimester when she developed signs and symptoms that any trained obstetrician would have immediately recognized as impending pre-eclampsia. She gained five pounds a week and developed swelling. She could only sleep propped up on a pillow because she couldn’t breathe pillow. She complained of shortness of breath and difficulty walking. All of her complaints were disregarded by her physician and staff in a condescending manner. It was only after she gained 15 pounds in one week did her physician reluctantly order lab tests based on her insistence.
On the night of her delivery, she went to the hospital because she could not breathe. Her blood pressure was extremely high, her platelets were low and she had significant protein in the urine. Angela had a lethal variant of pre-eclampsia called the HELLP Syndrome. Against Angela’s wishes, she was forced to lie on her back for a nursing procedure and fluid seeped into her lungs. She lapsed into a coma. An emergency C. Section was performed and it was discovered that she had an enlarged heart. Her infant daughter was born in distress and there was an 80 percent chance that Angela would die. Thank God she didn’t. Angela is now on a mission to warn pregnant moms about pre-eclampsia and urges them to “trust their instincts.” I totally agree.
Arrogance and condescension have no place in a patient-physician relationship and is a sure-fire way to end up in court. I urge all pregnant women to become proactive regarding their prenatal care and above all, trust your instincts. The days of the passive patient are gone. A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.