Her relatives withheld vital information

A real life account as witnessed by a maternity nurse

Mary was rushed into the hospital at around nine o’clock that night while I was on night duty. Her two relatives said it was an emergency and insisted she must be admitted at once. This surprised me as no diagnosis had been carried out. I asked what the problem was: they said she had complained of painful ribs, fever and chills, vomiting and headache. She was in her ninth month of pregnancy and the baby was due any day.

The first tests were therefore to determine whether she could be in labour. The diagnosis however showed she was not. A vaginal examination confirmed that the cervix had not dilated. Her waters had not broken either. The fetal heartbeat was normal. She had no signs of fever either and her blood pressure was regular. After observation, some pain killers were prescribed and she went home in the company of her two relatives. I was somewhat perplexed that they had rushed her to hospital yet she did not seem to have any indications of illness. I advised them to keep her under close watch as I suspected there was something untold.

At 11.00 pm Mary was returned to the hospital in another round of emergency. This time her condition had visibly worsened. Her blood pressure had shot up and she was very restless. I called the doctor urgently and Mary was admitted immediately.

What could have happened between nine o’clock and now? I wondered whether she had self-medicated herself after leaving hospital. I asked the relatives what could have gone wrong or if they knew anything that might help in the diagnosis.

Mary’s pregnancy was unplanned and she was of advanced age. She had complained how the family planning pills she had been using, had let her down. With five children — the last one in his teenage years — her current pregnancy was unexpected, but she had no choice but to carry the baby to full term.

It was while in the ward as the doctor attended to her that Mary developed severe convulsions. She went into a fit and it was then that the doctor realised what she was suffering from — eclampsia. Her blood pressure shot up to a new high.

Eclampsia is a serious complication during pregnancy characterised by fits and accompanied by severe hypertension (high blood pressure), proteinuria (protein in the urine) and oedema (excess fluid in the body). When diagnosed, it is a medical emergency.

It is a rare condition which evolves from untreated or undiagnosed pre-eclampsia. It results in epileptic-like fits which occur during or shortly after labour, but can occasionally happen towards the end of the third trimester.

Eclampsia fits manifest themselves in three phases: phase one indicates a tonic period of violent muscular spasm and rigidity. Lack of breathing (apnoea) causes blueness (cyanosis) in the skin and mucous membranes. This is followed by a clonic phase where the patient jerks with violent and uncontrollable movements. Finally breathing returns in the last phase, but with the risk of inhaling mucus or blood from the mouth or air passages linked to the mouth. The fits can lead to a coma.

Mary was still not in labour but the doctor prescribed immediate delivery of the baby. It was only then that I heard one of the relatives discussing how Mary had convulsed earlier that evening. She had even fallen! Simply but with potentially fatal results, the relatives had withheld vital information which would have been useful in treating Mary the first time she was brought to hospital. No one explained why!

Mary was laid on her side until she was breathing normally again and luckily it was not necessary to administer oxygen to her. We had to be careful to ensure that she did not hurt her baby during the violent muscular spasms. She was also medicated to control the fits and to lower her blood pressure.

Eclampsia fits can lead to spontaneous labour, therefore the doctor avoided sedatives (sleeping drugs). Once she calmed down we rushed her to theatre for a caesarean section to save the baby. She delivered a healthy baby boy and was herself out of immediate danger.

Mary’s condition, however, continued to spring surprises. Twenty minutes after coming out of the theatre she became restless at a time when a normal person would be drowsy. She even tried to get out of her bed unaided. We gave her some medication to calm her down but after an hour or so she got restless again. The doctor explained that eclampsia can hamper the effectiveness of medication. We also feared that the fits may have affected her brain. Repeated fits can be fatal to both mother and the unborn baby.

The mother may suffer cerebral haemorrhage (internal bleeding in the head), pulmonary oedema (excess fluid in the lungs) or renal (kidney) or hepatic (liver) failure. If the mother inhales blood and mucus caused by the attack, this may lead to pneumonia, a potentially fatal inflammation of the lungs.

The greatest risk for the fetus is death in utero (in the uterus) due to interruption of oxygen supply especially when the mother experiences hampered breathing.

After the operation we could not leave Mary alone with the baby until we were sure that the symptoms of eclampsia were gone. This was to avoid her hurting the baby accidentally. She could not breastfeed her baby for two days, so the baby was fed with dextrose.

On the fourth day she calmed down and breastfed the baby, but still under supervision. Her children thought that their mother was epileptic and they were counseled to distinguish eclampsia and epilepsy. We helped them appreciate the little baby that had become part of their family. After eight days in hospital she was discharged.

Mary has been attending post-natal clinics and both she and the baby are progressing well. The baby was lucky not to have been affected by his mother’s condition.

END: PG 3/18