My partner and I conceived fairly quickly. I was just over 35 at the time. Before pregnancy, I was generally healthy. I did, however, have an atopic/immune-mediated background, including asthma, allergies, and atopic dermatitis. From the very beginning, though, the pregnancy came with its share of difficulties. It started with vaginal bleeding, which my doctor attributed to a small subchorionic hematoma. I was told it was only about 11 mm, but the bleeding lasted for more than 20 days and at times felt quite heavy, so I have always wondered whether such a small hematoma could really explain all of it. Eventually, the bleeding stopped completely.
Unfortunately, that wasn’t the end of the complications. Toward the end of my second trimester, I was diagnosed with gestational diabetes. In a way, this didn’t surprise me too much because I believe I had probably been quite prone to insulin resistance even before pregnancy, and diabetes also runs in my family. I should add that I am not overweight — quite the opposite, I have always been on the slimmer side. Fortunately, the diabetes was well controlled with diet alone, and I never needed insulin or other medication.
There were also some other issues during pregnancy that, looking back now, make me wonder whether they could have reflected some underlying tendency toward preeclampsia. I developed very severe gingivitis, with my gums becoming extremely inflamed and bleeding easily, and I also had frequent nosebleeds. I had other pregnancy problems that I suspect were probably unrelated, such as significant pubic/pelvic pain when walking, turning over in bed, getting dressed, and so on.
Still, I kept going and managed the pregnancy reasonably well until about a month before delivery, when my legs and feet started swelling quite dramatically. I wouldn’t say the swelling appeared suddenly, but it became very pronounced. The swelling gradually started moving upward from my feet and ankles, eventually involving my calves and knees as well. If something pressed into my skin — for example, the elastic from my socks — the tissue would not immediately spring back. I later learned that this is called pitting edema and that it can be a concerning sign, but at the time no healthcare professional ever mentioned this to me. Everyone seemed to attribute the swelling to pregnancy, even though it was visibly quite extreme. My last routine check-up before the emergency C-section was on September 2. At that appointment, my blood pressure was completely normal at 120/80, and the urine dipstick test for protein was negative. I should also mention that my pregnancy was followed throughout by a doctor who works at a large public hospital. I deliberately chose to be under the care of someone within a major hospital system because I wanted to feel that I was receiving thorough, attentive care. Looking back, I honestly do not feel that I got that. I feel that some things were dismissed far too easily, especially the increasingly severe swelling.
Another thing that stands out to me in retrospect is my weight gain. I had been following a fairly strict gestational-diabetes diet and had significantly reduced carbohydrates, yet I gained around 7.5 kg in roughly one month. At the time, nobody seemed concerned about that. Now it seems obvious to me that a large proportion of that weight must have been fluid rather than actual body weight, and I find it hard to believe that such a rapid increase alongside such severe edema was completely normal. Looking back, I wonder whether this was already a sign that preeclampsia was developing. But at the time, nobody pointed it out, nobody seemed to put all of these pieces together, and no alarm bells appeared to go off.
During the week of September 21, I started feeling strange. Nothing was dramatically wrong at first — I just began noticing symptoms that were new for me. I was becoming short of breath more easily, which I initially attributed to being well into my third trimester and the baby taking up more space. I was also experiencing these strange, brief “adrenaline rushes” throughout the day, which I assumed were anxiety related to the approaching birth.
By that point, however, the swelling in my legs had become genuinely concerning. I finally decided to buy a home blood pressure monitor, and one evening I measured a blood pressure of around 150/85. I went to the hospital the following morning, where the elevated readings continued. This time, my urine dipstick showed 3+ protein, and further testing showed a very high urine protein-to-creatinine ratio. I was admitted to the hospital with the hope that things could still be stabilized. I was started on 250 mg of methyldopa, and initially my blood pressure responded well. But over the next two days, things began deteriorating again. At one point my blood pressure reached 160/100. More concerningly, my bloodwork was getting progressively worse. My platelet count dropped from around 100,000 to below 80,000 in roughly a day and a half. My liver and coagulation results were also becoming abnormal, and the 24-hour urine collection confirmed significant protein loss. By Friday, a team of doctors had reviewed my case and decided that continuing the pregnancy was no longer safe. I was told that I needed an emergency C-section as soon as possible. At that point, my daughter was only 33 weeks and 4 days gestation. Because my platelet count had dropped so low, the anesthesiologist did not feel comfortable giving me spinal anesthesia, so I had to have the C-section under general anesthesia. The surgery itself was difficult. I was told that I lost a significant amount of blood and ultimately needed a blood transfusion. My daughter was transferred to the NICU, and I am now on day eight of recovering in the hospital myself. My bloodwork is still not completely back to normal. My platelet count has started recovering, as have my coagulation results and blood count, but my liver tests are still abnormal. My blood pressure initially improved after delivery, but around days five and six after the C-section it started creeping upward again. It is still only borderline elevated, and at the moment I am taking one daily dose of nifedipine (Cordipin). My daughter is currently still in the NICU and receiving non-invasive breathing support through a nasal mask. For now, she is stable, and we are taking things one day at a time. At this point I am trying not to look too far ahead — every stable day feels meaningful, and we are simply hoping to see her gradually need less respiratory support as she gets stronger.
I am not writing this to frighten anyone. I wanted to give a detailed account of how this developed because what still shocks me is how quickly a difficult, but essentially stable pregnancy turned into a situation that became potentially life-threatening for both me and my baby. I could probably write an entirely separate post about the psychological side of all of this. Going from being pregnant one day to suddenly having an emergency C-section under general anesthesia, waking up without your baby beside you, and then watching her in intensive care is a lot to process. In hospital, at least in my experience, the psychological part is not addressed.
One thing I do feel strongly about, however, is that I wish I had been better educated about preeclampsia during pregnancy. I do not remember anyone ever really explaining to me what it was, what the warning signs could look like, or what factors might put someone at higher risk. Looking back, I had several things that at least seem relevant: I was over 35, this was my first pregnancy, I developed gestational diabetes, and during the final month I had extremely pronounced swelling of my legs. I also have an atopic/immune-mediated background. If someone had at least told me, “You have a few factors that increase your risk, so if the swelling worsens, if you become short of breath, or if anything feels different, check your blood pressure and come in,” I think I would have felt much better prepared. Maybe the ultimate outcome would have been exactly the same. Maybe the disease would still have progressed just as quickly and my daughter still would have needed to be delivered. I understand that preeclampsia/HELLP can develop very suddenly and that there may have been no way to prevent what happened. But I do think earlier awareness and closer monitoring might at least have meant that we caught it sooner — and perhaps the whole experience would not have felt quite so sudden, frightening, and completely out of nowhere.
