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Conception after pre-eclampsia

BY PETRE WILLIAMS-RAYNOR Career & Education editor williamsp@jamaicaobserver.com

Sunday, August 05, 2012    

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'SHOULD I have another baby?' It is perhaps the toughest question that a woman who has had pre-eclampsia will have to answer.

And their response is seldom a simple 'yes' or 'no', particularly for those who have had a severe case of the illness, which affects some pregnant women from as early as 20 weeks in the baby's gestation, putting both their lives in peril.

Trishon Mason-Hemans had this decision taken out of her and her husband Kenyon's hands when — four years after her first child had to be delivered because of pre-eclampsia — she discovered she was pregnant again.

She was 28 weeks along in her pregnancy and 25 years old at the time. The signs of pre-eclampsia, in her case, included high blood pressure and protein in the urine.

In other women, according to information from the BabyCenter.com, they also include:

* a reduced blood flow that can affect organs such as the liver, kidneys and brain;

* reduced blood flow to the uterus resulting in poor growth for the baby, "too little amniotic fluid and placental abruption (when the placenta separates from the uterine wall before delivery)"; and

* changes in the body's blood vessels, which cause the capillaries to 'leak' fluid into the tissues, resulting in swelling known as oedema.

She recalled the anxiety she experienced after learning initially that she had pre-eclampsia.

"I was saying I was gonna die or the baby was gonna die," she told the Jamaica Observer.

Doctors at the Victoria Jubilee Hospital in Kingston had to immediately deliver the baby — a little girl named Sydneé, who was born with two holes in her heart, fluid in her brain and strabismus (crossed eye/squint). Immediately after birth, she also had respiratory problems and now has asthma.

In the four years before learning she was pregnant with her second child, Mason-Hemans said the other problems experienced by her first child have either resolved themselves or were resolved with medical intervention. However, it was four years of stress.

Mason-Hemans remembers well the frequent visits to a variety of medical specialists, oftentimes via public transportation and at a high financial cost to her and her husband.

The couple resolved not to have any more children.

"Both me and my husband came to the conclusion that there weren't going to be any more babies. So we took precautions," she said.

Therefore, the news that she was expecting for a second time was gretted with more than a little terror.

"When I found out I was pregnant for the second time, I said, 'Oh my God, I hope it's not preemie baby," Mason-Hemans said, adding that she dreaded a repeat of the deadly illness which had forced the early delivery of her first child.

However, she soon accepted the reality of a new addition to the family and was determined to do all she could to get that baby to full term — even knowing as she did that there is no proven way to prevent pre-eclampsia, the only cure for which is the delivery of the baby.

"I made sure that all the things I wasn't doing right the first time, I did with this baby; I went and tested my [blood] pressure, did my blood tests and [ensured] that my feet weren't swelling as fast as with Sydnee," she said.

On top of that, she made sure to avoid salt, drank a lot of coconut water, and ate a lot of cucumber — all in an effort to help control her blood pressure.

Things went well; she made it to full term and just over a year ago gave birth to her second child — a healthy little girl named Kaylee.

Today, Mason-Hemans encourages women who have had pre-eclampsia to try again.

"Pre-eclampsia is really a [horrific] experience for every mother. After that, you wonder if you would have a problem with it with another baby," she told the Sunday Observer.

"But I figure more or less that every pregnancy is different. I would advise mothers to try again because all births are not the same. [But] take precautionary measures; drink a lot of coconut water, eat a lot of beet root — though I don't like it — and eat a lot of cucumber. And avoid the salt," Mason-Hemans added.

Consultant obstetrician/gynaecolgist at the University Hospital of the West Indies (UHWI) Dr Sharmaine Mitchell also considers that women who have had pre-eclampsia should have another go at having a baby. For one thing, she said the risk of the illness recurring is less.

"Definitely try for a second child because your risk is lower; it is just that you keep monitoring [for any signs of recurrence]," she said.

"What we usually recommend is that you go on low-dose aspirin — baby aspirin, one a day. It has been shown to make the outcome a lot better," added Mitchell, who also operates her own private practice.

"You only live once and you need to live your best life now. The thing to do is get to your ideal weight for height, take the low-dose aspirin, take the folic acid and then try again," she said further.

Dr Leslie Samuels, himself a consultant obstetrician/gynaecologist at the UHWI, said the decision to have a child after pre-eclampsia — which has killed 28 Jamaican women in the last five years, according to Ministry of Health data — is "a personal one and should be made by the patient and her partner".

"We [doctors] serve to inform and counsel the patients, giving them the wherewithal to make informed decisions," he said.

Like Mitchell, Samuels has said putting the patient with a history of pre-eclampsia on low-dose aspirin has been known to work — albeit not in all cases.

"Prevention in the strictest sense is not yet possible. There are medications, such as aspirin, which can make it less likely to occur, and/or to make it less severe if it does, but this is only true for those at highest risk. The mainstay of management is strict/close monitoring in pregnancy, and immediately after birth, with appropriate treatment if the problem occurs," he told the Sunday Observer.

Added Samuels: "For the average patient, with no additional problems, and with the same partner as before, the risk remains higher than a woman who had never had it, but less than it was in her initial pregnancy."

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