Dr. Erika Kube| Special to The Columbus Dispatch USA TODAY NETWORK

Amber came to the emergency department via ambulance with complaints of a severe headache that started the day before.

She wasn't sleeping much because she recently had a baby and was waking up numerous times each night to feed her son. She also cut back on caffeine because she was breast feeding.

Her headache worsened significantly in the early morning, when her husband ended up calling 911 to bring her to the emergency department.

Her husband started getting worried about Amber earlier that day because she never complained about anything and was generally never sick. She also wasn't herself. He figured her lack of sleep was the main issue. He told her he would get up with the baby, feed him and get him back to sleep. She woke up at 2 a.m. with her headache worsening and started to feel nauseated. She took some ibuprofen but vomited shortly afterward, which made her headache even more intense.

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When the paramedics arrived, they hooked Amber up to a monitor to check her vital signs. Her heart rate was normal, but her blood pressure was high. The paramedic repositioned the cuff, presuming it was a bad reading. Ambers husband was rocking their baby in his arms and looked over at the monitor with concern. Her repeat blood pressure was still high even higher than the first. Amber did not have a history of high blood pressure, so this was concerning.

The paramedics put Amber on their cot and placed an IV in her arm. They gave her nausea medications through the IV as well as pain medications. Ambers husband put the baby in his car seat, packed his diaper bag and loaded him into the car to follow behind the ambulance.

Amber arrived in the ED a few minutes later and said her nausea was better, but she was still feeling terrible. The paramedics alerted us on the radio of their concerns that Amber may be experiencing a condition called preeclampsia, given her elevated blood pressure, headache and that she had a baby two weeks prior. I was concerned about this diagnosis as well. I started Amber on magnesium to prevent her from having a seizure and medications to quickly lower her blood pressure. I called our on-call OB physician to help manage Ambers care.

Preeclampsia refers to the onset of high blood pressure (hypertension) with signs of injury to other organs in the body such as the kidney and liver in a pregnant or postpartum woman who has previously not had hypertension. Preeclampsia usually begins after the 20th week of pregnancy but can occur any time, including up to six weeks after delivery.

Preeclampsia, left untreated, can progress to eclampsia, a rare but serious complication of preeclampsia, when the woman develops seizures. Eclampsia can be dangerous, both for the mother and the fetus, and often requires immediate delivery of the baby, even if the baby is premature.

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Preeclampsia during pregnancy is treated with oral blood pressure medications and close monitoring. The best treatment for preeclampsia is giving birth, but the OB physician must decide when the fetus is developed enough to induce delivery and balance that with the severity of the mothers symptoms from preeclampsia. The OB physician may give the mother steroids to help develop and strengthen the fetuss lungs to minimize their complications at birth if they need to be delivered early.

There are several risk factors for the development of preeclampsia: a history of preeclampsia in a previous pregnancy, being pregnant with more than one baby, a prior history of high blood pressure, diabetes or kidney disease and a history of autoimmune disorders. It is believed that preeclampsia is caused by the placenta not developing properly due to a problem with the blood vessels that supply its blood.

Postpartum preeclampsia is most common within the first seven days after delivery but can occur as late as six weeks after delivery. It is estimated that preeclampsia complicates about 5% of pregnancies, and postpartum preeclampsia complicates even fewer. Many women who experience postpartum preeclampsia do not show any symptoms during their pregnancy and have normal blood pressures until after delivery. It can be very hard to diagnose because the woman is recovering from childbirth and focusing on taking care of their newborn. It is important for women to closely monitor their health and follow up with their OB-GYN physician as recommended. Health care providers need to remain vigilant and consider this diagnosis.

Ambers headache, a result of her postpartum preeclampsia and very high blood pressures, was severe enough that she had to seek emergent medical attention. Her blood pressure came down quickly with the medications I gave her in the ED, and thankfully she did not develop seizures. She was admitted to the hospital and spent the next several days being closely monitored. She was able to continue breast feeding and was finally able to get some sleep as her headache subsided.

When Amber went home from the hospital, she was wearing a blue bracelet to indicate her risk of preeclampsia. Our hospital system recently started a Blue Band Initiative to have women at risk for preeclampsia/eclampsia wear a blue bracelet to help medical workers consider this diagnosis in women to quickly identify these patients so we can initiate treatment.

The United States has the highest maternal death rates among developed countries and unfortunately there was significant increase in maternal mortality rates over the past couple of years. While this is a complex problem with numerous factors, this spectrum of disease is important to be aware of as we need to be vigilant about caring for pregnant women, new moms and their babies and we must reverse these tragic trends.

Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth.drerikakubemd@gmail.com

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Preeclampsia dangers don't end with delivery for some new moms - The Columbus Dispatch