TOXAEMIA OF PREGNANCY DUE TO VERY HIGH CHOLESTEROL LEVELS

Judi was one of my young primigravid mothers. She was 26 years of age a school teacher with a BMI of 27. Her blood pressure on her first visit was normal 120/70. At this stage she was very well, and all the routine pregnancy tests were normal. The pregnancy progressed well until 36 weeks, when her blood pressure was ,140/ 90 which meant it was elevated, the urine was clear. The toxaemia of pregnancy is usually a disease of primigravid women causing high blood pressure, it also causes kidney problems and it can progress rapidly and can be dangerous to both the mother and baby. I advised her to go home and rest. When she came next day the blood pressure was slightly elevated further to 150/90 the urine was still normal. However I decided to induce her, and deliver her as that was my gut feeling. My gut feeling played an important role in my obstetric management. The same day I admitted her to the labour ward. I started the induction by rupturing her membranes, this was OK. liquor (Fluid around the baby when in utero) was clear there were no signs of foetal distress. Luckily the induction of labour is generally easy in women with toxaemia of pregnancy.

However my joy was short lived. When I put in an intravenous needle, the fluid that came out was like milk.

I rang my pathologist he said she must have very high cholesterol. I sent the fluid which was really blood to pathology; her cholesterol came out to be 58mmols/ litre. This is extremely high. Normal cholesterol levels are around 6mmol/litre. During pregnancy the cholesterol levels do rise from the start but more so in the last trimester. This can cause toxaemia of pregnancy. She later told me that her mother suffers from high cholesterol but she had had no such problems. Normally cholesterol is not tested during pregnancy, but some research is being done to see if it should be tested. I started Judi on Syntocinon drip. This is a drug used to enhance labour. Luckily for Judi and me, Judi had an easy and quick labour and delivered a healthy male baby weighing 3620 Gms within 6 hours of induction. She did not what to breast feed. Within 6 weeks of delivery her cholesterol level came down to 28mmols/L. After this experience with Judi, I tested the cholesterol levels of all my toxaemia patients, but never found a high cholesterol level. I referred Judi to a physician and he kept her on a low dosage of anti-cholesterol drugs. I advised her to use condoms for contraception as she wanted another baby.  In just under two years she got pregnant again and her cholesterol levels started to rise. The physician very carefully supervised her cholesterol levels. At about 37 seven weeks her cholesterol came up to 28.4. I induced her again; she had a successful delivery of a healthy female baby 2870 gms in weight. After this she stayed on cholesterol tablets, I wonder if she followed her mother’s pattern. She cannot be given the pill for contraception, because the pill will cause her cholesterol to go up. I fitted her with Mirena for contraception. I followed her for few years, I found her to be very happy.

POST MENOPAUSAL PREGNANCY

OLDEST MOTHER WHO I HAVE EVER DELIVERED
AGE 55; IT WAS A GREAT JOY
Sumitra came to the outpatient department of obstetrics very quietly thinking she may be pregnant. She said she can feel something moving in her belly. She had had no periods for ten years; she was now 54 years of age. This was in 1960 when I was still a junior doctor. She had 3 grown up daughters and 4 grand children. She had no sons. She was mildly obese weighing 70 kilos. Her blood pressure was normal, she had no medical problems. On my clinical examination she was surely pregnant, I could hear the foetal heart .Of course there were no ultrasounds or genetic tests. I informed my professor about her. The only important thing about her was that she was the wife of a Member of Parliament. Her pregnancy progressed like a dream and she had an easy normal vaginal birth of a male healthy baby weighing 3 kilos. There was joy all round as they had no sons. Even I got a lovely sari as a present. It was a great joy for me as well. Many cases of spontaneous births have been reported after menopause, one in 1899 and then one in 1960. Both these women were 50 years of age. In recent times many older women have given birth through I.V .F technology. Latest birth is reported from India to a 70 year woman using donor egg, and using her 72 year old husband’s sperm in 2008. How old is too old to have a baby. Who will look after this baby?