[ANON POST] Diagnosing Fatal Pregnancy Complications

[orange_fell]

My story takes place in a very remote location with no access to the outside world. Among my characters I have a pregnant woman in her second trimester (I could change that to the third, if necessary). She is very young, 18 is the oldest she can be in this story. There is a doctor with them - a family doctor with modern USA education and background

Comments

[agirlnamedtruth]

Can't help with the rest but as someone who has been tested for kidney infections more than once by my GP (British version of a family doctor, I think), I know there's a little strip of paper (almost like litmus paper) that can test for protien in urine without lab assistance. Hope that helps:)

[agirlnamedtruth]

Thank you!
I know a doctor might have it in the office, but would they sell those kind of strips in the pharmacy?

[agirlnamedtruth]

It does! Thank you.

[agirlnamedtruth]

No worries :)

[kate_nepveu]

My copy of _Pregnancy, Childbirth, and the Newborn_ by Simkin et al. says that bleeding for placenta previa is usually in the third trimester, intermittent, and ranges from light to heavy.

Bleeding plus pain can be a sign of a placental abruption, the treatment for which varies from bed rest to immediate C-section depending on the severity of bleeding. If the bleeding isn't immediately life-threatening but is more than minimal, though, I suspect a vaginal birth would not be recommended and so you'd need to get the character out for a C-section.

[kate_nepveu]

So basically, it would be feasible to have her develop series of bleeding, growing continually worse as time progresses.
Thank you very much!
I am wondering now whether I should give her high blood pressure as well, just to be sure, of whether it would be entirely too much.
I actually begin to feel sorry for my poor character.

[squibstress]

My vote would be with pre-ecclampsia. Protein in the urine can be found with a dipstick that you could get in a pharmacy, and the other symptoms should be easy for a family doc to spot. While it doesn't always proceed to ecclampsia and seizures, it does so often enough to be one of the top three killers of pregnant women worldwide. The only real treatment is delivery. It can also progress to HELLP syndrome.

[squibstress]

Thank you! I didn't know that there was a home version of the protein in urine test, that might actually be a good solution!

[elialshadowpine]

tw for child death

My girlfriend developed pre-eclampsia at 26wks, was in the hospital until 28wks, when it took a severe and sudden turn towards actual eclampsia despite being on multiple IV medications to control high blood pressure and magnesium to prevent seizures. Actually, iirc, she did develop HELLP, which is when they rushed her in to an emergency c-section. It saved her life.

If they hadn't caught the HELLP development, or if she had been in a situation where she couldn't get to an ER ASAP then she probably would have died. So, that's probably the direction I'd go, because even with modern tech and in a hospital, pregnant women DO still die from eclampsia/HELLP.

[archangelbeth]

If her blood pressure skyrockets, then preeclampsia is pretty likely to turn into eclampsia. My blood pressure was so high that during the ambulance ride to the hospital-with-facilities-for-2-months-preemie-babies, the attending nurse kept fussing at me not to look at the ambulance guy behind me, or out the window at the pines strobing past, etc., because -- she told me later -- she was terrified that I was going to go into seizures at any minute, despite being on a mag-sulfate IV

[archangelbeth]

Thank you very much for all those details! I am thinking of using the pre-eclampsia and adding mild bleeding just to be sure.
Sorry you had to go through this! I remember having to go to a hospital once b/c I had both those symptoms (high blood pressure and high protein), but my blood pressure was down by the time I made it to the hospital, so I lucked out.
As for survival - this whole thing is a plot device to give another character enough motivation to smuggle the girl out of that place.

[archangelbeth]

Definitely lucked out! The kid was in the NICU for a long time, even after she was stable enough to be moved back to our local hospital (which was actually very fast; for 2 months early, she did very well!). I watched the people come in for normal deliveries and go out the next day, and just wanted to scream at them to realize how lucky they were to go home with their babies when I was hanging out in limbo.

A very nice limbo, admittedly, with nurses to chat with and in a hospital where good food could be delivered... But limbo. (And we were supposed to be moving soon, but I couldn't pack for various reasons including c-section healing, plus hanging out with the kid during the day...)

Glad to be helpful!

[chesneycat]

Seconding the suggestion of pre-eclampsia -> eclampsia, as it does seem to offer what you need.

Have you considered Cholestasis as an extra complication? It's not likely to be fatal, but it would make life very miserable for your character.

[chesneycat]

Tell me about it. I had the damn thing. For a few weeks, life was hell. And you can't even use cortisone or anything hormone-based.
I don't think I'll use it, though, poor girl has enough problems as it is :)