‘Trace of protein.’
‘I’ll take a look at her before I start clinic. Maggie, do we have an antenatal bed should I need one?’
Maggie sighed and pulled her notebook out of her pocket. ‘Yes, because Tom is going to discharge his twins lady this morning once Paeds have checked the babies.’
‘Good. I’ll let you know if I’m going to need it.’ Patrick followed Hayley out of the door and into the next room.
‘Charlotte, this is Patrick Buchannan, the consultant.’ Hayley picked up the notes and handed them to Patrick. ‘Charlotte carries her own notes.’
‘Which is helpful.’ Patrick scanned the notes, picking out the information that he needed. ‘Hayley, there’s no record of a platelet count from the day assessment unit—could you call them and see if they did one? It might just not have made it into the notes.’ He listened as Charlotte outlined what had happened, and by the time she reached the end of her story Hayley was back.
‘They only do it on new hypertensives.’
Patrick glanced at the blood-pressure reading in the notes but decided not to worry Charlotte by verbalising his thoughts. ‘All right, so we’ll start fresh. I want to do an ultrasound now, and then I want to do a full blood count and check liver function and renal function.’ While Hayley fetched the ultrasound machine, Patrick turned back to the woman on the bed. ‘I agree with Hayley—I don’t think this is a virus.’
Charlotte exchanged glances with her husband. ‘But I saw my GP in London before I left and he just said there was a lot of it around—everyone is ill.’
‘That’s true,’ Patrick said carefully, ‘but in this case it’s something different.’
‘You think it’s the baby?’
‘Yes, I do. Have you heard of pre-eclampsia?’
Charlotte shook her head. ‘No.’
‘It’s a condition that occurs only in pregnancy and it causes a number of changes in your body, including high blood pressure and a leakage of protein into your urine.’
‘But I felt fine until just before Christmas—surely it’s more likely to be a bug?’
‘In its early stages it has no symptoms, but as the condition becomes more serious a woman is likely to experience changes—for example, headaches, stomachaches, vomiting, sometimes visual disturbances.’
Charlotte stared at him. ‘I saw flashing lights for a short time yesterday evening.’
Patrick kept his expression neutral. ‘Right. Well, that might be related. The swelling may also be related.’
‘My doctor told me that no one takes any notice of swelling now—that it’s normal for pregnant women.’
‘It can be normal,’ Patrick agreed, preparing the ultrasound machine. ‘But it can also be a sign of problems. In fact, all those symptoms I just mentioned can be attributed to other causes, which is why the condition can be missed. I want to start by looking at the baby and the placenta, Charlotte. Has the baby been moving?’ As he performed the scan he kept questioning her, his eyes on the screen. ‘All right, there’s the baby’s head—and his heart—and that’s the placenta.’
Charlotte peered anxiously at the screen. ‘It all looks like a squirmy mess to me. Does the baby seem all right?’
‘The baby seems fine.’
Charlotte’s husband cleared his throat. ‘So how do you treat pre-eclampsia?’
‘You can’t treat it. You can manage it…’ Patrick pushed the ultrasound machine away from the bed ‘…but basically the condition ends when the baby is delivered.’
‘But I have another month to go!’
Patrick sat on the edge of the bed. ‘Charlotte, you need to prepare yourself for the fact we may need to deliver the baby sooner than that. At thirty-six weeks, your baby is well developed and should have no problems at all. We have to balance all the factors.’
‘All right. Obviously I want to do what’s right for the baby,’ Charlotte said nervously. ‘So what happens now?’
Patrick stood up. ‘I’m going to arrange for you to be transferred to the labour ward. Then I’m going to do a series of tests and when I have the results I’m going to decide what the best course of action is. In the meantime, I’m going to give you something to lower your blood pressure and Hayley is going to stay with you and monitor both you and the baby.’
Charlotte’s eyes filled with tears but before Patrick could speak, Hayley slipped her arm round Charlotte’s shoulders and gave her a hug. ‘You poor thing, this must be such a shock for you,’ she said soothingly, ‘but it will all be fine. I’m going to take you upstairs and make the room cosy, and we can have a good chat. You can tell me everything about your Christmas.’
She was so tactile, Patrick thought to himself as he stood up and picked up the notes. As sensitive with the patients as she was with his children.