The Phone Call That Changed How I Practice ObGyn
She had lupus. She had headaches. She was going to call her dentist. She never got the chance.
I came back to the office on a Tuesday after a long weekend.
There was a message waiting. Not from my patient. From her sister.
My patient was 34 weeks pregnant. She had systemic lupus erythematosus, stable for years, well controlled on hydroxychloroquine. Her pregnancy had been uncomplicated. Her blood pressures had been normal at every visit. Her labs were reassuring. She was doing everything right.
Over the weekend, she started having headaches. She also mentioned a toothache. She figured the two were related. She told her sister she was going to call the dentist on Monday.
She never made that call.
On Sunday, she had a seizure at home. By the time the paramedics arrived, she was unresponsive. She was rushed to the hospital. An emergency cesarean was performed. The baby was delivered but did not survive. Neither did my patient.
The diagnosis was eclampsia.
I have practiced obstetrics for more than 50 years. This was the only patient I have lost. And this case is the one I carry with me every day, because it was preventable.
Not preventable in the way we say it at morbidity and mortality conferences, with hindsight and distance. Preventable in the simplest, most painful way:
if she had called me instead of planning to call her dentist, she and her baby would almost certainly be alive.
A headache in pregnancy is not just a headache. It might be. But it might be the only warning you get before a catastrophe. And once eclampsia arrives, the window to save two lives is measured in minutes, not hours.
This post is about why every headache in pregnancy deserves a phone call, a blood pressure check, and a provider who takes it seriously. No matter what time of day. No matter how “stable” the pregnancy appears.
🎯 Free Subscriber Bottom Line:
What is the first thing to buy when the pregnancy test is positive?
Headaches during pregnancy can be the only warning sign of preeclampsia and eclampsia, a condition that kills mothers and babies, often within hours. Women with autoimmune conditions like lupus are at 3 to 4 times the risk. Symptoms like headaches are frequently attributed to benign causes (stress, tension, dental problems) by patients and providers alike. Eclampsia can develop without prior elevated blood pressures. Sixty percent of preeclampsia-related maternal deaths are considered preventable, and the most common contributing factor is delay in seeking care. One phone call can save two lives.
Below, paid subscribers get: The clinical evidence on headache as a preeclampsia warning sign. Why lupus patients face uniquely elevated risk. The atypical presentations that fool everyone. A symptom action guide every pregnant woman should have on her refrigerator. What providers should tell patients at every single visit. Why “call the dentist” should never be the plan for a new headache at 34 weeks.
