Když Informace Zachraňuje Životy: Skutečná Hodnota Včasného Záchytu Preeklampsie

Ve zdravotnictví často mluvíme o inovacích jako o nových technologiích, nových datech a nových možnostech léčby. To všechno je důležité. Ale někdy má největší dopad něco mnohem jednoduššího: správná informace ve správný čas.

Přesně to mi znovu připomněl rozhovor s Markétou Řehořovou, maminkou, která si prošla preeklampsií dvakrát. Její příběh není jen velmi osobní. Je také mimořádně důležitý pro každého, kdo přemýšlí o prevenci, a o tom, jak vypadá skutečně fungující péče o matku a dítě.

Preeklampsie patří k diagnózám, o kterých se stále nemluví dost, přestože mohou během krátké doby změnit úplně všechno.Z na první pohled bezproblémového těhotenství se najednou stává situace vyžadující okamžitou pomoc.Ohrožené není jen miminko, ale i žena samotná. A právě proto nestačí jen kvalitní nemocniční péče ve chvíli, kdy už problém propukne. Klíčové je, aby žena věděla včas, na co se ptát, jaké vyšetření nepodcenit a proč může včasný screening rozhodnout o dalším průběhu celého těhotenství.

Ticho před krizí

Na příběhu Markéta je velmi silné to, jak nenápadně všechno začalo. Od začátku těhotenství se necítila úplně dobře, ale neexistoval jasný důkaz, že se děje něco vážného. Screening dopadl dobře. Kontroly nepůsobily dramaticky. Přesto tam byl vnitřní pocit, že něco není v pořádku.

To je moment, který bychom neměli podceňovat. Ve zdravotnictví se stále učíme lépe pracovat s daty, biomarkery a algoritmy, ale lidská zkušenost, intuice a subjektivní vnímání vlastního těla zůstávají důležitou součástí celého obrazu. Samozřejmě samy o sobě nestačí pro diagnózu. Ale často upozorní na to, že žena nežije svůj stav jako klidné, normální těhotenství, i když to tak zvenku může vypadat.

Markéta v rozhovoru popsala moment, kdy se po 24. týdnu poprvé nadechla s pocitem, že snad už bude všechno dobré. A o dva týdny později skončila v nemocnici. Tato křehkost je pro preeklampsii typická. Situace může dlouho působit relativně stabilně, a přesto se velmi rychle zlomit.

Diagnóza, která přišla, ale nebyla vysvětlená

Jedna z nejsilnějších částí rozhovoru se netýká jen samotné nemoci, ale i způsobu, jakým byla sdělena. Markéta popsala moment, kdy jí lékař řekl, že má preeklampsii. A tím to v podstatě skončilo. Bez širšího vysvětlení. Bez jasného popisu rizik. Bez odpovědi na základní otázky, které v takové chvíli každou ženu logicky napadají.

Co to přesně znamená?
Je ohrožené dítě?
Jsem ohrožená já?
Půjdu ještě domů?
Co se bude dít dál?

Tohle je velmi důležitý moment. Ve zdravotnictví někdy předpokládáme, že sdělení diagnózy znamená předání informace. Pro pacienta to ale takto nefunguje. Samotný název diagnózy ještě neznamená porozumění. Pokud člověk nerozumí tomu, co se v jeho těle děje, jak se může jeho stav vyvíjet a proč se mění plán péče, zůstává ve stresu  a ten se dál prohlubuje nejistotou.

U preeklampsie je přitom právě tato nejistota mimořádně nebezpečná. Nejde jen o psychiku, ale i o schopnost správně reagovat, ptát se a vnímat vážnost situace. 

Nemoc, která nemusí bolet nápadně, a přesto je život ohrožující

Preeklampsie je zrádná i tím, že nemusí mít na začátku jednoznačný obraz. U některých žen se projeví výrazněji, u jiných zůstává dlouho skrytá. Vysoký tlak, bílkovina v moči, bolesti hlavy, tlak pod žebry, zhoršení laboratorních hodnot, růstová restrikce plodu. To všechno může být součástí obrazu, ale ne vždy přichází všechno najednou a ne vždy žena ví, co přesně tyto příznaky znamenají.

Právě proto je tak důležitý screening a systematická prevence. Když je nemoc zachycena pozdě, prostor pro klidné rozhodování se rychle zužuje. Lékaři pak často neřeší ideální scénář, ale menší zlo. Neřeší, jak těhotenství ještě pohodlně vést dál, ale jak zabránit mnohem těžším následkům.

V Markétině případě šlo nakonec o velmi tvrdou realitu. Zhoršující se stav, vysoký tlak, bílkovina v moči a postupně i jasné sdělení, že další čekání by mohlo znamenat trvalé poškození ledvin. To je chvíle, kdy si člověk uvědomí, že preeklampsie není komplikace, kterou lze brát jako nepříjemnost navíc. Je to stav, který může během krátké doby ohrozit dva životy současně.

Když důvěra není doplněk, ale součást léčby

V rozhovoru se opakovaně vracelo jedno téma, které podle mě bývá ve zdravotnictví podceňované: důvěra. Ne abstraktně, ale velmi konkrétně.

Markéta několikrát popsala, jak zásadní pro ni bylo, že narazila na lékaře, kterému věřila. Na člověka, který jí dokázal vysvětlit situaci s klidem, srozumitelně a bez zbytečné dramatičnosti. Právě to jí v nejkritičtějších chvílích pomáhalo udržet se psychicky nad vodou.

To je přesně ten typ zkušenosti, který by měl být součástí odborné debaty o kvalitě péče. Komunikace není měkká nadstavba. Komunikace je klinicky relevantní. Ovlivňuje spolupráci pacientky, její orientaci v situaci, schopnost zvládat stres i to, jestli věří rozhodnutím týmu ve chvíli, kdy už jde opravdu o čas.

Zvlášť v porodnictví a neonatologii, kde jsou emoce extrémně silné a rozhodnutí přicházejí rychle, je forma sdělení téměř stejně důležitá jako samotný obsah. Žena nemusí slyšet uklidňující fráze. Potřebuje slyšet pravdu tak, aby jí rozuměla a aby ji tato pravda nezbavila posledních zbytků vnitřní stability.

Druhá zkušenost a ještě vyšší riziko

Mimořádnou sílu má celý příběh i proto, že nešlo o jednorázovou zkušenost. Markéta se rozhodla pro další těhotenství, přestože věděla, čím si prošla. Ptala se lékařů, zajímala se o pravděpodobnost opakování a dostala informaci, že riziko recidivy je 20 procent.

To je přesně ten typ čísla, který může pro různé ženy znamenat něco úplně jiného. Pro někoho je to nízké riziko. Pro jiného příliš vysoké. Ale důležité je něco jiného: když žena dostane informace srozumitelně a s respektem, může se rozhodovat vědomě. A to je zásadní rozdíl oproti situaci, kdy je ponechána v mlze.

Ani druhé těhotenství se bohužel nevyvíjelo dobře. Miminko bylo menší, objevily se vážné problémy a nakonec přišel znovu boj o čas. Tentokrát ještě tvrdší. Markéta prodělala eklampsii, tedy nejzávažnější formu onemocnění. Stav, který může bez okamžité lékařské pomoci skončit smrtí matky.

Právě tady se celý příběh dostává za hranici individuální zkušenosti a stává se silnou výpovědí o tom, jak důležitá je připravenost systému. Nejen odborná, ale i komunikační. Jak rychle se pozná zhoršení. Jak rychle se jedná. Jak rychle se pacientce vysvětlí, proč už není prostor čekat.

Co se mezitím změnilo

Velmi podstatná část rozhovoru se týká i toho, co víme dnes a co tehdy běžnou součástí péče ještě nebylo. Dnes už je mnohem silněji zakotvené povědomí o screeningu rizika preeklampsie a také o preventivním významu aspirinu u rizikových žen, pokud je nasazen včas a pod dohledem lékaře.

To je obrovsky důležité. Ne proto, že by aspirin nemoc zázračně odstranil. Ale proto, že může oddálit její nástup a zmírnit její průběh. A v oblasti předčasného porodu znamenají i dva týdny navíc dramatický rozdíl.

Rozdíl mezi dítětem narozeným s váhou kolem 600 gramů a dítětem, které dostane čas dorůst. Rozdíl mezi těhotenstvím ukončeným na hranici extrémní nezralosti a těhotenstvím, které se podaří udržet déle. Rozdíl mezi velmi těžkým startem do života a výrazně lepší prognózou.

To je důvod, proč považuji prevenci za jednu z nejpraktičtějších forem inovace ve zdravotnictví. Ne každá inovace musí být nová technologie s velkým marketingovým příběhem. Někdy je tou nejdůležitější inovací zavedení postupu, který dokáže včas identifikovat riziko a dát ženě i lékařům větší prostor jednat.

Proč je prevence pořád podceňovaná

Zarážející je, jak často se na prevenci nahlíží jako na něco nepodstatného. V některých případech je prevence tím, co odděluje klidný průběh od náhlého zhoršení.

U preeklampsie to platí dvojnásob. Nejde jen o to, že screening může odhalit riziko. Jde o to, že žena pak chápe, proč se sledují určité hodnoty, proč jsou důležité kontroly, proč není vhodné něco podcenit a proč je někdy třeba reagovat velmi rychle.

Prevence má význam i z psychologického hlediska. Informovaná žena se nedostává do nemocnice bez představy o tom, co se děje. Lépe rozumí tomu, co se děje. Lépe se ptá. Lépe vnímá varovné signály. A paradoxně může být i klidnější, protože nejistota bývá často horší než pravda.

Právě proto bychom měli mluvit o screeningu preeklampsie mnohem častěji. Ne jen mezi odborníky. Ale i veřejně, srozumitelně a bez zbytečného zlehčování.

Komunikace jako podceňovaná součást prevence

Na příběhu Markéty je ještě jeden velmi důležitý aspekt. Prevence není jen vyšetření nebo léčba. Prevence je také způsob komunikace. To, co ženě řekneme. To, co jí neřekneme. To, jestli chápe význam diagnózy. To, jestli ví, co má sledovat. To, jestli ví, kdy má přijít dřív, než má plánovanou kontrolu.

Jinými slovy, komunikace sama o sobě může být preventivní nástroj.

Pokud žena opravdu rozumí tomu, proč je její stav rizikový, je větší šance, že nebude podceňovat symptomy. Pokud rozumí významu screeningu, je větší šance, že ho neodloží. Pokud chápe, že některé formy preeklampsie mohou být dlouho téměř bezpříznakové, je menší šance, že nebezpečí vyhodnotí příliš pozdě.

Tohle je oblast, kde má zdravotnictví stále velký prostor ke zlepšení. Odborné poznatky jdou rychle dopředu, ale jejich převod do srozumitelné řeči pro pacientky často zaostává.A právě v těchto situacích se hraje o víc, než se může zdát

Příběh, který nekončí strachem

Je důležité dodat ještě jednu věc: tento rozhovor není jen citlivý, ale i nesmírně nadějný. Obě Markétiny děti jsou dnes v pořádku. To je výsledek kvalitní péče, vysoké úrovně české neonatologie, důsledného sledování a také velké vnitřní síly celé rodiny.

Cílem není ženy vyděsit. Cílem je, aby měly informace. Aby věděly, že preeklampsie je vážná, ale že právě včasný záchyt, kvalitní péče a správná rozhodnutí mohou zásadně zlepšit výsledek pro matku i dítě.

Ve zdravotnictví potřebujeme přesně tuto kombinaci. Pravdivost a naději. Odbornost a lidskost. Data a komunikaci. Prevence bez strašení. Informace, které nepřetěžují, ale dávají smysl.

Proč o tom mluvit nahlas

Jako někdo, kdo se dlouhodobě pohybuje na pomezí klinického výzkumu, zdravotnických inovací a prevence, jsem přesvědčená, že právě tady se ukazuje, co je ve zdravotnictví opravdu důležité. Technologie mají obrovskou hodnotu. Výzkum má obrovskou hodnotu. Ale pokud se jejich přínos nedostane včas k člověku, který ho potřebuje, zůstává jejich dopad omezený.

Proto o preeklampsii mluvím. Proto otevírám i tyto citlivé  rozhovory. Protože někdy opravdu může jedna správná informace ve správný čas změnit osud celé rodiny.

A to není málo. To je přesně ten důvod, proč má prevence ve zdravotnictví tak zásadní místo.

Jestli chce moderní zdravotnictví působit skutečný dopad, nestačí reagovat až ve chvíli, kdy je pozdě. Musí umět předvídat, vysvětlovat a jednat včas. U preeklampsie to platí dvojnásob.

A právě proto se o ní pořád musí mluvit víc.

Timecode:

00:00 Úvod a Markétin příběh

00:28 Intuice a první obavy

02:38 Krvácení a hospitalizace

04:14 Diagnóza preeklampsie

05:42 Zhoršování a plán porodu

07:38 Porod v centru péče

09:27 Neonatologie a první dny

12:59 Komunikace lékařů

14:36 Dlouhodobý vývoj dcery

17:02 Rozhodnutí pro druhé dítě

22:46 Druhé těhotenství varování

28:58 Záchvat a akutní císař

34:59 JIP a zprávy o synovi

40:33 Doporučení a screening

42:27 Aspirin jako prevence

44:53 Závěrečná rada a rozloučení

Links:

Pavlina Walter: https://www.linkedin.com/in/pavlinawalter/

Website: PavlinaWalter.com

Guests:

Markéta Řehořová

Website: Ing. Markéta Řehořová – Nedoklubko

Instagram: @marketa.rehorova

Transcript:

Pavlína Walter: Good day. Today, I would like to welcome Markéta Řehořová, a mother who has experienced preeclampsia firsthand. Her story illustrates how a seemingly normal pregnancy can turn into a struggle for the lives of both the baby and the mother. Markéta, welcome.

Markéta Řehořová: Good day, Pavlína.

Pavlína Walter: Markéta, may I ask right at the start: when was the moment you realized something might not be right?

Markéta Řehořová: I must admit that I didn’t feel completely comfortable in that pregnancy from the very beginning, even though nothing was actually happening. I just didn’t have a good feeling; I didn’t perceive the pregnancy as being "fine" for me. The actual problem didn't arrive until much later. Around the middle of the pregnancy, I started having difficulties that I wasn't able to recognize yet. I was essentially just waiting for disaster to strike, and I was terrified that I would lose the baby.

Pavlína Walter: So, there was already intuition.

Markéta Řehořová: Yes, I think so. My initial feeling was that it wasn't possible that I was pregnant. It happened very quickly, so it was quite unexpected for me. I didn't really get used to the idea until the third month. Then I started fearing the screening; when that turned out well, I thought, "Phew, okay." Then I became a bit fixated because I’m the type of person who needs information, not that I was actively searching for it, but I simply knew that the 24th week in the Czech Republic is the date when babies are given a "chance at life." I fixated on that term. I remember very well driving home from a check-up after the 24th week, and for the first time in that pregnancy, I breathed a sigh of relief.

Pavlína Walter: And...

Markéta Řehořová: Then I blamed myself for it, because two weeks later, a very serious problem arose, and I ended up in the hospital.

Pavlína Walter: So, it wasn't information from the doctor, everything seemed fine, the screening was fine but somehow it became complicated.

Markéta Řehořová: Yes. I had information from the big screening at 20 weeks that my daughter was nearly two weeks smaller than she should be. Since I wasn't knowledgeable about these things yet, I assumed it was perhaps genetic. The doctor pointed it out but didn't say it was alarming, just that she was two weeks smaller. So, I kept that in mind. At the next check-up, the doctor found the findings to be fine, so I felt relieved at the 24th week. And indeed, two weeks later, something completely unexpected happened: bleeding. I absolutely couldn't handle the situation mentally because I thought, "And now it’s here."

Pavlína Walter: And what was the diagnosis?

Markéta Řehořová: The diagnosis was a burst vein on the cervix, which I only found out about the next day. When they hospitalized me, I was truly afraid that Míša [the baby] would die inside me. It was very stressful. I arrived at the Apolinář hospital intake, and they measured my blood pressure and said, "You have high blood pressure, but it might be nothing; you’re under stress, so we’ll wait and see what happens." So we waited. In the afternoon, they did some tests and said, "We'll wait and see; it’s not quite right, the pressure hasn't settled, but the bleeding is fine, the girl is fine, just small, so we'll see." No one had voiced a diagnosis yet.

By the second or third day, they put me in the delivery ward. I had almost no belly at all, and I felt terrible. I didn't belong there. I didn't know what was going to happen, and I thought if the bleeding was fine, they would examine me and let me go home. I was 14 days away from my state final exams, and I needed to study. The whole time I had been studying, I didn't go out much, and I started blaming myself again: "You should have been exercising or doing other things." A lot of guilt came while I was in the hospital before the birth. When the doctor came to me after three days with a diagnosis, he turned to me and said, "You have preeclampsia." And then he turned back. I just stood there, looking at him, and asked: "What does that mean?"

Pavlína Walter: Did you know? Were you not informed at all?

Markéta Řehořová: I only asked, "And will I go home again?"

Pavlína Walter: And...

Markéta Řehořová: He just turned and said, "You won't be going home anymore." And that was all I learned upon receiving that diagnosis. I had to grapple with that information. At that moment, I knew it was bad, but I didn't know what it was. I immediately started looking for information, I wrote to my family, and we all started looking for resources, which were very scarce back then. I didn't know what would happen. They just told me that I definitely wouldn't be discharged and that within 14 days, it was likely the baby would have to come into the world, though it might take a bit longer, but no longer than a month.

Pavlína Walter: So, already in those early weeks...

Markéta Řehořová: 26th week, when they told me it would likely be a month at most. I hoped. I didn't know what kind of disease it was; I was only just finding out. It didn't seem possible to me that such a thing existed.

Pavlína Walter: And the doctor didn't provide information about what it was? Couldn't they explain it?

Markéta Řehořová: No. No one explained in detail what was happening. Rather, during examinations, they would tell me why they were doing something, for example, that they were looking for protein in the urine and that it was fine for now. Well, in a few days, they said it wasn't quite fine anymore and that it was worsening. As the disease progressed, I started to feel very ill. I had high blood pressure and massive headaches, because it's all related, it's actually a multi-systemic disease. That pressure then damaged my kidneys; I had protein in my urine and it worsened very quickly.

The primary problem at that moment was the kidneys. The baby girl was fine for now. In such cases, they monitor the flow [Doppler] closely to see if the baby is well-nourished, and that looked okay-ish. The monitor was also fine, which calmed me down. But I had such headaches that I cried. My mom asked me why I was crying, and I said, "I'm not crying; it just hurts so much that the tears are flowing on their own, I don't know what to do about it, I just have to endure it." I was given medication for high blood pressure; every two days, they measured the protein in my urine and always said it was getting worse.

After 14 days, they came one day and said, "You know what, in two days we will schedule the delivery." There was one very empathetic doctor there who explained some things to me and in whom I had great trust. He told me, "Look, this is the best solution, because if we waited more than two days, you could lose your kidneys and be on dialysis for the rest of your life." That woke me up.

Pavlína Walter: This is such a powerful story that it brings tears to my eyes. But wasn't it another shock being told you were giving birth in two days? You were unprepared, and the baby was not yet developed. What were you afraid of at that moment?

Markéta Řehořová: I knew there was nothing else to be done. They said it could be fine. They didn't say "it will be fine," you don't say that, but "it could be fine." You are with us, the baby is small, but we will take care of her. They actually calmed me down tremendously because I trusted them. I needed to know that if things were this bad, I was in good hands and that hope existed. I held onto that hope the entire time.

Pavlína Walter: So, you gave birth at Apolinář. If it had been elsewhere, how might it have ended?

Markéta Řehořová: In the Czech Republic, there are 12 hospitals that can care for babies from the 24th week, which is where I fell. The problem came in the 26th week, and I gave birth at 29+1. The Czech Republic is at a world-class level regarding neonatology. At Apolinář, they also concentrate babies in the so-called "grey zone." Today it’s even more specialized, but even then, babies after the 22nd week, if everything was optimal, could be given a chance at life. That's why they told me my 28th week was actually a "high" week.

Pavlína Walter: Did that calm you?

Markéta Řehořová: Very much. Really very much. Even after the birth, the staff assessed that my daughter was "big." For me, it was a shock, but at that moment, a pleasant one.

Pavlína Walter: So, this first story of yours ends with a happy ending.

Markéta Řehořová: Definitely. It was, of course, incredibly difficult and mentally extreme. Even what the little one had to experience at the start of her life was on the edge. However, she was in care where they simply knew how to handle these children. Even though she had a relatively low weight because she was "hypotrophic" [IUGR], thanks to the fact that she was quite mature (29+1 is actually a pretty good week), she went through it very well. It wasn't easy; she had one infection at the beginning. After three days, they told us that if everything stayed fine, she would just grow, but in neonatology, every parent knows the situation can change in a moment for better or worse. It’s literally like a seesaw.

We were in total shock. I didn't handle the first visit well mentally; I was afraid to touch my daughter. My psyche was failing me; I didn't know what to do with myself, and then the hormones. When I went there the next day, I got "tasks" from them. Those tasks are the only thing for parents where they feel they can help the baby. They are so important. That’s what kept me going: I was pumping milk. Because my daughter was doing well, we could do "kangaroo care" early on, and that was a huge moment. In that crisis, when they put the baby on your chest, and everything is fine, you know that is the most important thing. You don't want to look ahead. It's only when you're home that you think about it all, but in that moment, you just want it to stay that way. Then bad news came again like a seesaw. Something one didn't expect, even if they warned you. At that time, I found a leaflet for Nedoklubko [a non-profit for premature babies] in the parents' room.

Pavlína Walter: And...

Markéta Řehořová: Even though the doctors were giving me a lot of information, I felt like whoever wrote that leaflet understood me. It was "from parents, for parents." I found answers to the questions swirling in my head. Doctors don't inform you that far ahead; for them, the current situation is important, but I wanted to know the diagnoses, too. In the leaflet, I evaluated which were serious and which could be managed.

When they told me there was a problem, I immediately recalled that leaflet. It was an infection. Unfortunately, when we first heard about my daughter’s infection, we were told a terrible scenario, there was even talk of death. That was an absolute shock for me. In hindsight, I know the situation wasn't so extreme as to inform us in that way. It's about communication and the kind of person someone is. I'm not angry with the doctor, but it was a moment that hit me enormously.

Pavlína Walter: Those are the sentences you don't want or need to hear. What sentences did you need to hear at that moment, and which did you not?

Markéta Řehořová: I think information from doctors should be neutral, neither negatively nor positively biased, but never purely negative. Sometimes it’s enough just to use a different word. Don't start with a negation; don't say something is failing or that it will be bad. It's enough to say: "We'll see, it could be good," because that's actually the truth. It could be bad or good. I understand they must inform about the baby's condition, but in hindsight (I later had a son with the same problem), I know when the severity was truly critical. With my daughter, it was a relatively minor infection. By the third day, we learned she was already doing better. These babies can react to treatment very quickly. I understand doctors have to inform about all risks, but back then, I don't think it was necessary to that degree.

Pavlína Walter: How old is your daughter now?

Markéta Řehořová: My daughter will be eighteen.

Pavlína Walter: That is a wonderful age. Was there any developmental problem, or did she develop normally like other children?

Markéta Řehořová: I had a "textbook" child. We only had to subtract those two and three-quarters months [corrected age]. I am so proud of both children. I will repeat my enormous gratitude for that care. Without it, it certainly wouldn't be this way. If we hadn't been where we were, the children wouldn't be indistinguishable from healthy children. We had no short-term or long-term issues in development. My daughter developed truly according to the textbooks.

Pavlína Walter: So, mothers who have a positive screening for preeclampsia don't need to fear that the baby will be born with some developmental defect?

Markéta Řehořová: A developmental defect is not the primary problem with preeclampsia. It depends more on how early the baby is born. The consequences are a result of premature birth. Problems can pile up if the birth is very early and difficult. The most serious diagnosis that causes permanent consequences and which every parent fears most is a brain hemorrhage. Infections can be treated; they can be fatal, but they are often temporary. A brain hemorrhage cannot be completely stopped, and when it happens, doctors are often helpless. They wait to see how it absorbs. There are five grades: one and two are okay, three we'll see, four is serious, and five means permanent consequences.

Pavlína Walter: You are a huge hero because you went through this experience twice. What led to your decision to have a second child? Weren't you afraid of the risk of preeclampsia? And it was there.

Markéta Řehořová: I was clear about it. Although I am a Libra and I often hesitate, when I feel something, I know it’s right, and I do what my instinct tells me. Even in kindergarten, I knew I wanted a girl and a boy, in exactly that order. When I gave birth to my daughter with such complications, my husband was literally afraid for two lives. I knew if I brought up the topic of a second child, he might panic and say no. I had to fight for him, too.

Internally, I knew I wanted that baby. For the first year, I was in shock; I felt alone, as if no one understood me. Around the time my daughter was a year and a half, the fears faded because she was developing normally. By the time she was two, I was already pregnant. It happened very quickly again. I got pregnant exactly on her second birthday. I believed that it would work out the second time, that I would have a big baby, and I would come to neonatology to show off how it has a happy end.

I didn't go into it without thinking. Back then, almost nothing was known about preeclampsia. There was no medicine and no screening. They only dampened the pressure and gave pain medication. I asked the doctor what the chance was of it recurring. He told me: "20%." If he had said 80%, I don't know if I would have had the courage. But I evaluated 20% as something we could handle.

Pavlína Walter: That would be fine.

Markéta Řehořová: I was absolutely positive. I changed gynecologists because I didn't trust the first one. Even though I know the disease often cannot be predicted, and doctors aren't to blame.

Pavlína Walter: Can we remind mothers what the symptoms are?

Markéta Řehořová: They told me they are like a mosaic. It manifests differently, but high blood pressure is the main clue.

Pavlína Walter: And do you have it normally?

Markéta Řehořová: I don't, but I likely have a genetic predisposition to it. When the body has trouble during pregnancy (diabetes, pressure), it often points to the Achilles' heel of that organism. My father has high blood pressure and a pacemaker; my grandfather died early of a heart attack. I'm not the type people would expect it from. I'm young and thin, but it’s not related to that. It’s about genetics and the vessels in the placenta. Those didn't work correctly for me; the babies were under-nourished, and that’s why they were small. The problem starts at the beginning when it isn't visible and manifests only in the second half of pregnancy. Once it manifests, it cannot be stopped.

Pavlína Walter: When did they find the risk in your second pregnancy?

Markéta Řehořová: My new gynecologist monitored me very carefully. At the big screening, the baby was slightly small again. Up to the 20th week, I tried to stay mentally strong; I told myself I would "push through it." But after the 20th week, my psyche betrayed me because I knew that now it could start manifesting. I went to check-ups with great fear. In the 22nd week, they said the son was small. Internally, I braced myself and said, "At the next check-up, he'll be bigger, he'll outgrow Míša." My daughter was 860 grams, and I fixated on the idea that my son had to be at least 850 grams by the 26th week. But I went to that crucial check-up feeling that it wouldn't be good. The doctor measured my son; he was 660 grams, and one vessel in the umbilical cord wasn't working. I had to go to the hospital immediately.

With my daughter, everything was working, but he was suddenly in a life-threatening situation. There are three vessels in the umbilical cord, and in my son, the flow completely stopped in one of them in the 26th week.

Pavlína Walter: So you were in the hospital again from the 26th week?

Markéta Řehořová: Yes, at exactly the same time. My husband and my in-laws, who were already retired, took care of my daughter. I had great support, but of course, it wasn't good for a mother's psyche.

Pavlína Walter: Did they tell you that you would likely give birth within two weeks?

Markéta Řehořová: I was already informed, so I expected it. I went into that fight consciously. It was a battle for time. It was terribly upsetting that his life was at risk. They told me that if another vessel clogged, it would happen instantly, and no one might notice. The first week (26 to 27), I didn't want to lie in the high-risk ward. I said if they measured the heart rate twice a day, I would come in for it. If it happened at night in the hospital, the result would be the same as at home, they couldn't stop anything. It would be a sudden moment. The doctors didn't forbid me from going home, and that first week it worked. I felt strong. But the second week, I stopped feeling well. I stopped believing we had time, and I wanted to be in the hospital. My blood pressure was high; my head didn't hurt, but overall, I felt sick. The monitor wasn't good, so they hospitalized me, saying we would plan the delivery in two days.

My daughter was born at 29+1; my son was supposed to be 29+0. I thought that’s how it was meant to be; I like those numbers. It was exactly two and a half years after my daughter. The weight estimate was 680 grams. Everything was going according to plan until the eve of the delivery. That's when I had a seizure. I didn't recognize it because I was fixated on the morning delivery. I already had the pre-op exams, medication, and everything ready for the C-section. I wanted to go to sleep and wake up in the OR in the morning, just like with my daughter. With my daughter, I was conscious; I saw her immediately after birth. I thought it would be the same, but in the evening, I started feeling terribly ill.

Naively, I thought I could walk it off. Then I couldn't even walk. In the high-risk ward, they were counting on me as a morning patient, but I felt terribly uneasy. I attributed it to nervousness. Then something started "pressing" me. It’s hard to describe; everything in the center of my body was pressing. Even though I knew the symptoms, it didn't occur to me that the most serious state was coming. I had no vision disturbances; my kidneys were okay for now. I thought the delivery was planned because of the little one, not because of me. I didn't correctly identify that pressure in the center of my body. It doesn't actually hurt.

Pavlína Walter: Can you explain what eclampsia is?

Markéta Řehořová: Eclampsia is the peak state of preeclampsia. It can occur before, during, or after birth. If a woman is without medical help, she will die. It looks like an epileptic seizure; the woman loses consciousness, cardiac arrest occurs, and the baby has no chance of survival.

Pavlína Walter: When did the moment come that the doctors arrived?

Markéta Řehořová: I asked for help myself. I was so sick I knew I couldn't breathe through it. I literally crawled on all fours to the nurses. I ran into a nurse who wasn't exactly empathetic, it's about people. She gave me an antacid [antacid], saying I had heartburn. I obediently took it, but in the bathroom, I realized how crazy I was being. I realized that if someone didn't save me immediately, I would die. I felt it.

I came out of the bathroom, and the nurse was already calling Doctor Koutský. He was an angel. He picked me up off the floor and took my hand. I saw the urgency; he was very forceful but empathetic at the same time. He said, "Come on, we have to get to the OR quickly. I’ll put you in the hands of the best doctor, and everything will be fine." I believed him. I even asked him if we shouldn't wait for my husband, who was already on his way. He turned and said very emphatically: "I have seen such cases, and it wasn't pretty. We are going now." I obeyed instantly.

The anesthesiologist, in a panic, asked me six times what I had eaten. I knew if they didn't put me under immediately, I wouldn't make it; I was doubling over in pain. I was still looking at the clock. My son was supposed to be born on December 6th. They put me under just before midnight. I woke up in the ICU, but in a different ward with more intensive care. I had a lot of adrenaline in me; I wanted to get up immediately and handle things. I had no idea what I had been through. I was fixated on the fact that everything should have gone according to plan, and this didn't.

Pavlína Walter: How long did you wait there?

Markéta Řehořová: I woke up at five in the morning, very soon after heavy anesthesia. I found out I had been on the operating table for two hours after the birth. My son was already in an incubator. He wasn't doing as well as my daughter, partly due to my anesthesia, which affects the babies, and also, he was smaller. They immediately examined him for a brain hemorrhage, which can occur as a result of that extreme pressure. I learned all of this later.

I prayed for a doctor to walk in and tell me the little one was okay. I wished to have one specific female doctor there whom I knew from my daughter. Finally, Doctor Sebroň entered another angel. Just the fact that he smiled gave me hope. If it were bad, he wouldn't be smiling like that. Meanwhile, I had been fighting for my life for those two hours in the OR. My husband sat outside the OR. The son was already in the incubator, and doctors kept coming out saying, "Not yet, we'll wait a bit more." My blood pressure was 250 over 150, and for two hours, there was nothing they could give me; my body wasn't reacting. A heart attack could have come, anything. Finally, the pressure calmed down. When I woke up, they said I looked dead. But that doctor’s smile was a little light of hope. And it was there.

Pavlína Walter: This is an extremely powerful story. Are both children fine now, then?

Markéta Řehořová: My son's journey was longer and harder. He was smaller, and boys generally handle that adaptation worse. But we managed beautifully. There were states where he had a serious infection just before an operation. With the second pregnancy, I already knew what to fear. The fears that were useless the first time fell away, but the objective ones were added. I oriented myself in that situation faster. I was no longer afraid he would have a brain hemorrhage when he was three years old. I tried to pass that information to other mothers so they wouldn't be so terrified in situations that aren't objectively that serious.

Pavlína Walter: Today I encounter patients who either underestimate the risk of preeclampsia or think it doesn't concern them because the disease doesn't hurt. What would you recommend to these mothers?

Markéta Řehořová: I think a mother should be very well-informed by her doctor. Objective information about the risks is enough. Very few mothers know that preeclampsia can end in death. Preeclampsia is divided into early and late. Late (after 36 weeks) has a higher baby weight and fewer complications. But in the 24th or 26th week, the situation is completely different. It affects fewer women, but those are in life-threatening danger. Without help, the story would end badly. It doesn't happen much in the Czech Republic, but a year ago, I read about a mother who unfortunately died of preeclampsia here along with her baby.

Pavlína Walter: Could it have been prevented? Did any treatment exist then?

Markéta Řehořová: Treatment doesn't exist to this day; there is only prevention that can delay the disease and mitigate the consequences. For my son, it would have been crucial. Today it’s known that aspirin helps. If started in time, the onset of the disease is delayed. The prognosis for a 600-gram baby is completely different from a one-kilogram baby. Aspirin must be taken under a doctor's supervision if the first-trimester screening is positive. It is scientifically proven that it works.

If the screening is negative, a woman can breathe a sigh of relief, even though it can happen exceptionally, it’s mathematics. But the effectiveness of the screening is enormous. Maybe I wouldn't have had an eclampsia seizure and my son wouldn't have had to be 600 grams. But 15 years ago, this wasn't yet being done in the CR.

Pavlína Walter: And in conclusion, if you had to give mothers one single piece of advice, what would it be?

Markéta Řehořová: Inform yourself consciously right at the beginning of the pregnancy. When a woman is newly pregnant, only she, her partner, and the doctor know. Gynecologists aren't yet obligated to inform about preeclampsia screening, though most do. Women should take an interest in themselves. It’s important to understand the difference: genetic screening addresses the baby’s health, but preeclampsia screening addresses the life of both the mother and the baby. If they don't undergo it in time, there’s no turning back. Aspirin can only help if started early.

Pavlína Walter: Great. I hope mothers will go for screenings. Thank you very much.

Markéta Řehořová: I also thank you for the opportunity. Awareness is extremely important. Even though we aren't doctors and don't save lives directly, information has enormous power. If it helps even a single mother, it’s great.

Pavlína Walter: Thank you, Markéta. Goodbye.

Markéta Řehořová: Thanks.