Preeclampsia and HELLP Syndrome
76Preeclampsia
Signs of Preeclampsia
In addition to swelling, protein in the urine, and high blood pressure, symptoms of preeclampsia can include:
- Rapid weight gain caused by a significant increase in bodily fluid
- Abdominal pain
- Severe headaches
- A change in reflexes
- Reduced output of urine or no urine
- Dizziness
- Excessive vomiting and nausea
per Wikipedia:
Pre-eclampsia (US: preeclampsia) is a medical condition where hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant protein in the urine. Its cause remains unclear, although the principal cause appears to be a substance or substances from the placenta causing endothelial dysfunction in the maternal blood vessels.[1] While blood pressure elevation is the most visible sign of the disease, it involves generalized damage to the maternal endothelium and kidneys and liver, with the release of vasopressive factors only secondary to the original damage.Pre-eclampsia may develop at varying times within pregnancy and its progress differs among patients; most cases are diagnosed pre-term. It has no known cure apart from ending the pregnancy (induction of labor or abortion). It may also occur up to six weeks post-partum. It is the most common, dangerous complication of pregnancy and it may affect both the mother and the fetus.[1]
Preeclampsia and HELLP - could it happen to you?
When you are pregnant, it is just not practical (or beneficial) for your doctor to tell you every single complication that can occur during pregnancy. They stick to the major problems so you don't spend your nights on the Internet, convinced you have a plethora of problems and your child is going to have developmental delays becuase you had a half glass of wine with dinner. However, one condition I do think is common, that I wish my doctor had spent a little time explaining to me, is Pre-eclampsia. Because I had it. And if I had known what was happening to my body, I would have reacted very differently than I did.
Not only did I have preeclampsia, but I was also a victim of HELLP syndrome, which occurs in roughly 5% of women who get preeclampsia. Talk about luck.
My Story
For starters, I had, for the most part, a very average pregnancy. I wasn't happy about gaining 48 lbs (I didn't know at the time that part of the reason was due to my preeclampsia), but I was able to stay active and my baby boy was doing just fine in utero. I had never even heard of preeclampsia. I had heard the term toxemia, but only peripherally from one of my many pregnancy books I was pretending to keep up on. At 36.5 weeks pregnant, I woke up at 2:30 a.m. on Saturday morning (4/26/03), feeling like an elephant was sitting on my chest. I thought, this is either the worst heartburn ever, or the baby is pushing with both feet against my lungs, heart and chest cavity. I tried yoga, walking, stretching, TUMS (a pregnant lady's best friend), drinking water, breathing deeply, laying in different positions on the floor...everything. But when nothing I tried relieved the pressure, I started to worry.
After about an hour of this (in hindsight, I never should have waited an hour, but what did I know?), I finally woke my slumbering husband, who'd grown accustomed to sleeping through my fitful nights. He insisted I call the doctor, so I did.
I told the doctor on call (I want to make it perfectly clear this was not my OB) what I was experiencing and she said, "Well, pregnant women experience a lot of things." To her credit, she did say she couldn't diagnose me over the phone, but her first comment, to me, belittled the severity of my situation. I started to think it was normal, and that maybe I was overreacting. My husband and I decided to wait another 30 minutes and if it didn't go away, we'd go to the hospital. Well, the feeling passed, so we just went about our day normally. And the next day, and 2 more days after that.
It wasn't until 6 a.m. Tuesday morning (4/29/03) that it happened again, this time, I had a small seizure in bed - my arm sort of did this weird shaking-seizing thing. This time, we went straight to the ER. And wouldn't you know it? After waiting 30 minutes just for triage, they took one look at my 8.5 month belly and sent me over to the maternity ward. By foot, I might add. I got over to maternity and they at least gave me a wheelchair. BUT - they were appalled that I was not triaged and walked me back over there to get a diagnosis. Meanwhile, I am SO uncomfortable. Feel like I can harldly breathe, pressure on my chest is so great.
They take my blood pressure and it is 190/120! My normal BPR is 110 over 70, by the way. Right after they took my blood pressure, I threw up (another sign of the sickness). Then, the ER doc came in and said, "Mrs. Fliess, you're having your baby today."
My doctor assessed me and found I was also suffering from HELLP syndrome. My platelet count was at 75 million/L, which is class II severity. Three platelet transfusions could not raise the number. Only after the baby was delivered did this number start to rise. One of the doctors' biggest fears was that I would bleed to death from the c-section becuase my blood was not clotting. (My OB told me later that he essentially started a platelet transfusion on the operating table, cut me open, grabbed my baby out and sewed me up as quickly as possible.)
I wasn't even close to being able to deliver naturally, so they decided on an emergency c-section. At 10:10 a.m. I had an emergency c-section. But becuase of all of my complications, my poor husband couldn't be in the room, and I had to be completely knocked out. It totally sucked.
I spent a night in the ICU, seeing my baby boy about 5 hours after surgery - and I remember being so groggy. The photos of me with tubes in my nose, 2 IVs and a beautiful 6 lb boy in my arms are etched in my memory forever.
I am thankful to be alive. I am thankful that my son came into the world as healthy as can be. I think if I had known all about pre-eclampsia before my emergency, I would have been a lot more scared, but it also may not have escalated to HELLP syndrome - I'd have been checked out at the first sign of trouble.
I went on to have a 2nd healthy boy after a perfect pregnancy. I hope my story helps someone, even if it is just to get the word out.
Web MD's definition
- Preeclampsia
Web MD info page on Preeclampsia
What is HELLP Syndrome?
per Wikipedia
HELLP syndrome is a life-threatening obstetric complication considered by many to be a variant of pre-eclampsia. Both conditions occur during the latter stages of pregnancy or sometimes after childbirth.
HELLP is an abbreviation of the main findings:
Elevated Liver enzymes and
It is very rare, but can be fatal. Its incidence is reported as 0.2-0.6% of all pregnancies. Of women with (pre)eclampsia, 4-12% also develop signs of a "superimposed" HELLP syndrome. Mortality is 7-35% and perinatal mortality of the child may be up to 40%. HELLP usually begins during the third trimester, and usually in Caucasian women over the age of 25. (Padden, 1999.) Rarely, cases have been reported as early as 23 weeks gestation.
Just some of the Signs and symptoms:
- Headaches
- blurred vision
- nausea, vomiting
- pain in abdomen
- seizure
Often, a patient who develops HELLP syndrome has already been followed up for pregnancy-induced hypertension (gestational hypertension), or is suspected to develop pre-eclampsia (high blood pressure and proteinuria). Up to 8% of all cases present after delivery.
There is gradual but marked onset of headaches (30%), blurred vision, malaise (90%), nausea/vomiting (30%), "band pain" around the upper abdomen (65%) and tingling in the extremities. Oedema may occur but its absence does not exclude HELLP syndrome. Arterial hypertension is a diagnostic requirement, but may be mild. Rupture of the liver capsule and a resultant hematoma may occur. If the patient gets a seizure or coma, the condition has progressed into full-blown eclampsia.
Patients who present symptoms of HELLP can be misdiagnosed in the early stages, increasing the risk of liver failure and morbidity (Padden, 1999). rarely post caesarean patient may present in shock condition mimicking either pulmonary embolism or reactionary haemorrhage.
Classification
The platelet count has been found to be moderately predictive of severity: under 50 million/L is class I (severe), between 50 and 100 is class II (moderately severe) and >100 is class III (mild). This system is termed the Mississippi classification (Martin et al 1990).
Treatment
The only effective treatment is delivery of the baby. Several medications have been investigated for the treatment of HELLP syndrome, but evidence is conflicting as to whether magnesium sulfate decreases the risk of seizures and progress to eclampsia. The DIC is treated with fresh frozen plasma to replenish the coagulation proteins, and the anemia may require blood transfusion. In mild cases, corticosteroids and antihypertensives (labetalol, hydralazine, nifedipine) may be sufficient. Intravenous fluids are generally required.
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Comments
Hi Monique! Not to worry you, but please keep in mind that you can still suffer from preecclampsia during subsequent pregnancies. I think the percentage is 25%. So, if you're thinking of having more :)... remind your OB about your first pregnancy.
I had preeclampsia with my first and HELLP post delivery with my second. After a month of bedrest and hospital trips (due to high bps), I thought I was home free. Little did I know what awaited me! The swollen liver is not a fun feeling! Just be careful - I have been told to stop having children.
Wow - post delivery. That's scary. This whole thing is much more common than I ever thought. Glad you're okay!
Thank you so much for sharing your experience. I had the same thing happening to me with my second baby. I felt the same as you did and i wish the doctors had more information ahead of time. I delivered the baby at 34 weeks and i stayed in the hospital for 6 days I would love to have a 3rd baby but i will need to go for consultation before taking a decision. I always ask to myself, what if it happens again? could I die? I have two beautiful girls and i want to be there for them. I wish they could prevent this Syndrome.
Alicia
Alicia, Thanks for sharing your story as well. It was scary and in my small way (hubpages) I'm hoping to spread the word to other pregnant women, or women trying for a baby.
Pregnancy is different for every woman, but if diagnosed with preeclampsia it can be miserable, even fatal. Experiencing symptoms like high blood pressure, swelling (particularly in the hands and feet), sudden weight gain, headaches, sudden onset of nausea or vomiting after the first trimester, changes in vision, or stomach and/or right shoulder pain, could mean preeclampsia. But it’s often diagnosed too late, with the only “cure” being delivery. Women are often put on bed-rest for the remainder of their pregnancy and may deliver prematurely. However, there is a new test that can prevent complications from preeclampsia and help your pregnancy to full term: the MIST test. This is a non-invasive test given between the 16 and 20 weeks of pregnancy and can determine whether or not you will develop preeclampsia and will then be able to take proper precautions. Give yourself peace of mind and ask your doctor today for the MIST test. Visit http://www.misttechnologies.com/ for more information.
Thanks for sharing your story. I was literally on my death bed with hellp syndrome. I was 19, 26 wks pregnant, and I had gained a whopping 120 pounds and I was only 130 to begin with. Me and my daughter almost died. Some doctor had a lot of energy and determination that day the nurses told me he would not give up on her he kept working even after someone told him "it's not gonna happen" now she is the cutest most energetic 3 yr old you've ever seen... I continued to get worse after labor. I went into a coma, my mom had our pastor come in and pray over me. They didn't know that I would make it, but luckily I pulled through. I feel like God made miracles happen that day. It's important that women realize this is out there. It's rare but it does happen and when you realize the symptoms you can catch it in time.
Wow, Abby, your story is unbelievable. Thanks so much for sharing it. I had never heard of HELLP, and had only heard of 'toxemia' (preeclampsia) peripherally. Thank God for great doctors and that you and your daughter survived and are healthy now.
I too went undiagnosed, until I was 41 weeks! Basically I have low blood pressure anyway, so although I had a lot of fluid retention and my BP was creeping up the midwife din't really take much notice. I also suffered headaches but then I wasn't really sleeping because I felt so bad. It was only when I started showing protein in my urine that they began to get worried. I was then taken to hospital and told I would be induced. The worst thing was that I was hoping for a home birth and I had complications with having my waters broken.
It is all to easy for Dr's and Midwives to blame health problems on just being pregnant, but this could have been very serious to me and my baby. It was not even really seriously considered until I was overdue and my health really beginning to suffer (I had so much fluid all over I couldn't be touched without it hurting). Just because your blood pressure is not sky high does not mean there isn't something seriously wrong. If you have to make a fuss, make a fuss! Luckily I came through and have a wonderful son (who has his own problems). I will also say that although it is more common in first time pregnancies, this was my second pregnancy (and I was never allowed to put my feet up with a toddler at home as well!). Great hub and a problem that really needs to highlighted.
It is amazing how common it is and how few people know about it. I too had and continue to have a very low BP, so my doctors were not alarmed that it was pretty high for me (not alarmingly high enough i guess) during my pregnancy. Glad you are OK.
Ten years ago, I was 25 when I became pregnant with my first child. I had to take fertility drugs to get pregnant after having been on depoprovera for two years. When I finally became pregnant we were thrilled. But by about 4 weeks into my pregnancy, I had morning sickness something awful..because it lasted all day! I literally lost about 15 pounds my first trimester. I thought I had a great doctor. We lived in a very rural community and the fact that my Dr did sonograms at every appt was great.
Everything seemed to be going better. I had begun to gain weight into my 2nd trimester, though he advised that I watch my salt intake, as I was gaining a little fast and showing a little swelling. On a Monday, at my 27 week appt, my BP was slightly elevated. On that Friday evening, I started not feeling very good.
I felt like I just couldn't breath. My chest felt really tight and I was just ansy and uncomfortable. I just sort of paced around for a while waiting for my husband to get home from work. When he got there, the feeling was getting more alarming to me, so we drove to the hospital. Once we had arrived there, the tightness was beginning to become painful in my lower chest. My bloodpressure was pretty high, so the doctor on call (not by doctor) was paiged to come in. (I remind you that this was in a rural community, there was only one doctor on call for the entire hospital, and he had to be called in). So after waiting about half an hour for him to arrive, my pain is worse, the tightness is worse, my bloodpressure is higher. He believes I'm having a gallbladder attack. Advises the nurse to give me tagament and to make an appt on Monday to have a sonogram of my gallbladder. He then goes home!! So the nurse gives me the medicine, which I immediately proceed to throw up. The pain is getting pretty bad by now and I'm just pacing and agitated. So the doctor is called and he has the nurse admit me. (No, he doesn't return to the hospital until the next morning, just in case you were wondering) I am given an IV, and treated with demoral throughout the night to control the pain and medicine for my blood pressure which just kept increasing despite the medicine. By morning, my kidneys had begun to shut down, as I was peeing blood. The sonogram they sent me for was negative for gallbladder issues. They drew blood following that, which came back positive for protein in my urine, and a blood platelet count of about 77,000. At this point (nearly noon and the first time I have seen the doctor since the previous night) he comes into the room and tells me that he has no idea what is wrong, but another doctor he talked with says I need to be immediately taken to the major hospital which is about 4 hours drive away. He tells me the baby was not going to live and they weren't sure if I would make it either. Oh, and did we want to go by ambulance, or have Eaglemed send the helicopter?? Truely, are you really asking me this question???? I chose the helicopter. By that evening, I was being taken into surgery, where I was put to sleep, given platelets, my level had dropped to about 40,000. and my daughter was delivered at 8:10 pm weighing a whopping 1 pound 8 ounces. She was delivered at 27 1/2 weeks. Today, she is 10 years old!
It is scary to have such a life threatening illness out there that doctors are completely unaware of. Looking back now, after having information about HELLP syndrome (I've spent hours reading about it on internet websites) I had a lot of symptoms of this that could have possibly allowed me to prolong my delivery had it been caught. I never chose to have any more children. The earlier HELLP onsets in the pregnancy, the greater the risk of subsequent pregnancies. I was greatful to have survived and to have a child that survived. I spent 2 months in an NICU watching her grow. I brought her home weighing 4 lbs 12 oz. about 2 weeks before my actual due date. She has been healthy ever since.
I believe in miracles because I was given one, but figured once in my lifetime was enough to ask for.
I am just out of the hospital after loosing my baby boy at 24 weeks because of Hellp syndrome. Initially i had thought i was going through bad digestion since i had diarrhoea and vomitting with severe epigstric pain. When i had severe chest pain and not able to breath at night i called OB on call, she said it is heart burn and told me to take milanta and tums. It just helped me that night. Next night i ended up sitting whole night because lying down made me breathless. We went to urgent care in the morning, they checked my BP and protein in the urine , both were high. They thought i was having some gall bladder issues and did a sonogram of the entire abdomen. Everything was alright. I was sent home with Pepsin , another acid reflux medication. Same night i had another attack of epigastric pain which almost resembled heart attack pain. I did take pepsin and it helped me. By morning my pain was almost gone and i was relieved. I sudenly got a call from doctor saying i need to get admitted to hospital immediately as i was spiilling 5 gms of protein in my urine (Which is 15 times more than than than normal). They said i might have to delive the baby and sent me to a hospital which had a well equipped neonatal care unit. Unfortunately my baby boy was 3 weeks behind in growth. and doctors said he won't survive even if they tried. They ended up terminating my pregnancy at 24 weeks. It was very disappointing and terrible to go through this. Today i am happy to be alive to take care of my 5 year old boy. I pray to god to give everyone strength to go through this mystery disorder during pregnancy. Now we are afraid to even think about another pregnancy. I really don't want to go through this again.
I was 28 weeks when I developed pre-eclampsia and admitted to hospital. Within 2 days the pre-eclampsia developed into HELLP syndrome and I was knocking at deaths door. They started me on a drip to prevent brain hemorrhaging and fits. My BP was thru the roof and they couldn't get much blood from me to see if I would clot or not. After 11 times of poking me they got 2ml of blood. The last thing I said to my husband when they took me to theater was look after our daughter as I did not think I would come out alive. I was knocked out for the ceasar and only woken the next day to see my daughter that was born at 28 weeks weighing only 1kg. Nothing prepares you for when you see your beautiful baby all proded with tubes coming out of both nostrals, in her tummy and in her leg. I held my daughter for the first time 11 days after she was born and finally off the ventilator. She was in NICU for 2 months and came home a month and two weeks before her due date. We had a rollercoaster of events with a premmie baby but I look at her now at 18 months weighing 9kg's and can't believe the road we walked. I did have complications after having her and was on BP tablets for 9 months before it rectified itself. I am now considering if I should have another baby but also worried that this will happen again? Any suggestions?
Bailey, Thank you so much for sharing your story. It does seem amazing to me that so many women can suffer from this and neither they (we) or the doctors seem to know very much about it. I'm so relieved to hear that you and your baby survived. While my situation was dire, my son was at least in his 36th week. They just kept saying, he'll be fine - we're worried about you. And at that point, I was so sick, I didn't even care - just wanted him to be okay.
Dear Lucky to be Alive, I am so sorry for your loss. My one hope is that more women and doctors become aware and educated about these things so they can see the signs early and get the best care possible. I did go on to have a second child, and had zero problems. For what that's worth.
Hi Tracy,
Sorry it's taken me so long to respond. For me, they said that as soon as the baby was born, my BP and platelet count should start to get back to normal. It took me about 3 days to get my platelets back up and my BP went back to normal almost immediatley.It is suprising and disheatening to hear you were on meds for 9 months! Just shows how each case is different and how many unknowns are left with this condition. I wish you the best of luck with your decision to have another one. No one would fault you for hesitating or saying NO way. We actually had an oops, and I was a bit scared, but ended up not having anything more than heartburn. It was amazing - I only gained 25 lbs, as compared to my 55 with Pre-Ec/Hellp. It was fun having a normal pregnancy. Good luck.
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Monique says:
14 months ago
thanks for posting, Sue! This happened to me too. :) I thought I was having heart burn for a week, when in reality my liver was about to burst! I delivered at 36 weeks to a healthy boy.