Preeclampsia and HELLP syndrome Anonymous. The Women's Health Activist 35. 4 (Jul/Aug 2010): 9.

Full Text Beth Frazer, a preeclampsia and HELLP syndrome survivor, and a volunteer with the Preeclampsia Foundation stated her unforgettable experience with such complication. `I remember the first time I heard the word preeclampsia: it was November 10, 2008, and I was blissfully pregnant with twins. Although this was my first pregnancy, I am a practicing attorney with a propensity to research and so considered myself to be an educated patient. I believed that everything was progressing perfectly. I thought that my headaches, blurred vision, shortness of breath, sudden weight gain, and swelling were all a normal part of pregnancy. In actuality, however, these were all signs that my kidneys and liver were shutting down, my red blood cells were destroying themselves, and my brain was swelling. Fortunately, I was scheduled to have a routine OB appointment that day, at which time a urine test revealed that I was spilling protein. Several hours later I was diagnosed with HELLP Syndrome, a severe variant of preeclampsia, and was told that I was dying. Two days later our beautiful twins were born, 20 weeks premature and too small to survive. My doctor said that, had my OB appointment been scheduled even 48 hours later I would have suffered a massive seizure or hemorrhage. I had no idea that my symptoms were actually serious warning signs. I now know that preeclampsia, often described as a hypertensive disorder of pregnancy or by the old fashioned term toxemia, is a known cause of premature births in the U.S. and is a leading cause of maternal and neonatal death. It is the reason that a pregnant woman s urine and blood pressure are tested at every OB appointment. But I never heard of it before. I was left physically weak, heartbroken, and completely confused. I set out to learn everything I could about what had happened to me, and figure out whether it would happen again. In doing so I found the Preeclampsia Foundation, and I realized that I wasn t alone. I found tens of thousands of women have suffered situations similar to mine, most of whom had also been unaware of preeclampsia before their own diagnosis. I learned that preeclampsia has no known cause, and has no known cure other than immediate delivery of the baby. If it is diagnosed early enough, however, preeclampsia can often be managed, allowing the pregnancy to progress a bit further and result in better outcomes for both mother and baby. I studied the signs and symptoms of preeclampsia. I analyzed the

different ways it presents itself, from the classic case of a pregnant woman whose blood pressure creeps up during her third trimester, to more unusual cases like my own. I researched the latest tests and theories and medical developments. And, finally, my husband and I met with our Maternal Fetal Medicine specialist ( MFM ), a highrisk OB, to discuss our future. We discussed the risk factors for preeclampsia, which include a history of preeclampsia, particularly preeclampsia before the third trimester. I underwent testing and learned that I might have blood-clotting disorders, which might also put me at risk for preeclampsia. Nonetheless, my MFM felt that awareness and treatment of these risk factors would allow us to successfully manage a future pregnancy. Armed with the blessing of my MFM and knowledge of preeclampsia s signs and symptoms, I became pregnant again. Those first few months were terrifying and anxiety-ridden. My MFM monitored my blood pressure, blood work, and urine protein levels constantly, as well as the development of my baby first every other week, then every week, then twice a week. Being informed empowered me, and I was reassured knowing that I recognized those symptoms that needed to be reported and acted upon. We all held our breath as slowly but surely milestones were met. First, 20 weeks, when I previously developed preeclampsia, then 24 weeks: viability. Then 28 weeks. Then 30 weeks and 32 weeks, then 34. . . And, surprisingly, preeclampsia never developed! I sit here now with a beautiful baby boy snuggled up on my lap. Born full term and healthy, he is a true testament to the power of preeclampsia education and awareness. It is possible to have a healthy mother and baby after a preeclampsia diagnosis, or even after a preeclamptic pregnancy! The key is to not only receive regular prenatal care, but also be your own advocate. Know the signs, know the symptoms, know your body, and trust yourself. AHRQ, March 2010 Copyright National Women's Health Network Jul/Aug 2010 Word count: 492 Indexing (details) Cite Subject Health care; Womens health; Pregnancy; Births Title

Preeclampsia and HELLP SYndrome Author Anonymous Publication title The Women's Health Activist Volume 35 Issue 4 Pages 9 Publication year: 2010 Publication date: Jul/Aug 2010 Year:2010 Publisher: Washington Publisher National Women's Health Network Place of publication: Washington Country of publication: United States Journal subject: Women's Interests ISSN 15478823 Source type: Magazines Language of publication: English Document type: General Information Subfile: Womens health, Pregnancy, Births, Health care ProQuest document ID: 864099491 Document URL: http://search.proquest.com/docview/864099491?accountid=38748 Copyright National Women's Health Network Jul/Aug 2010 Last updated: 2011-04-30 Database ProQuest Career and Technical Education Copyright 2012 ProQuest LLC. All rights reserved.

HELLP syndrome
HELLP syndrome is a group of symptoms that occur in pregnant women who have:
y y y

H -- hemolysis (the breakdown of red blood cells) EL -- elevated liver enzymes LP -- low platelet count

Causes A cause for HELLP syndrome has not been found. HELLP syndrome occurs in about 1 to 2 out of 1,000 pregnancies, and in 10-20% of pregnant women with severe preeclampsia or eclampsia. Most often HELLP develops before the pregnancy is 37 weeks along. Sometimes it can develop in the week after the baby is born. Many women have high blood pressure and are diagnosed with preeclampsia before they develop HELLP syndrome. However, in some cases, HELLP symptoms are the first warning of preeclampsia and the condition is misdiagnosed as:
y y y y y y

Flu or other viral illness Gallbladder disease Hepatitis Idiopathic thrombocytopenic purpura (ITP) Lupus flare Thrombotic thrombocytopenic purpura

Symptoms
y y y y y y y y

Fatigue or feeling unwell Fluid retention and excess weight gain Headache Nausea and vomiting that continues to get worse Pain in the upper right part of the abdomen Blurry vision Nosebleed or other bleeding that won't stop easily (rare) Seizures or convulsions (rare)

Exams and Tests During a physical examination, the doctor may discover:

y y y y

Abdominal tenderness, especially in the right upper side Enlarged liver High blood pressure Swelling in the legs

Liver function tests (liver enzymes) may be high. Platelet counts may be low. A CT scan may show bleeding into the liver. Tests of the baby's health will be done. Treatment The main treatment is to deliver the baby as soon as possible, even if the baby is premature. Problems with the liver and other complications of HELLP syndrome can quickly get worse and be harmful to both the mother and child. Doctor may induce labor by giving drugs to start labor, or may perform a C-section. Patient may also receive:
y y y

A blood transfusion if bleeding problems become severe Corticosteroid medications to help the baby's lungs develop faster Medications to treat high blood pressure

Outlook (Prognosis) When the disease is not treated early, up to 1 out of 4 women develop serious complications. Without treatment, a small number of women die. The death rate among babies born to mothers with HELLP syndrome depends on birth weight and the development of the baby's organs, especially the lungs. HELLP syndrome may return in up to 1 out of 4 future pregnancies. Possible Complications There can be complications before and after the baby is delivered, including:
y y y y y

Disseminated intravascular coagulation (DIC) -- a clotting disorder that leads to excess bleeding (hemorrhage) Fluid in the lungs (pulmonary edema) Kidney failure Liver hemorrhage and failure Separation of the placenta from the uterine wall (placental abruption)

After the baby is born and HELLP syndrome has time to improve, most of these complications will go away. Although there is no known way to prevent HELLP syndrome, it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as HELLP syndrome early. References Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 33. Wakim-Fleming J. Liver disease in pregnancy. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2010:section 6.