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Re: OB: Fun with preeclampsia--very long! From: Kathi Wilson (wilsonk@gtn.on.ca) Fri Jul 27 18:48:05 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: John Robertson MD: "Re: OB: Fun with preeclampsia--very long!" Previous message: Deborah J. Wage: "Re: Case help" Maybe in reply to: Garry Siegel: "OB: Fun with preeclampsia--very long!" Next in thread: John Robertson MD: "Re: OB: Fun with preeclampsia--very long!" Reply: John Robertson MD: "Re: OB: Fun with preeclampsia--very long!" Reply: Robert Woolley: "Re: OB: Fun with preeclampsia--very long!" Joe Cutchin wrote: > Robert: you obviously have not had the priviledge to see a platelet > count go from 100K to 20K in a short period of time, without > proteinuria. The sickest client with HELLP that I, personally, have been involved with was a woman who presented at 37 weeks w/ "heartburn" that persisted throughout the day despite using remedies. She resisted being assessed at the hospital because she thought we were overreacting. Her BP was 130/90 on assessment, a mild but not significant elevation for her. No proteinuria. Interestingly, the consultant on call (a newbie, actually) only ordered a CBC (which I bet she *never* does again), which demonstrated a *very* mild thrombocytopenia of 121 K. She wanted to send the woman home. My midwife partner stood her ground and said "uh, uh, she's not going home until we do some liver functions". Ta, da. Mildly elevated AST and ALT. Over the next ten hours, her platelets went from 121 to 40, her LFT's soared, and her BP really didn't go up any more than it had been at presentation. Unlike the usual PIH presentation, she didn't respond to induction at all, and was sectioned before she got any sicker. She was transfused w/ 9 units of platelets (4 initially, and then another five, and they continued to drop after transfusion). (I shudder to think what would have happened if she'd been sent home....) She ended up w/ all the "letters" in HELLP. Hgb postpartum fell to about 70, bili quite elevated. Got quite a bit sicker pp before she started to get well. This is a disease w/ many end organ manifestations. Proteinuria is only one of them, and may not ever appear. I have a *very* healthy respect for anything that even faintly sniffs funny w/ PIH, and epigastric pain in pregnant women makes me twitch something awful. BTW, w/ a severe pre-eclamptic, our guys put in a foley *and* start oxytocin simultaneously. This was the first time I had not seen it work. -- Kathi Wilson, RM Ilderton, Ontario, Canada mailto:wilsonk@gtn.on.ca ********************** Thames Valley Midwives 346 Platts Lane, London, Ontario, Canada http://tvm.on.ca mailto:info@tvm.on.ca Next message: John Robertson MD: "Re: OB: Fun with preeclampsia--very long!" Previous message: Deborah J. Wage: "Re: Case help" Maybe in reply to: Garry Siegel: "OB: Fun with preeclampsia--very long!" Next in thread: John Robertson MD: "Re: OB: Fun with preeclampsia--very long!" Reply: John Robertson MD: "Re: OB: Fun with preeclampsia--very long!" Reply: Robert Woolley: "Re: OB: Fun with preeclampsia--very long!"

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