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I found help in Re: Info on HELLP syndromeFrom: Gail (anonymous@obgyn.net)Sat, 21 Mar 1998 10:24:23 -0600 (CST)
At Sun, 23 Nov 1997, D. Ashley Hill, M.D. wrote: > >The following may help to clarify information on preeclampsia, severe >preeclampsia, eclampsia, and HELLP syndrome. I placed each of these in >a different category because, while they are each part of the same >disease process, ob/gyns look at them as somewhat different entities. > >Preeclampsia (sometimes called toxemia) is simply the development of >hypertension (in this case a blood pressure of at least 140/90, protein >in the urine, and edema. All 3 must be present. Contrary to popular >belief, edema, for example swollen ankles, is not enough to diagnose >preeclampsia, as 85% of normal pregnant women get edema. In "mild >preeclampsia" the blood pressure is below 160/110, whereas in "severe >preeclampsia" it is at that level or higher, and other manifestations >are present, as discussed later. It occurs almost exclusively in >humans, with an incidence of about 15% in first-ever pregnancies, and 6% >in women with one or more prior pregnancies. One is at increased risk >of preeclampsia if she has had it in prior pregnancies. It is more >common in first pregnancies. It is much more common with twins, >triplets, etc. The cause is unknown (which is a very frustrating issue >for ob/gyns). There are no known ways to prevent preeclampsia (other >than contraception or abstinence). Treatment of mild preeclampsia >consists of bedrest on one's side, very careful fetal and maternal >monitoring, including blood work and urine evaluation, and, in most >cases, delivery via induction of labor, as long as the baby is near >term. A c/section is not necessary in many cases, and in fact it is >usually safer for the mother to deliver vaginally. > >Severe preeclampsia is preeclampsia along with any of the following: BP >of 160/110, a severe headache, severe pain below the right ribcage, >significant visual disturbances, growth restriction of the baby or very >low fluid, or a variety of abnormalities of the blood or clotting >system, including low platelet count, anemia, or the destruction of >blood cells. Severe preeclampsia can cause many problems, including >abruption (where the placenta tears from the side of the uterus, >producing bleeding), stillbirth, maternal stroke, kidney failure, >inability of the blood to clot, liver rupture, and, in many cases >worldwide, death. This is an uncommon event in the U.S., but thousands >of women die worldwide from preeclampsia each year. Treatment usually >consists of delivery of the baby. Sadly, in some cases it is necessary >to sacrifice the life of the baby by delivering at a very early >gestational age to save the life of the mother. Unfortunately, 65% or >so of women who have severe preeclampsia will get it again during the >next pregnancy. 1/5 will have it during the second trimester of the >next pregnancy, a very dangerous situation. Severe preeclampsia can >also affect the brain, producing visual changes, the liver (as described >below), the kidneys, leading to dialysis, and the lungs, producing fluid >on the lungs. The baby can also develop many problems. Understandably, >ob/gyns have a great deal of respect for this troublesome disease. > >Eclampsia is when seizures occur. One cannot have "borderline >eclampsia" since there is nothing borderline about a seizure! > >HELLP syndrome stands for "Hemolysis, Elevated Liver tests, and Low >Platelets) and is a subset of severe preeclampsia. This condition is >usually treated by delivery of the baby, as it can lead to liver rupture >(sometimes requiring over 100 packs of blood transfusion), DIC, a >condition where the blood does not clot, leading to hemorrhage and >perhaps emergency hysterectomy, and maternal cardiac and renal problems. >The incidence of HELLP in subsequent pregnancies is thought to be about >5%. > >Although the above information is frightening to consider during >pregnancy, I should point out that most women with elevated blood >pressure during pregnancy do very well. Few will have the problems >described above. However, sometimes, even in a developed country like >the U.S., bad things happen to otherwise normal pregnant women. Someone >always wants to know "how could this happen to me; I had a perfectly >normal pregnance." You should know that this is an unpreventable >disease, that getting it is more genetics and bad luck than anything >else, that your doctor did not cause this nor could he or she prevent >it, and that you and your partner are certainly not to blame for >"causing" preeclampsia. > >I hope this clarifies some of the issues about this disorder. > >-- >Ashley Hill >D. Ashley Hill, M.D. >Associate Director >Department of Obstetrics and Gynecology >Florida Hospital Family Practice Residency >Orlando, FL >http://www.gate.net/~dahmd > >I apologize, but I am unable to answer personal e-mail >due to time constraints. > Thank you Dr. Hill for this article. This is something I was looking for and I can pass on to friends who are pregnant now. Just a few more questions though to anyone who can help. I stopped working at about 20 weeks, so I wasn't having job stress. I ate a very healthy diet and rested a lot. I was being seen at an MTF (military treatment facility). I didn't gain any weight until about 28 to 30 weeks. I was gaining 10+ lbs a week plus had edema in the legs, hands and face, and frequent headaches, slight itching and at 31 weeks had vomitted several times. My BP was steadily going up, but no one was checking my baseline. At the MTF you see an NP until 32 weeks then you get to see a Dr and you usually see a different one each time. At my 32 week ckeck I kept asking the NP's if it was normal to be as swollen as I was and to be gaining so much weight in such short periods. She told me I had nothing to worry about except that I was over eating!!! When I mentioned toxemia she explained that my BP wasn't high enough to be considered for toxemia. Two days later my body was just ballooning I was so swollen. I went Back to the hospital and they monitored my blood pressure for 3 hours and sent me home still not looking at my baseline BP from my first checkup. ( I tend to have low blood pressure) Four days later I went back to the hospital because I was still swelling. (My wedding band could not even make it over my fingernail.) They kept me for 24 hour observation. The next day they said they were going to keep me there until I had the baby and I was only at 33 weeks. I was told they really didn't think I had toxemia, maybe just a mild case. My urine wasn't showing anything bad but my BP was up and they did not know why I was so swollen. They did not put me on bedrest and did not prepare me at all for dealing with a disease I knew very little about. That evening I had a headache and at one point started shaking, but I thought I might have been cold even though I felt really warm. After a while the shaking subsided. At 5am the next morning I started shaking all over and could not controll it. I was shaking violently by the time the nurse got to me and was having trouble staying focused. No one had told me about seizures. I had read about it, but you don't get them if you only have "mild" toxemia. I was then put on mag and transferred to civilian hospital that could handle such a pregnancy. My kidneys were not functioning properly by this time and I ended up delivering two days later by emergency c because of congestive lung failure. If I get pregnant again what can I do to prevent such early onset. (I already have a specialist picked out and will not be going back to the MTF) And how important is protien in the diet. I've heard high protein can lower your risks. And what should I have done before I get pregnant. I've been told to go get things checked before I get pregnant but what exactly do I ask to have checked. ie liver panels, kidneys, BP ? Thanks in advance to anyone who can help. Sorry I wrote so much.
-- Gail
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