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Featured Birth Story this week

Marsha's Story

Having lost one baby to antiphospholipid Syndrome when she didn't feel well at 24 wk. she was dismissed as having heartburn and sent home. HELLP surfaced this time and Caleb was born at 1pound. 


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Updated 5/01/01

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Signs of PIH/HELLP


90% of patients with HELLP have generalized symptoms.  65% complain of epigastric pain, 30 % with nausea and vomiting, and 31 % with headache.  Any woman who complains of these problems in the third trimester should be evaluated for HELLP. If there is any significant platelet drop as well, HELLP should be suspected.  In a recent survey only 2 of 14 patients who entered the hospital with HELLP were correctly diagnosed. (1)

The signs and symptoms of PIH (pregnancy induced hypertension)  and pre-eclampsia are classified as mild, moderate or severe. They include: hypertension, proteinuria (the presence of excessive protein in the urine) and edema. 

Mild pre-eclampsia objectively presents with mild hypertension of about 140/90 or a increase of 30mm Hg systolic and 15mm Hg diastolic over baseline blood pressure. Edema of mild PIH is differentiated from normal dependent edema of pregnancy by weight gain of greater than 2lb per week. Urine protein is in the range of 1+ or 2+.

Edema frequently accompanies normal gestation, so that its presence alone is not a useful in diagnosing pre-eclampsia, while its absence does not eliminate the diagnosis. 30% of all pregnancies show signs of edema.  For example sudden and rapid weight gain often proceeds overt manifestation of the disease. On the other hand severe disease can occur even in the absence of edema (the "dry" pre-eclamptic). Edema of the hands and face is more likely to be associated with sodium retention and is therefore a more reliable indicator of pre-eclampsia than is dependent edema. Edema is diagnosed as clinically evident swelling, but fluid retention may also be manifest as a rapid increase of weight without evident swelling.
 

Elevations in blood pressure after mid-pregnancy in previously normotensive women are often the initial clue of impending  pre-eclampsia. Since blood pressure is measured at every antepartum visit it comes as no surprise that hypertension has been the focus of most studies regarding pathophysiology and therapy in pre-eclampsia.
 

The diagnosis of pre-eclampsia is uncertain in the absence of proteinuria. However is that proteinuria may be a late manifestation, and it may be prudent to treat women as pre-eclamptics even before proteinuria develops.
 

Severe PIH is differentiated by the appearance of subjective complaints of, headaches, visual disturbances, and epigastric or right upper quadrant abdominal pain. BP is in excess of 160/110 or rise over a period of time to greater than 60mm Hg systolic and 300mm Hg diastolic over baseline. Proteinuria is 3+ to 4+ . Edema is often pitting, and weight gain is in excess of 10lb per week. Oliguria (reduced excretion of urine)  of less then 400ml in 24 hours is also diagnostic.
 

The liver is not involved primarily in pre-eclampsia but becomes the target organ in severe cases. Vasospasms (spasms in the blood vessels, resulting in a decrease in their diameter) lead to a reduction in blood flow to the uterus and other organs which in turn is responsible for the hypertension found in PIH. They are also responsible for the visual disturbances and low urine output. These same Vasospasms are also responsible for the anemia that occurs in HELLP along with the hematacrit level falling. This reduced blood flow is also a complication of delivery.
 

In some reported cases of HELLP, pre-eclampsia was absent or mild. Patients presented with HELLP Syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet counts) often have right upper quadrant and epigastric pain, and a peripheral blood smear consistent with a microangiopathic hemolytic anemia. There may be decreases in platelet counts.
 

With HELLP changes in the liver occur. It become swollen and engorged causing the epigastric or right upper quadrant pain and tenderness. Liver rupture, hemorrhaging have also been reported. Along with Liver failure and jaundice. Hypoglycemia is a particularly grave laboratory finding; however, the cause of the hypoglycemia is yet obscure, even though it is obviously related to liver failure. The low platelet count associated with HELLP syndrome appears to be due to increased peripheral vascular destruction. Liver cell damage results in the elevated enzymes.

HELLP signs
1. Weakness & fatigue
2. Nausea & vomiting
3. *Right upper quadrant and/or epigastric pain
4. Headache
5. Changes in vision
6. Increased tendency to bleed from minor trauma
7. Jaundice
8. Diarrhea
9. *Shoulder or neck pain

*Patients with HELLP syndrome who complain of severe right upper quadrant pain, neck pain or shoulder pain should be considered for hepatic imaging regardless of the severity of the laboratory abnormalities, to assess for subcapsular hematoma or rupture. (2)

There are various classes of HELLP. They are:
Class 1 is considered most severe form with patients with platelets under 50,000
Class 2 patients have a platelet level between 50,00 & 100,000
Class 3 patients have a platelet level between 100,000 & 150,000
 

Still looking for more HELLP information?  Effects of HELLP on Mother & Child will take you to the next page.  Also if you have a HELLP story to share please stop by the HELLP Syndrome Birth Stories Page and leave or read a story.  Here you will also find up to date HELLP/Pre-E net articles and books.  You will also find WebRing information at the above listed url.

(1)Schroder W, Heyl W. HELLP-syndrome. Difficulties in diagnosis and therapy of a severe form of preeclampsia. Clin Exp Obstet Gynecol 1993;20:88-94. 

(2)Barton JR, Sibai BM. Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count).
Am J Obstet Gynecol 1996; 174:1820-7.


Introduction to PIH/HELLP

Signs of PIH/HELLP

Effects of HELLP on Mother & Child

Chances of PIH/HELLP in subsequent Pregnancies

Prevention

My Body After HELLP

If you have an HELLP Syndrome story please take a moment to share it with us.  Please tell us what lead up to your having HELLP and what the outcome was and how you are doing today and whether you have had any pregnancies since having HELLP.
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Journals: Read the passages of moms who are going through or who have went through another pregnancy after having HELLP.
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12/16/00