Did I have HELLP syndrome?
How is this different to pre-eclampsia? HELLP syndrome is an acronym for Haemolysis (rupture of red blood cells), Elevated Liver enzymes, Low Platelets. It is characterised by pain under the ribs on the right side. Often confused with heartburn (but not relieved by antacid) or gallstones. Occasionally it is confused with cholecystitis (Inflammation of the gall bladder.)
It is a complication of Pre-eclampsia and associated with high blood pressure / proteinuria.
What is the likelihood I’ll get pre-eclampsia again in a future pregnancy? Are there any preventative measures that can be taken beforehand?
If you have had pre-eclampsia before you are more likely to get it again in a subsequent pregnancy. However, familiarising your self and those who are around you to the signs & symptoms alongside adequate antenatal care is very important.
How likely is it that I might not get it again at all in a future pregnancy?
Is it very likely I will due to the severity and how it appeared to come on so suddenly this time?
Research shows that if you get pre-eclampsia again it tends to follow a similar pattern although often less severely. It also shows that on average it happens up to 2 weeks later in gestation than the previous occurrence
Pre-eclampsia cannot be prevented although reducing risk factors can be a help. Reducing body mass index and the use of aspirin taken under your doctors guidance has shown to be helpful.
Could it have been coming on gradually this time and I just didn’t have/recognise the symptoms or do you think it did come on without warning?
Possibly. Latest research says that from onset to delivery is on average 0-14 days. However pre-eclampsia is generally a progressive condition that is only ‘cured’ by delivery of the placenta.
Can you start developing symptoms of HELLP before symptoms of pre-eclampsia?
Yes – usually high blood pressure / proteinuria are picked up by routine screening as they do not always cause symptoms that are easily felt. Vomiting / pain as previously described & headaches are the commonest feelings. Many women describe feeling ‘fluey’.
If so, how could this be picked up in the future? Increased monitoring is the only real way of being sure. Home monitoring using protein dipsticks or an ‘approved in pregnancy’ blood pressure monitor are a good addition to professional monitoring.
Did my condition at any time progress to Eclampsia? Was I at risk of/close to having a fit? Can Eclampsia come on without any warning or prior symptoms? If so am I more likely to get this in a future pregnancy?
Eclampsia is a Greek work which directly translates to ‘bolt from the blue’. It means to ‘fit’. So if you had eclampsia, you fitted. If you didn’t fit it would have been Severe Pre-eclampsia. (pre-fit) Eclampsia can happen without prior ‘noticeable’ symptoms. Your risk of getting it again is increased however your consultant will be able to give you a more accurate assessment of the risk as s/he will have all your medical information to hand.
What are the extra tests you’re carrying out on me? Is it likely I might have an underlying illness which contributed to me getting pre-eclampsia? Could this make a future pregnancy too dangerous?
Women with a history of pre-eclampsia have been shown they are likelier to have ‘stickier blood’ than those women who haven’t. Some of these conditions might include Lupus or an auto-immune disorder like thyroid problems. Anti-phospho- Lipid disorder also increases your risk of pre-eclampsia. Recurrent miscarriage is sometimes a sign of these conditions. These conditions are easily screened for with blood tests. A positive result could influence the way your next pregnancy is cared for.
It was thought I’d had a very early miscarriage (5 weeks) the month before we got pregnant (I didn’t have to have a D&C done). We conceived again immediately with no period in between. Could this have been a risk factor or could there have been anything left from that pregnancy which affected this one?
Miscarriage effects 1 in four pregnancies, it is usually difficult to know the exact cause and most women never find out the cause of their loss, even if they have investigations. It can be hard to accept that no-one can say for certain why it happened.
The main causes of miscarriage are thought to be:
Genetic: In about half of all early miscarriages, the baby does not develop normally right from the start and cannot survive.
Hormonal: Women with very irregular periods may find it harder to conceive and when they do, are more likely to miscarry.
Immunological: Problems within the blood vessels which supply the placenta can lead to miscarriage.
Infection: Minor infections like coughs and colds are not harmful, but a very high temperature and some illnesses or infections, such as German measles, may cause miscarriage.
Anatomical: If the cervix (neck of the womb) is weak, it may start to open as the uterus (womb) becomes heavier in later pregnancy and this may lead to miscarriage. An irregular-shaped uterus can mean that there is not enough room for the baby to grow. Large fibroids may cause miscarriage in later pregnancy.
Is the pre-eclampsia likely to have had any long term effects on my health or caused any lasting damage to my organs? Are there tests that can be done to check that my organs are functioning normally again?
Unfortunatley Pre eclampsia can have long term health effects. Again this is due mainly to the high blood pressure. Blood tests to measure liver & kidney functions are available.
Am I likely to now suffer with high blood pressure later in life? Has my risk of heart disease or stroke now increased?
There is research to suggest this yes. Each persons ‘risk’ varies so you would need to speak to your health care providers to fully assess your risk.
Although my diet was reasonably healthy before I got pregnant and very healthy while I was pregnant do I need to make changes to it?
A healthy – well balanced diet is all that is needed. Some women need to take a ‘multivitamin’ tablet for use in pregnancy to ‘top up’ their natural supplies. Women with low calcium diets may also benefit from calcium supplements. You need to speak to your doctor about this BEFORE taking supplements.
Although special diets are sometimes publicised, there is no evidence that diets prevent pre-eclampsia.
Could extra scans have picked up a potential problem?
Possibly yes. Although not an exact science, scans are good at detecting potential ‘blood flow’ problems across the placenta. Growth scans are also a good way of measuring baby’s development and created an alert if he was growing too slowly.
Could the fact I had to have a caesarean affect a future pregnancy? Is it likely I’d have to have a caesarean again in any future pregnancy?
It is possible that you would need another Caesarean but this must be decided between you & your care givers. There are different types of caesarean which must be managed differently. Many women are able to deliver vaginally; these are generally termed as VBACs. (Vaginal birth after Caesarean.)
Are there any steps I can take to monitor myself in a future pregnancy, for example can we get hold of the strips that measure protein in urine so I could check this each day?
There is no reason why if you really wanted them, dipsticks could not be provided to add as an additional screening to your routine antenatal care. If using a blood pressure monitor it must be one approved for use in hypertensive pregnancy.
We’re very worried that even with careful monitoring it could still come on as quickly as it did this time.
It is entirely normal to be worried. Our online support group & befriending services can all offer emotional support throughout your pregnancy. They are free services.
Would you recommend buying our own blood pressure monitor or have they been proved to be not very accurate?
Blood pressure monitors in pregnancy can give very inaccurate results. We recommend if you do choose to buy your own machine its worth investing in a product validated for use in hypertensive pregnancy. Those that have not been validated could be very inaccurate meaning your could have a high reading & be worried unnecessarily or more dangerously have a low / normal reading & you be very unwell. If in doubt phone the helpline in the manufacturers leaflet with your machine. To our knowledge, the only validated machine available in the UK market is the Microlife A 3BTO which is available for approx £50
If I have to take medication to try and reduce the risk of pre-eclampsia occurring again what would this be and what side effects might it have for me or the baby?
Aspirin & heparin are the most common medicines used.
They are both ‘anticoagulants’ (anti – clotting, sometimes known as blood thinning) but work in different ways. Heparin involves a daily injection where as aspirin is generally a once a day tablet. They help to make the part of your blood called platelets less sticky. This means your blood is less likely to clot and therefore slip across the placenta more easily.
Aspirin is not generally recommended if you are Asthmatic, have a stomach ulcers or the like or are allergic to any medicine called ‘Non steroidal Anti-Inflammatory Drugs’ This however must be discussed with your doctor as the benefit could outweigh the risk.
Heparin also involves needing frequent blood tests to measure how ‘thin’ your blood is.
Bruising is a common side effect. There is also an associated risk of bleeding. This risk /benefit must be discussed with your doctors.
Both drugs must be used under the strict direction of your doctors.
If I do get pregnant again what should we do as soon as we find out? Should we see our GP and ask for a referral? Could we request that we deal with a particular consultant? Yes to both!
Ideally these conversations should happen before you conceive. This way, when you do feel ready to try again & subsequently fall pregnant, you will know exactly what the plan is and be able to access the right care package for you without delays.
How would a future pregnancy be managed? Would there be a plan put in place as soon as I was pregnant so we knew what to expect at each stage?
Early consultant input is recommended. Consider talking to a Pre Eclampsia Expert.
Use the NICE / PRECOG guidelines as a framework to plan your care.
Possibly the use of aspirin / heparin or for some women, both.
Doppler scans at around 24 weeks to measure blood flow across the placenta can be helpful & regular growth scans.
As you approach the gestation of your last pregnancy, more frequent checks from your Health professional.
Home monitoring equipment in addition to professional check ups.
Access to a Support group / befriending can all help you to enjoy your pregnancy & help you to get the most ‘value’ from your appointments.
I hope this helps but I am sure there will be more questions to follow...