Preeclampsia: Second Pregnancy Risks (HELLP Syndrome)

HELLP Syndrome

If you had preeclampsia in a previous pregnancy, you are at an increased risk of developing it in future pregnancies. Your degree of risk depends on both the severity and the time when the disorder developed in your first pregnancy. In general, the earlier in the pregnancy you developed preeclampsia and the more severe the disorder, the more likely you are to have it again (see Figure 1).

If you had HELLP syndrome in a previous pregnancy, regardless of the time of onset, your risk for developing HELLP syndrome in future pregnancies is approximately 5%, while your risk for developing preeclampsia is 20%. If you had eclampsia in a previous pregnancy, your risk of developing it again is about 2% and your risk for developing preeclampsia in future pregnancies is 25%. If you had hypertension and abruptio placentae (premature separation of the placenta) in a previous pregnancy, your risk for having this condition again is approximately 10%.

Preventive Measures

To decrease your chances of developing preeclampsia in a second pregnancy, consider the following.

•Before becoming pregnant, ask your doctor to perform a thorough evaluation of your blood pressure and kidney function.
•If you or a close relative had vein or lung blood clots before, ask your doctor about testing you for clotting abnormalities (thrombophilias ). These genetic defects increase your risk for preeclampsia and placental blood clots.
•If you are obese, consider weight loss.. Weight reduction may decrease your risk of developing preeclampsia again.
•If you have insulin-dependent diabetes mellitus, good control of your blood sugars before becoming pregnant and early in pregnancy reduces your risk for having preeclampsia again.

The prevention of preeclampsia has been the focus of multiple clinical trials. The following medications and supplements have been extensively studied for their potential to prevent preeclampsia:

•calcium (for example, Os-Cal);
•fish oil supplements (for example, Promega);
•supplements with vitamins C and E; and
•baby aspirin (for example, Ecotrin Adult Low Strength).

However, large studies have not shown calcium supplementation, baby aspirin, or fish oil supplementation to be beneficial in preventing preeclampsia. Early studies with vitamins C and E show a possible beneficial effect, but larger studies should be conducted before these agents can be broadly recommended. .

The best way to improve the outcome of your pregnancy is to see your doctor regularly. Begin prenatal care at the onset of your pregnancy and keep all your scheduled prenatal visits. Likely, your doctor will obtain baseline blood and urine tests during one of your initial visits. Throughout your pregnancy, these tests may be repeated to aid in early detection of preeclampsia should you develop the condition again. The frequency of prenatal visits may need to be increased.

If you do develop preeclampsia, you and your baby will be monitored regularly. Treatment, which centers on delaying the onset of severe disease and prolonging delivery until fetal maturity, may include daily self-measurement of blood pressure and restricted activity. If there is any change in your condition, you may be hospitalized promptly.

Article source: www.healthline.com

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

How does preeclampsia affect the baby? (HELLP Syndrome)

HELLP Syndrome

HELLP is the medical term for one of the most serious complications of pre-eclampsia, in which there is a combined liver and blood clotting disorder.

H stands for Haemolysis (rupture of the red blood cells);

EL stands for Elevated Liver enzymes in the blood (reflecting liver damage);

LP stands for Low blood levels of Platelets (specialised cells which are vital for normal clotting)

How does preeclampsia affect the baby?

Prematurity

Preeclampsia is responsible for 15% of premature births in the US each year. It is the leading known cause of preterm birth. According to the March of Dimes, in 2001, 476,250 infants were born prematurely…over half from unknown causes. Preeclampsia represents 30% of the known causes of prematurely--or approximately 70,000 premature births.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

What is Preeclampsia? (HELLP Syndrome)

HELLP Syndrome

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms.

Typically, preeclampsia occurs after 20 weeks gestation (in the late 2nd or 3rd trimesters or middle to late pregnancy), though it can occur earlier. Proper prenatal care is essential to diagnose and manage preeclampsia. Preeclampsia, Pregnancy Induced Hypertension (PIH) and toxemia are closely related conditions. HELLP Syndrome and eclampsia are other manifestations of the same syndrome. It is important to note that research shows that more women die from preeclampsia than eclampsia and one is not necessarily more serious than the other.

Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

Preeclampsia and HELLP Syndrome (HELLP Syndrome)

HELLP Syndrome

The etiology and pathogenesis of preeclampsia and HELLP syndrome remain unclear. Some theories center on the explanation that abnormal placentation results in placental ischemia and the production of a circulating toxin that causes endothelial cell injury.[5] The injury is believed to cause vascular constriction within multiple organ systems, activation of the coagulation system, increased capillary permeability, and platelet activation with platelet consumption in the microvasculature, all resulting in hypertension, proteinuria, edema, and thrombocytopenia. Why certain women with severe preeclampsia develop HELLP syndrome is unclear, but it has been postulated that these women may have more endothelial injury with greater activation of the coagulation system. Immunologic factors have also been proposed as the underlying initiator of preeclampsia and HELLP syndrome. Maternal cell-mediated immune response to pregnancy with cytokine-mediated endothelial damage may be an important factor.

HELLP syndrome occurs across all ethnicities, races, socioeconomic classes, and age ranges. It is seen in both primigravidas and multiparous patients. Presenting symptoms include epigastric or right upper quadrant pain (65%), nausea and vomiting (50%), malaise (90%), and nonspecific viral syndrome-like symptoms; some patients may present with hematuria or gastrointestinal bleeding.[3] Hypertension and proteinuria may be absent or only slightly abnormal. The differential diagnosis is vast and includes acute fatty liver of pregnancy, appendicitis, gallbladder disease, gastroenteritis, hemolytic uremic syndrome, hepatic encephalopathy, systemic lupus erythematosus, thrombotic thrombocytopenic purpura, and viral hepatitis.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

HELLP Syndrome Diagnosis (HELLP Syndrome)

Hellp Syndrome

There is also considerable debate regarding the definition, diagnosis, incidence, etiology, and management of HELLP syndrome. It is a multisystem disease that is characterized by microangiopathic hemolytic anemia, hepatic dysfunction, and thrombocytopenia. Sibai estimated it to affect 2% to 20% of patients labeled with severe preeclampsia and 10% of women with eclampsia. It is often insidious in onset and not accompanied by the usual signs of preeclampsia, hypertension, and proteinuria, and therefore is easy to miss in its earlier, milder form. Criteria to establish the diagnosis of HELLP syndrome generally accepted are as follows:

• Hemolysis: abnormal peripheral smear, increased bilirubin <> 600 IU/L;
• Elevated liver enzymes: aspartate aminotransferase (AST) ≥ 72 IU/L, lactate dehydrogenase (LDH) > 600 IU/L; and
• Thrombocytopenia: platelet count <>Hellp Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

Symptoms and Treating of HELLP Syndrome (HELLP Syndrome)

HELLP Syndrome

Symptoms of HELLP Syndrome
HELLP syndrome is often accompanied by a number of different symptoms. It is important that you be aware of these symptoms and seek medical help immediately if you develop any of them. Symptoms include:

• nausea
• vomiting
• severe headaches
• pain in the upper right side of the abdomen, just under the ribs
• edema, or water retention
• high blood pressure
• convulsions
• low blood platelet count
• elevated liver enzyme count

Sometimes the pain caused by HELLP syndrome can be confused with heartburn. If your heartburn does not radiate up your chest or does not subside after taking antacids, visit with your health care provider for an examination.

Treating HELLP Syndrome
There is no easy cure for HELLP syndrome. The only sure way to control the syndrome is by delivering the baby. If your baby is older than 34 weeks, it is likely that she will be delivered immediately, probably by cesarean section. Typically, symptoms disappear within a week of delivery.

If your baby is under 34 weeks and your symptoms are less severe, your health care provider may recommend bed rest and close monitoring until your baby reaches 34 weeks. You may be given medications to control your high blood pressure, along with increased fluids. You may receive intravenous corticosteroids, which will help your baby’s lungs to grow and develop more quickly.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

How Do You Know You Have HELLP Syndrome?

HELLP Syndrome

The symptoms include fatigue, general malaise, pain in the upper right part of the abdomen, nausea, vomiting, headache, blurry vision, and water retention accompanied by excessive weight gain. Some women also have convulsions. Because most of these symptoms are common in a normal pregnancy or mimic other ailments like the flu, HELLP syndrome is difficult to diagnose. Report any seizures, abdominal pain, or flu-like symptoms to your doctor right away.

If your doctor suspects the syndrome, she will order a complete blood count to look for signs of hemolytic anemia and a platelet count. She will also order liver function tests that detect specific enzymes which signal liver damage, and she may order blood-clotting studies.

A number of other diseases that involve blood vessel and clotting abnormalities can be confused with HELLP. These include: systemic lupus erythematosus (SLE); acute fatty liver of pregnancy (AFL); thrombotic thrombocytopenic purpura (TTP); and other collagen vascular diseases.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

Facts About HELLP Syndrome (HELLP Syndrome)

HELLP Syndrome

HELLP syndrome is the medical name given to a serious complication of Pre Eclampsia involving a combination of liver and blood disorders. HELLP stands for H (haemolysis - red blood cell damage); EL (elevated liver enzymes - indicating liver damage); and LP (low platelets in the blood leading to a bleeding tendency). HELLP syndrome may be associated with other signs of Pre Eclampsia, such as high blood pressure, protein in the urine and swelling of the hands, feet or face. However, this is not always the case, and this may make its diagnosis more difficult. Women with HELLP syndrome often complain of a pain in the upper abdomen below the ribs, which is indicative of a tender liver. There may also be heartburn, vomiting and headache. The upper abdominal pain of the HELLP syndrome can be very severe, and is not relieved by simple remedies such as antacids, which would be the case if heartburn, for example, was the cause of the pain. HELLP syndrome symptoms can often be confused with other problems such as gallstones (cholelithiasis), inflammation of the gall bladder (cholecystitis) or liver inflammation (hepatitis).

As with the more typical cases of Pre Eclampsia, HELLP syndrome can arise at any stage during the second half of pregnancy.

The diagnosis of HELLP syndrome can be made by blood tests which examine liver enzymes, red blood cells and platelets. As with typical Pre Eclampsia, delivery is required for cure of the HELLP syndrome,irrespective of the stage of the pregnancy and maturity of the baby. Because the HELLP syndrome can be associated with a bleeding tendency secondary to a deficiency of platelets, it may be necessary to administer platelet transfusions. This may be particularly important before undertaking any surgery, such as a Caesarean section.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

HELLP Syndrome Causes (HELLP Syndrome)

HELLP Syndrome

The etiology and pathogenesis of preeclampsia and HELLP Syndrome remain unclear. Some theories center on the explanation that abnormal placentation results in placental ischemia and the production of a circulating toxin that causes endothelial cell injury.[5] The injury is believed to cause vascular constriction within multiple organ systems, activation of the coagulation system, increased capillary permeability, and platelet activation with platelet consumption in the microvasculature, all resulting in hypertension, proteinuria, edema, and thrombocytopenia. Why certain women with severe preeclampsia develop HELLP Syndrome is unclear, but it has been postulated that these women may have more endothelial injury with greater activation of the coagulation system. Immunologic factors have also been proposed as the underlying initiator of preeclampsia and HELLP Syndrome. Maternal cell-mediated immune response to pregnancy with cytokine-mediated endothelial damage may be an important factor.

HELLP Syndrome occurs across all ethnicities, races, socioeconomic classes, and age ranges. It is seen in both primigravidas and multiparous patients. Presenting symptoms include epigastric or right upper quadrant pain (65%), nausea and vomiting (50%), malaise (90%), and nonspecific viral syndrome-like symptoms; some patients may present with hematuria or gastrointestinal bleeding.[3] Hypertension and proteinuria may be absent or only slightly abnormal. The differential diagnosis is vast and includes acute fatty liver of pregnancy, appendicitis, gallbladder disease, gastroenteritis, hemolytic uremic syndrome, hepatic encephalopathy, systemic lupus erythematosus, thrombotic thrombocytopenic purpura, and viral hepatitis.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

HELLP Syndrome: Etiology and Pathogenesis (HELLP Syndrome)

HELLP Syndrome

The pathogenesis of HELLP Syndrome is not well understood. The findings of this multisystem disease are attributed to abnormal vascular tone, vasospasm and coagulation defects.2 To date, no common precipitating factor has been found. The HELLP Syndrome seems to be the final manifestation of some insult that leads to microvascular endothelial damage and intravascular platelet activation. With platelet activation, thromboxane A and serotonin are released, causing vasospasm, platelet agglutination and aggregation, and further endothelial damage.2 Thus begins a cascade that is only terminated with delivery.

The hemolysis in HELLP Syndrome is a microangiopathic hemolytic anemia. Red blood cells become fragmented as they pass through small blood vessels with endothelial damage and fibrin deposits. The peripheral smear may reveal spherocytes, schistocytes, triangular cells and burr cells. The elevated liver enzyme levels in the syndrome are thought to be secondary to obstruction of hepatic blood flow by fibrin deposits in the sinusoids. This obstruction leads to periportal necrosis and, in severe cases, intrahepatic hemorrhage, subcapsular hematoma formation or hepatic rupture. The thrombocytopenia has been attributed to increased consumption and/or destruction of platelets.

Although some investigators speculate that disseminated intravascular coagulopathy (DIC) is the primary process in HELLP Syndrome, most patients show no abnormalities on coagulation studies. Patients who develop DIC generally do so in the setting of well-developed HELLP syndrome. All patients with HELLP Syndrome may have an underlying coagulopathy that is usually undetectable.

Source

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

HELLP Syndrome Characteristics (HELLP Syndrome)

HELLP Syndrome

HELLP Syndrome characterized by hemolysis, elevated liver enzyme levels and a low platelet count, is an obstetric complication that is frequently misdiagnosed at initial presentation. Many investigators consider the HELLP Syndrome to be a variant of preeclampsia, but it may be a separate entity. The pathogenesis of HELLP Syndrome remains unclear. Early diagnosis is critical because the morbidity and mortality rates associated with the HELLP Syndrome have been reported to be as high as 25 percent. Platelet count appears to be the most reliable indicator of the presence of HELLP Syndrome. The D-dimer test may be a useful tool for the early identification of patients with preeclampsia who may develop severe HELLP Syndrome. The mainstay of therapy is supportive management, including seizure prophylaxis and blood pressure control in patients with hypertension. Women remote from term should be considered for conservative management, whereas those at term should be delivered. Some patients require transfusion of blood products, and most benefit from corticosteroid therapy. Rarely, patients with refractory HELLP Syndrome require plasmapheresis. (Am Fam Physician 1999;60:829-39.)

The acronym HELLP was coined in 1982 to describe a syndrome consisting of hemolysis, elevated liver enzyme levels and low platelet count.1 The syndrome has been considered a variant of preeclampsia, but it can occur on its own or in association with preeclampsia. Pregnancy-induced hypertension, preeclampsia and HELLP Syndrome are related and overlap in their presentations. Because of the serious associated morbidity and mortality, family physicians who provide maternity care need to be aware of HELLP Syndrome so that they can identify it early.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

HELLP Syndrome and Your Pregnancy (HELLP Syndrome)

HELLP Syndrome

How is HELLP syndrome treated?
The main treatment for HELLP is to deliver your baby. This may have to be done before your due date. Most women with this illness start to get better a couple of days after their babies are born. If you aren't too sick, your doctor may wait a few days before delivering your baby. You may have to take a steroid. This medicine helps both you and your baby. If you have bleeding, you may need blood transfusions or other treatments in the hospital. Some women with HELLP syndrome get very sick. Rarely, this illness is fatal.

What can I do to prevent HELLP syndrome?
There is no way to prevent this illness. The best thing you can do is see your doctor regularly and tell your doctor about your symptoms at every prenatal visit. If you have HELLP syndrome during one pregnancy, you can have it again during your next pregnancy. The illness is usually less severe the second time.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

Why is HELLP syndrome a concern?

HELLP syndrome

In addition to the risks of high blood pressure during pregnancy, which include poor blood flow to organs and possible seizures, HELLP syndrome can cause other problems. The breakdown of red blood cells may cause anemia, and blood clotting problems may occur.

A serious blood clotting complication called disseminated intravascular coagulation (DIC) may lead to severe bleeding or hemorrhage. Placental abruption (early detachment of the placenta) may also occur. Pulmonary edema (fluid buildup in the lungs) is also a serious complication.

Severe disease may place the mother and fetus in danger and it may be necessary to deliver the baby early to prevent further complications. Recovery from HELLP syndrome may take several days after delivery. HELLP syndrome is a serious disease and can be life threatening for both mother and her baby.

HELLP syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

What is HELLP syndrome?

HELLP syndrome

HELLP syndrome is a serious complication of severe pregnancy-induced hypertension (high blood pressure problems of pregnancy). It occurs in about 2 percent to 12 percent of women with high blood pressure of pregnancy. It usually develops before delivery, but may occur postpartum (after delivery) as well. HELLP syndrome consists of the following problems:

• hemolysis - red blood cells break down.
• elevated liver enzymes - damage to liver cells cause changes in liver function lab tests.
• low platelets - cells found in the blood that are needed to help the blood to clot in order to control bleeding.

HELLP syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...

HELLP Syndrome Information (Hellp Syndrome)

HELLP Syndrome

HELLP Syndrome basically begins with a client having flu-like symptoms as early as the middle of the second trimester to after the baby is born (about the first week postpartum). Blood pressure and proteinuria, cardinal signs of impending pre-eclampsia, may or may not be present.

Hemolysis may produce symptoms similar to those of anemia or hepatitis.

Elevated Liver Enzymes: HELLP Syndrome impairs liver function; levels may be elevated or may not be affected. These enzymes include aspartate aminotranaminase (AST) and alanine aminotransaminase (ALT)

Right Upper quadrant pain is the result of the obstruction of blood flow in the liver. There may also be hyperbilirubinemia, thus making a misdiagnosis of hepatitis sometimes likely. Other symptoms may include:

• Nausea
• Vomiting
• Headache
• Despondency
• Edema
• Bleeding gums (this is rare)
• Shortness of breath (due to pulmonary edema)
• Decreased placental perfusion
• IUGR (Intrauterine growth retardation of fetus)
• Maternal cerebral edema causing headaches and visual disturbances
• DIC (Disseminated Intravascular Coagulation - a disorder where anticoagulation and procoagulation effects exist at the same time causing an array of physical complications)

HELLP Syndrome may be misdiagnosed as hepatitis, gallbladder disease, idiopathic thrombocytopenic purpura, or thrombotic thrombocytopenic purpura.

HELLP Syndrome

OTHER RELATED INFORMATION

Please LIKE , Tweet , +1 and Share if you like this article...