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

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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

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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

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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

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