My rollercoaster adventure with Pre-E/HELLP syndrome
Posted On Tuesday, April 02, 2013 by Courtney
My pregnancy story starts with an emergency cerclage placed at 23 weeks 3 days for an incompetent cervix; almost 5 weeks of subsequent hospital bedrest; and following that, 7 weeks of strict bedrest at home. My story ends with me being induced at 36 weeks and 3 days due to rapid onset of pre-eclampsia and HELLP syndrome and staying 5 days in the hospital due to high blood pressure postpartum.
I have had borderline hypertension since before my pregnancy, with it spiking at doctor's appointments due to my white coat syndrome that would cause me severe anxiety when getting my blood pressure taken. Once I relaxed my blood pressure was about 130/80 usually. So at my twice weekly appointments for fetal monitoring, (I was considered high risk after my cerclage), I was allowed to relax and my blood pressure stayed the same. However, at 35 weeks and 6 days, at the appointment to remove my cerclage, my blood pressure spiked to 160/90. I attributed it to me being nervous about the cerclage removal, but still told my perinatologist that I was nervous about it being so high. After the cerclage was removed and I was exiting the room, my doctor wanted me to give a urine sample then go to fetal monitoring. My blood pressure after relaxing during monitoring was still 140s/90s and there was protein in my urine. Subsequently, blood was taken and I was told to do a 24 hour urine collection. The only real symptom I was having was slight swelling in my feet, which I attributed to normal pregnancy symptoms. I had no pain, no significant weight gain, no headache, nothing. I frequently monitored my blood pressure at home, and noticed while relaxed my blood pressure after being discharged from the hospital was usually 120s/80s but began creeping up to 140s/80s, which prompted me to go to L&D and express my concerns. I was hooked up to the monitor and my blood pressure was taken, and funny enough it was not elevated at all. I was released after spending a couple of hours and nothing appearing wrong.
After my blood work had returned, my OB had mentioned that my platelet counts appeared to be low. Also, I was not told until later, but I had a high number of protein in my urine according to the 24 hour urine collection test. Nevertheless, I was reassured by my OB that the platelets being low might be because they were clumping, which is caused by some solution they use in the tubes that my blood was taken in. My blood was redrawn and I was awaiting results. That night, after being released from L&D and going home to take a nap, I received EIGHT missed phone calls from the perinatologist on call. As I picked up the phone to look at it I received a call again, and the perinatologist told me to urgently go to L&D because my platelets appeared to clump again but be very low. I was to be induced that night at 36 weeks and 3 days. Once admitted to the hospital, I was told that I had developed HELLP syndrome, my platelet count had indeed decreased, and that I would need to get another blood test to see if I can even get an epidural. All the while my blood pressure was being taken and it was consistently 130s/80s. I was started on magnesium sulfate and pitocin while anxiously waiting for the blood work to come back to determine whether I could get an epidural. My platelets by then had dropped to 90, which is a lot lower than 150 which was considered normal. However, I was allowed the epidural and labor progressed, and after 7 hours, my beautiful daughter was born. Unfortunately, the magnesium sulfate I was on to prevent seizures caused me to sleep off and on during labor, and caused my daughter to be born with some difficulty breathing. She, like me, was so out of it she would forget to breathe. She ended up going to NICU, and stayed for 5 days due to developing jaundice as well. She is now 3 weeks old and so far she has had no problems.
For me, postpartum was almost as nerve wrecking as the second and last trimester of pregnancy. I was continued on magnesium sulfate for 48 hours, and my blood pressure appeared to be ok. My liver enzymes were still slightly elevated and my platelet count had decreased slightly according to my OB and my nurse. However, on my 3rd day, my OB discharged me, but my blood pressure was taken one final time, and ended up being 175/90. The nurse who took it had convinced my doctor not to discharge me with such a high blood pressure. Subsequently, my OB changed his mind and decided he wanted me to stay that night. Originally I was unhappy as I was ready to go home, but looking back on it I am so grateful for that nurse. My blood pressure began to stay elevated, even while lying on my left side, which prompted me to stay another additional night. One additional night turned into 2 more nights and my blood pressure could not be brought down. Eventually I was put on a significant dose of blood pressure medication to get it to at least 150/80. Once it did I was discharged. After a trip to urgent care post discharge and a primary care visit, I was prescribed 2 medications, and finally after 3 weeks postpartum, my blood pressure began to stabilize. For the time being, I am still on medication, and I am getting my liver function and platelets checked to make sure there are no more issues with HELLP syndrome. So far so good.
It's extremely scary to think about how much worse things could have gotten, and I'm eternally grateful for both my OB and perinatologist for getting me through such a rollercoaster pregnancy.