I forgot about HELLP

[flori]

I've become so absorbed in learning everything I can about PE (symptoms, risk factors, what can/can't help prevent it a second time around) that I forget that I had HELLP. "Atypical" HELLP according to my MFM (no H), but HELLP nonetheless.

Looking back I had the URQ pain from 21w3d. I went to L&D that night because of the pain but after some IV pain meds, it subsided. Doctors originally thought it was a gallstone, which ultrasounds proved I did have. The pain came back once in a while until week 24 when I had a mild form of it daily until it got so severe I had to go back to L&D. I didn't have any swelling or massive weight gain at all, but I did have +2 protein in my urine at 24w6d. Baby came the morning of our 25th week.

So now I'm pouring over stories of people who've had it in subsequent pregnancies and am terrified. I had just gotten used to the idea of everything possibly turning out okay next time, but this monkey wrench is killing me. Now I wonder if I should even worry so much about PE or if I should focus my obsession on HELLP? My hope was born through reading the stories of successful pregnancies following PE, but now I realize that I am not in that group of women. I'm not sure how to handle this.

I guess I just needed to share.

[sam10]

Ahhh, once traumatized by PE/HELLP, it is hard to shake the feeling of fear, worry, and panic. To me it is like looking at it from every angle and re-visiting every angle, and then realizing that there is a whole other side to it! It never seems to stop. Most of the time I am ok, but sometimes it still comes back and creeps up, and hey just having a headache, a normal cold can bring back the fear, and the panic, which is when I need to tell myself, it is just a cold! I am not sure how long it will take not to react in this way, but I have come to accept the fact that it has become part of who I am, for now...

[caryn]

If it makes you feel better, it is rational to focus on PE and not HELLP. Odds are good that if you develop this in subsequent pregnancy it will appear as PE and not HELLP, though of course both are possible. But the odds are in favor of PE.

http://www.preeclampsia.org/forum/viewt ... 19&t=39963
and
http://www.preeclampsia.org/forum/viewt ... ce#p240078

are good if you haven't seen them.

[angieb]

Technically, I only had hellp (normal bp, didn't spill protein that they found), but my doctors still always call it "severe pre-e" most often (which makes me crazy cause I'm a rule following former teacher and the pre-e "diagnostic rules" say that I only had atypical HELLP, not pre-e at all.)

Anyway, in my second pregnancy, even the weird way things went bad the first time, my doctors were still primarily worried about pre-e. So much so that they had me monitoring my bp 3x a day, etc. , but only once or twice ran labs my entire 36 week pregnancy. (The plan was labs as needed, and they weren't needed, though I did ask for them around 26 wks and they came back normal.)

I was really not sure if i should worry more about hellp or pre-e in my second pregnancy, but it turned out neither was an issue.

[flori]

Angie, I've been thinking about how your doctors were primarily concerned with pre-e and I wonder how long I would have stayed pregnant if it wasn't for HELLP. Do doctors try to push it and let you stay preeclamptic if it means keeping baby in longer?

I know my protein was 300ish around 24 weeks but my bp was controlled (finally) with TONS of medication (Methyldopa, Labetalol). I did not have any swelling. Afterwards I couldn't grasp why the kept saying preeclampsia to me when I didn't have high bp at the time (except when I was in surgery, it skyrocketed). My MFM actually decreased my bp meds and had me run hypertensive in hopes that it would help Gracie with growth. Maybe they just interchanged the terms? I'm confused.

Bleh. I'm overthinking, I suppose.

[caryn]

They'd probably call that PE - because your pressures *were* up, just controlled with medication - with "superimposed HELLP" on top of it. If PE patients stay pregnant for a while past diagnosis, a fairly large percentage of them will go on to develop HELLP in addition to the PE. So when severe PE patients are hospitalized to be pushed as far as possible, they usually end up running labs frequently to watch for those indicators in the bloodwork.

Some docs won't use bp medication at all, on the grounds that it could "mask" the onset of preeclampsia. But if they remember that you're on meds and correct for that fact, they will start to call you a PE patient once you start spilling protein because you'd clearly be hypertensive without those meds.

This condition can be talked about a few different ways, and none of them are really satisfactory. Some people will say that there are a lot of different diseases under the "preeclampsia" umbrella, because there are different functions breaking at different times and different types of onset and different courses for the illness to follow - HELLP patients look very different from postpartum PE patients from early onset IUGR and PE patients. Some people will say that all the different diseases belong under the "preeclampsia" umbrella, because they all stem from some breakdown of the mother's tolerance for hosting a foreign organ, or from the need to grow a baby large enough to survive but small enough to fit out. Some people just end up with the diagnosis "gestational hypertension" because it's clearly correct, but there wasn't time to run a 24 hour catch, and so even if she technically had preeclampsia that data will never end up in a study of PE!