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HELLP Syndrome PP?

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HELLP Syndrome PP?

Postby amjon » Sun Aug 04, 2013 06:43 pm

by amjon (62 Posts), Sun Aug 04, 2013 06:43 pm

Has anyone developed HELLP syndrome after the baby was delivered? I delivered my twins at 37 weeks on June 19. At 34 weeks they started really monitoring my BP and I started having chest pain and right sided pain. I was told by my OB that I had acid reflux (without doing any kind of check and dismissing me when I told her the pain felt nothing like heartburn pain, which is what acid reflux essentially is) and the right sided pain was babies. My MFM wanted it checked out, so they ordered blood work which came back okay. They did end up diagnosing chronic hypertension superimposed with pre-e around then from a 24 hour urine that was slightly elevated. The OBs continually ignored me when I told her my BP was high (even as high as 160/110) and that I kept having chest pain. I was in and out of the hospital until my planned 37 week delivery. After delivery I started getting pretty bad headaches (which I rarely have) and more chest pain. I was told over and over again that everything was normal (without doing any kind of check). My OB dismissed me at 3 weeks PP (even though I was extremely high risk) and told me she would see me next year for my pap. I ended up having DH take me to the ER at 6 weeks PP for chest pain. It felt the same as the "acid reflux" the OB told me I had, but wouldn't go away and was more intense that it had been. They ruled out clots in my lungs and cardiac issues, but my liver enzymes came back severely elevated. The doctor was not comfortable sending me home without checking it out, so they did an abdominal U/S which showed both an enlarged, fatty liver and enlarged gallbladder and kidney. After I delivered my daughter (27 week stillborn) my BP shot up PP. I saw a doctor several weeks later that told me he highly suspected I had HELLP syndrome with her, but had most of the issues PP. I am thinking this may be PP HELLP syndrome that started out mild and since it was ignored by the OB has come to the point the my liver is damaged and gallbladder now needs to come out.
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Re: HELLP Syndrome PP?

Postby laney_p » Tue Aug 13, 2013 11:49 am

by laney_p (38 Posts), Tue Aug 13, 2013 11:49 am

HELLP syndrome can, in some rare cases, manifest itself postpartum: I've seen only maybe one or two women come through the Foundation that had it manifest solely postpartum, though a LOT of HELLP cases I have seen that happen near term have consequences for looooong after the delivery process. (Unfortunately, since HELLP is relatively rare, it's harder to aggregate cases!)

It may have been that you had a milder variant of HELLP during your pregnancy, that was sort of masked by your more obvious BP issues, and only manifested itself more severely after delivery. Preeclampsia can manifest up to 6 weeks postpartum, so it stands to reason that your HELLP might have lasted that long as well. Of course, having multiples increases the risk factors for a lot of issues, including preeclampsia and HELLP.

Sorry to hear of all that you are still going through involving your liver and gallbladder, as well as what you have been through in the past with your pregnancies. :( You should definitely check out the Foundation's page about HELLP http://www.preeclampsia.org/health-information/hellp-syndrome and share with your OB if you haven't already. And probably a good idea if you do decide to try again and you haven't already, to consider going to a high-risk specialist and detailing your full history to him or her. The Society of Maternal-Fetal Medicine has a MFM locator on their website if you don't know of one locally: https://www.smfm.org/MFM%20Member%20Locator%20Page.cfm.
Director of Community Relations for the Preeclampsia Foundation
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for more information, please visit www.preeclampsia.org

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Re: HELLP Syndrome PP?

Postby eleni » Sat Aug 17, 2013 12:22 am

by eleni (469 Posts), Sat Aug 17, 2013 12:22 am

Experts who have addressed this in the past have suggested that this is only answered by extensive lab testing. A small portion of HELLP first presents postpartum for the first time; Acute Fatty Liver of Pregnancy (AFLP) usually is a late pregnancy problem that has variable degrees of severity, again scrutiny of lab data is required. HELLP does not usually cause permanent damage to the liver, but we think some patients experience permanent kidney damage - a research question we want to pursue. Women with AFLP have it because of a mitochondrial problem we think is an interaction between the fetus and the mother, and it can take a long time to recover and most do completely. But there are patients who need transplants as well. Most if not all HELLP eventually resolves postpartum once all pregnancy tissue stops functioning, and very few if any have long term residual liver effects. You should get a consult from an informed MFM who still knows something about the M in Maternal-Fetal Medicine who is willing to review this for you.

Best wishes!

Eleni
Eleni Z. Tsigas
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Preeclampsia Foundation

2x PE survivor; 29 week daughter died, 35 week IUGR son made it after 2 weeks of NICU fun; 3rd pregnancy PE-free resulted in strapping 8 pounder son, born at term.
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