HeLLP/Pre E/Eclampsia connection

[jennashell]

Reading a lot of these posts, I'm trying to figure out what the connection is or if there is one from hellp to pre e.

I had eclampsia at 29 weeks with baby #1, and was told that my kidneys had started to not function correctly.

Baby #2 I had pre e at 32 weeks and delivered at 36.

Would they have told me if I had hellp too? Does pre e put you more at a risk for hellp or is it something seperate?

[kbielec]

http://en.wikipedia.org/wiki/HELLP_syndrome
Check out the definition...I had hellp and my liver and kidneys started to not function...seems like you may have had it...it should be in your chart - have you ever looked over your records?

[jennashell]

We tried to get my records when I switched ob's, but they had been altered. Would it have shown up in both pregnancies or just the first?

[caryn]

HELLP stands for Hemolysis, Elevated Liver enzymes, Low Platelets, and does not require either a hypertensive blood pressure reading nor protein in the urine. A preeclampsia diagnosis (for research purposes; some people don't get quite these numbers before being treated for preeclampsia) is at two readings of either of 140/90 and a 24-hour proteinuria of 300 mg. Eclampsia is preeclampsia that's progressed to the point where the woman begins seizing. But all are actually the result of issues with implantation of the placenta that result in a maternal immune response to the placenta -- which makes sense when you remember that the placenta is a foreign organ.

Having either PE or HELLP puts you at higher risk to develop hypertensive pregnancy complications in future pregnancies -- which could mean anything from mild gestational hypertension at term to HELLP at 20 weeks gestation. The first one is more common; most women have more severe cases in their first pregnancies and milder cases in subsequent pregnancies.

Everyone's kidneys start to fail with PE -- that's what the proteinuria is measuring -- but HELLP has a distinctive bloodwork signature and a diagnosis does not require kidney complications, although we've several posters here who did develop both conditions simultaneously.

The links in my .sig have a lot more information -- holler if any of this doesn't make sense, because this is a *weird* condition.

[jennashell]

Thanks for the info. I'm going to read it a second time to be sure I've got it. I had at least 15 seizures with baby one. They started in the car, and ended 2 hours later with delivery. I was told my bp was aprox 260/150 when I went into the last seizure. About a month before I felt funny, and had gained 7 lbs in 2 weeks! I had only gained 5 during the whole first 26 weeks. They said my bp was a little high and would be fine. I called a week later and told them I felt sick, they told me to come in next week. I called a few days later and told them something was wrong, that I had this weird feeling that I was going to die. I told them I was nauseous, couldn't see, and had horrible headaches. They told me to come in when I could.

For baby 2 I started to notice it around week 32 and was watched close and put on meds. At week 35 +6 days I had an ultrasound and was told that the baby was not getting better and I would have to deliver within 2 weeks. I went to my doc that afternoon and my bp and protein was up so they took her that afternoon to be sure.

If it is immune related, would that mean my immunity is building up and I would go longer next time? That would be amazing!!!

[caryn]

You don't really build up immunity, but subsequent pregnancies are often easier -- the idea is that the spiral arteries are stretched out by pregnancy, which makes it easier for the placentas in later pregnancies to implant into the uterine lining. :)

[jennashell]

What/Where are the spiral arteries?

[caryn]

They're the ones that supply blood to the placenta, in the uterine lining.

The placenta is half maternal and half fetal -- they all have maternal sides and fetal sides and the tissue looks very different. The cells that come from the blastocyst (the little ball of cells that turns into the placenta and the embryo) do what they call "remodelling" of the spiral arteries, to make them wider and flare them open to supply blood. In preeclampsia this process breaks somehow, and the placenta winds up being shallowly implanted and short of blood.

[jennashell]

Hmm, this makes sense With baby #1, the umbilical cord had dissintegrated. With baby #2 it was really tiny-could that be related? Does excersice help with blood flow? Thanks so much for the info.

[caryn]

I'm not sure if there's a connection specifically to the umbillical cord, but I would think that's totally reasonable, since it's pretty much part of the placenta.

Researchers are still looking at exercise as a therapy -- whether or not getting more exercise before pregnancy, or a certain kind in pregnancy, would help change that immune response at all -- so I'd clear any sort of exercise that you might want to do with your docs. I was walking 4+ miles a day during my PE pregnancy so it wasn't a magic bullet, but any therapies can work just on some people and not on others (which is why it takes so long to figure out whether or not things generally work or not!)