history of HELLP, residual proteinuria, poss. pg.

[expert@preeclampsia.org]

Hi Drs.

I development severe PE with HELLP syndrome at 23+ weeks in my last pregnancy (December 2006). I am still being treated with Natrilix for high blood pressure. My last two urinalysis showed haematuria and proteinuria and I was tested for Lupus but was negative. I Dr has asked that I stay on Natrilix for 3 months and retest. My last 3 BP readings were 116/80, 120/84 and 110/70 (within the last 4 weeks).

My partner and I really wants another child and I am off oral contraceptives. I am now worried that I got pregnant over the weekend and I would like to know the implications for myself and the child if this is so.

I know there is a strong possibilty the PE will return in future pregnancies. How can I have a happy and successful pregnancy this time around?

Awaiting your response

[expert@preeclampsia.org]

As usual this answer is hypothetical as there is little information about this patient other than her recent blood pressures and she reportedly still manifests proteinuria (not quantified), and hematuria.

First this patient definitely requires the services of a physician specialized in high risk pregnancy, preferably a maternal-fetal-medicine expert, but it is also unclear who is evaluating her underlying medical problems. From the limited information it appears she requires evaluation by a nephrologist because of the persistent proteinuria and hematuria , and depending on renal function and other blood tests, further testing might have been in order including a renal biopsy. All this should preferably have taken place before attempting conception.

Second, while it is true that HELLP only recurs in ~5% , this pregnancy is at a higher risk for superimposed preeclampsia because of the suspicion of underlying disease, the persisting hypertension that so far requires antihypertensive control, and we do not know if she was tested for underlying thrombophilias after the last gestation. Still most women would be told that another pregnancy can be undertaken but under an expert’s supervision, This is because even with these multiple risk factors 60-70% or more of such gestations will end with a live birth

Finally, natrilix is a new generation diuretic with very little data in relation to gestation, and would be best replaced (if needed) by one of the thiazides for which there is considerably more pregnancy experience (and many would stop all diuretics).