chances of death or disability

[expert@preeclampsia.org]

I have a question! I have had severe PE, HELLP, and Eclampsia. My husband and I are trying to make the horrible decision on weather to try again or not. I know that I have a very high risk of developing pe again. But are their any stats on mortality. If I got PE again what would be my chance of me actually dying from this, and or the baby dying directly due to this, not neonatal deaths from prematurity.

Here is a little of my history: I have been tested for all underlying causes and do not have any.

DD born 1/23/2005. I had severe morning sickness, from 6 weeks to 23ish weeks. By five months I had lost 19% of my pre-pregnancy body weight. Then I started gaining weight normally. I had an u/s at 29 weeks and measured at about 28 weeks. I had a lot of swelling until my 33 week appointment. At this appointment I had +2 protein and elevated BP. I was sent to L&D. This was no a Thurs evening, Friday I was about the same. I had another U/S and she had not grown at all, still measured 28-29weeks. Sat morning woke up with the headache, my labs were much worse, my bp were tipping in the 200’s/110’s. They started induction, and mag. She started having decals during delivery, she came about 10min later at 4:20pm that Sun afternoon. She had the cord around her neck twice, and her apgars were 1 and 4. She was 3pds 3onces, and 14 ½ inches. I was on mags post part for 24 hours. I recovered normally, without further complications. My BP was back to normal with in a week.

DS was conceived on April 9th 2006, Had severe morning sickness again from about 6weeks to about 19-20weeks. Lost weight again. At 23 weeks (by my calc’s and 25 weeks says the DR????) I noticed the littlest bit of swelling in my ankles. I rested overnight and the swelling did not go down. I went in to L&D, and my BP was 135/80 (normally 100/60-70). I also had +3 protein. Was on strict bed rest in the hospital. This was on Sunday night. By Monday morning my protein had gone away, and my BP was the same. An u/s was done and He was measuring around 22-23 weeks. I stayed about the same until Wednesday night, except my BP was creeping up 140-160/90-100. My labs were getting worse and I had fluid in my lungs, I had been gaining around 10-13 pds a day. I was being given IV fluids, and was told to drink at least 64 ounces a day, my output went from around 800cc to 400cc to nothing in 8 hour periods. Thurs morning I woke up with the headache at 4:20 am. I was given Tylenol, but didn’t help. I woke up again at 7:30am and was throwing up. I was given fenigren(SP?) to help the throwing up. This was around 9ish. I “fell asleep” and went into grand mal seizures at 9:30am. Med records state that they think this was from a drug reaction not PE but we will never know for sure. I had an E-Csection at 10:32am on Sept 21st 2006. His apgar scores were 4 and 1. He was 1pd 6ouncces and 11 ½ inches. He only lived 27 days due to preemie complications. I came out of my coma early that evening. I was developing HELLP. My BP was still high, 160/90. I was kept on mags and bp meds until the following Mon or 4 days post. Tues day I started passing out, and getting dizzy. My BP had bottomed out and many times could not be found. I was taken off the BP meds. I was having heart palpitations, in fear of more seizures I was put back on mags. The next three days my platelets kept dropping. At one point they were 63000, they could have gotten lower but it was not in my records. On day 8 post my platelets started coming back up. But I was not feeling any better, they check my mag level in my blood and found that I was in a very toxic state from a mags overdose. They stopped that immediately. After two more days of detox, from the mags I was doing a lot better. My BP 6 months out is a little higher then it was 112/75. I had my heart evaluated and it had been damaged, but was told that it should repair itself in six months.

We were told that another pregnancy would kill me. We got a second opinion from a high risk specialist. They said my risk of getting PE again was 50%, and of getting HELLP 2%. No one knows when or how bad. I am willing to risk 50 % for a healthy baby, but not at the risk of my daughter being without a mother, and husband without a wife. What are the chances of this? I know there is always some chance.

Thank You

[expert@preeclampsia.org]

Your chance of getting preeclampsia is quite high. The major risk is have a preterm infant that dies or survives with disability.

The risk of dying is hard to assess. This, in large part is dependent on the care system you are in. In your pregnancy in 2006, you were at risk to die. Your seizure was probably from preeclampsia. In general, I counsel women that I can protect them from the risk of dying - at the expense of delivering a preterm baby. This reassurance is dependent on a care system that is aggressive with medical management of hypertension.

It would be important to have a baby in a level 3 care system getting care from a specialist in maternal fetal medicine. Do you have any hypertension when not pregnant? Do you have any proteinuria when not pregnant?