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atypical preeclampsia

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atypical preeclampsia

Postby expert@preeclampsia.org » Tue Jan 30, 2007 10:33 am

by expert@preeclampsia.org (322 Posts), Tue Jan 30, 2007 10:33 am

Background:

1st pregnancy: lost 30 pounds, diagnosed with hyperemesis gravidium, gained less than half back, monitored fairly closely. Poor stress tests at 36-37 weeks showing contractions, bloodwork indicated obstetric cholestasis. I was induced at 37 weeks and a few days, baby was fine and HG went away immediately. Aside from the HG, I felt fine, no blood pressure or swelling issues.

2nd pregnancy: HG again, was much better managed with hydration and zofran, lost minimal weight. Same contractions as before but more noticible since I was watching for it. Bloodwork was monitored intermittently, began seeing the peri frequently due to the contractions. Ultrasounds showed normal baby growth, low amnio fluid (dehydration the cause?), but no cervical change so I was taken off bedrest at 31 weeks and a few days. Bloodpressure was fine. Had another blood draw on my way out the door, I felt fine, great really compared to the HG, so I went shopping.

Peri got the bloodwork, massively elevated liver enzymes. I was hospitalized on mag, got the steroid injections, and delivered 36 hours later by c-section. Baby was 4 lbs 11oz, 32 weeks on schedule, no problems. Minor O2 support and sent home in 8 days. I swelled horribly AFTER the delivery, and bp went up high, something like 150/110. I was still discharged in 3 days like normal, no medications or concerns. It eventually went down as did the swelling. The diagnosis for this round was atypical pre-eclampsia.

In reading your forums, FAQs, etc, I'll believe the atypical part. Does this really sounds like pre-e to you, some strange form of HELLP without the hemolysis and low platelet, obstetric cholestasis? The peri obviously felt it was life threatening to go the mag and delivery at 32 week route, but, I FELT FINE. Not that anyone wanted to listen to me :)

I would really like to have another child, but I want to make sure I, and my peri, make the decision as informed and prepared as possible. I wish I had my actual lab results to share, but in general does this sound like anything you have heard before?
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Re : atypical preeclampsia

Postby expert@preeclampsia.org » Tue Jan 30, 2007 10:34 am

by expert@preeclampsia.org (322 Posts), Tue Jan 30, 2007 10:34 am

This is certainly within the SYNDROME of preeclampsia. To me, massive elevation in LFT's is in the 1000's. This in isolation is somewhat unusual for preeclampsia. What was your bilirubin? Was your blood glucose ever low? The most unusual part of your case is the first pregnancy without preeclampsia and preterm preeclampsia in the second. One of the best predictors of being "safe" from preeclampsia is a normal first pregnancy. This raises some questions:

• How many years between pregnancies? Cardiovascular risks increase with age as will the risk for preeclampsia.
• What might have changed in your health status? chronic hypertension? autoimmune disease? thyroid disease? A normal first pregnancy suggests that something changed changed.

I would want to know if the hypertension has clearly resolved, if proteinuria is present (24 hour urine), autoimmune disease work-up.

Yes, you do have a risk of preeclampsia with the next pregnancy. SOme of the sources of the risk may be identifiable and treatable. (eg, Htn, hyperthyroidism)
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