Outcomes after first preg. w/sPE + deliv. before 34 weeks

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midwestmom
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Re: Outcomes after first preg. w/sPE + deliv. before 34 week

Postby midwestmom » Wed Jan 16, 2013 05:09 pm

Caryn,
First of all, I LOVE your descriptions of the complexities of PE. I read your message, and am trying to figure out which "camp" I would fall into - I delivered my son at 29+2 wks from severe PE but no HELLP but a "decent size kiddo" :-) no IUGR.
Thanks Caryn! Lauren :-)
Lauren
Son born by emergency C-section due to severe preeclampsia in August 2009. Born 29wks2days weighing 3lbs, he is a healthy toddler now.

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caryn
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Re: Outcomes after first preg. w/sPE + deliv. before 34 week

Postby caryn » Wed Jan 16, 2013 04:55 pm

This (small) study showed a decrease in hypertensive disorders with conception before 26 months postpartum. That said, I agree with your docs in the case of HELLP - for complex reasons that I will try to explain sensibly. :D

All of these conditions seem to have different progressions and different triggers, but to share a common final pathway. It's beginning to look like some placental bed disorders (preeclampsia with IUGR and late miscarriage when the placenta doesn't take over at the end of the first trimester) are downstream from a shallow implantation caused by an immune response to a foreign placenta, and some placental bed disorders (HELLP or preeclampsia with a fetus that is large for dates) are downstream from an immune response to a foreign placenta that's demanding too much from the mother's metabolism. In either case you get a very annoyed maternal immune system and a lot of other symptoms in common.

So if this holds up: if you had HELLP, and a decent-sized kiddo, you *don't* want to conceive until some of the trophoblast that remodeled the spiral arteries supplying the uterus have died off, postpartum. But if you had PE with a small kiddo, you *do* want to conceive before that trophoblast has died off.

It's all a targeting problem to implant the placenta Just Right, not too hot or too cold. (Do you feel like Mama Bear yet?)
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

LeosMom
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Re: Outcomes after first preg. w/sPE + deliv. before 34 week

Postby LeosMom » Wed Jan 16, 2013 02:34 pm

Hi Caryn,

I'm so confused. Are you saying studies are showing you should have a subsequent pregnancy within two years to minimize risk of recurrence? Because we had consults with two different MFM teams about when to try again, and both advised us to wait two years before trying to conceive again to minimize risk of HELLP recurrence. So that's what we did.

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caryn
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Outcomes after first preg. w/sPE + deliv. before 34 weeks

Postby caryn » Wed Jan 16, 2013 09:23 am

"The only risk factor for recurrent gestational vascular complications in subsequent pregnancy was a long time interval between two pregnancies, with an increased risk in case of delay beyond 26 months."

http://www.ncbi.nlm.nih.gov/pubmed/23313394

Oh look, there's the two-year window again! So the idea is this: the remodeling of the spiral arteries persists to some degree postpartum, and that remodeling makes implantation of subsequent placentas easier. This seems (anecdotally, and in several small studies like this one) to reduce risk of PE/HELLP and other placental bed disorders.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy


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