Post Reply FAQ Members Login

HELLP (or pre-e) and subsequent miscarriage

This section is for discussions with other women who have probably been through the same signs/symptoms that you may be experiencing. Please note, we cannot offer medical advice and encourage members to discuss their concerns with their doctors. New members, come on in and introduce yourself!

HELLP (or pre-e) and subsequent miscarriage

Postby Mari2013 » Thu Jan 02, 2014 02:45 pm

by Mari2013 (24 Posts), Thu Jan 02, 2014 02:45 pm

Hi everyone! I posted a few months ago about TTC after HELLP, which I had and caused me to deliver my daughter at 29 weeks. We consulted with a MFM and decided to try again, adding Lovenox and low dose aspirin. I did get pregnant and unfortunately lost that baby around 15 weeks, discovered at 18.

My OB thinks the miscarriage was due to an immune reaction against the placenta, similar to what started HELLP. She said the response is getting more sensitive and earlier each pregnancy. So she would not recommend a 3rd pregnancy because I could get even more sick or get HELLP or pre-e earlier than 29 weeks.

I am just curious if anyone else had a similar experience or advice with a pregnancy after HELLP or pre-eclampsia? Have you read anything like this anywhere?
Mom to one amazing toddler girl, delivered at 28 weeks due to severe HELLP.
Mari2013
Registered User
 
Posts: 24
Joined: Mon Jun 17, 2013 01:16 pm

Re: HELLP (or pre-e) and subsequent miscarriage

Postby MomTimesThree » Fri Jan 03, 2014 00:13 am

by MomTimesThree (563 Posts), Fri Jan 03, 2014 00:13 am

I'm so sorry to hear of your miscarriage. Besides your history was there a specific reason she thought a autoimmune/placenta issue might be the cause? You might consider following up with the MFM again and reviewing things with them- although I'm guessing this was done already, but double checking that you were checked for autoimmune disorders.

Again, I'm so very sorry for your loss. I hope you receive answers that can help you chart the course ahead.
Lauren
2008-Our Baby Girl, PTL born too early at 30w6d, Fought so hard... Forever Loved & Missed
2010- Lil' Bro, Pre-E at 29 weeks... Induced at 36w6d, Born 37w
2012- Lil' Sis, Super-imposed pre-e at 25 weeks, PTL & GD at 35 weeks, Evicted 36w
MomTimesThree
Forum Moderator
 
Posts: 563
Joined: Sat Feb 11, 2012 08:54 pm

Re: HELLP (or pre-e) and subsequent miscarriage

Postby Mari2013 » Fri Jan 03, 2014 07:02 am

by Mari2013 (24 Posts), Fri Jan 03, 2014 07:02 am

Thanks, Lauren. No autoimmune issues showing up in my blood work. She is going by my history and the timing of the miscarriage
Mom to one amazing toddler girl, delivered at 28 weeks due to severe HELLP.
Mari2013
Registered User
 
Posts: 24
Joined: Mon Jun 17, 2013 01:16 pm

Re: HELLP (or pre-e) and subsequent miscarriage

Postby lemons » Fri Jan 03, 2014 01:33 pm

by lemons (75 Posts), Fri Jan 03, 2014 01:33 pm

First, I am so sorry that you have lost your second child, especially after experiencing HELLP with your first..Just curious if you are seeing an OB or a Maternal Fetal Medicine (MFM) specialist? I believe that there is a second phase of placental invasion that happens at about the time of your miscarriage. Did your physician explain why she thought it was immune related and not a consequence of failed placentation due to another reason? And did you present with physical changes like higher BP, changes in protein excretion , or changes in liver or kidney labs (HELLP labs) during/after your miscarriage? I think I would want to consider all of this in deciding whether or not to consider another pregnancy. It is my personal experience that OBs tend to discourage another pregnancy while MFMs tend to talk about the realities of another pregnancy without giving their own opinion about whether to proceed with one. If you haven't discussed your situation with an MFM, I would highly recommend doing so.

To leave you with a bit of hope, one of our forum members just gave birth to a healthy, full term baby after having severe PE with her first, and a second trimester loss with her second. I will see if she has a minute to chime in.

Good luck in your search for answers and I hope you find peace with whatever decision you make.
Diana, happily married since 2007.
Miscarriage at 10 weeks (June 2009).
DD at 30+0 weeks weighing 2lbs 9oz (October 2010) due to PE and IUGR. Today, a happy and healthy toddler.
lemons
Registered User
 
Posts: 75
Joined: Wed Feb 01, 2012 06:41 pm

Re: HELLP (or pre-e) and subsequent miscarriage

Postby Mari2013 » Fri Jan 03, 2014 03:18 pm

by Mari2013 (24 Posts), Fri Jan 03, 2014 03:18 pm

Thank you, Diana. This discussion was with my OB. I was seeing a MFM during the pregnancy, but we did no follow-up after the miscarriage. I agree that OBs tend to be more conservative. My OB said she is more conservative in her advice than the MFM and RE ( who I also consulted pre- conception) because she is the only who actually has to take care of the patients when they get sick, whereas the specialists do not.

I had no unusual labs, BP, anything to indicate HELLP or pre-e. I had just done a 24 hour urine as a baseline a few weeks before the loss and everything was fine. Her opinion is based solely on the timing of the miscarriage and previous HELLP.

I am going to read about the second stage of the placenta that you mentioned. Thanks for that recommendation, your advice and the inspiring story. Glad to see your daughter is doing well!
Mom to one amazing toddler girl, delivered at 28 weeks due to severe HELLP.
Mari2013
Registered User
 
Posts: 24
Joined: Mon Jun 17, 2013 01:16 pm

Re: HELLP (or pre-e) and subsequent miscarriage

Postby jenh » Fri Jan 03, 2014 07:49 pm

by jenh (117 Posts), Fri Jan 03, 2014 07:49 pm

I can't speak to any specifics for your case, but I can share my own experience. I had severe PE and what I believe was undiagnosed HELLP at 35 weeks with my first child. I had a miscarriage with my second. My third was induced at 37 weeks with mild PE. My fourth was also lost to miscarriage. My fifth/sixth (twins) were born at 36 weeks with moderate PE. Miscarriages can happen to anyone and usually there isn't a known cause. However, many of the things that can predispose a woman to PE/HELLP also predispose to miscarriage. That doesn't mean, though, that you can't have a successful pregnancy.
Jen
Wife to Brett 6/30/02
Mom to Ethne Joy 10/12/03, 35 weeks, severe PE
Mom to Catie Grace 12/8/06, 37 weeks, mild PE
Mom to Riley Faith and Gavin Arthur 7/7/09, 36 weeks, PIH 22 weeks, PE 31 weeks, severe post partum PE
Mom to two angels 12/05 and 7/08
Running a Marathon for the PF: http://www.whatyourunningfor.blogspot.com
jenh
Registered User
 
Posts: 117
Joined: Fri Dec 26, 2008 03:02 pm

Re: HELLP (or pre-e) and subsequent miscarriage

Postby Mari2013 » Sat Jan 04, 2014 08:01 am

by Mari2013 (24 Posts), Sat Jan 04, 2014 08:01 am

Thanks Jen
Mom to one amazing toddler girl, delivered at 28 weeks due to severe HELLP.
Mari2013
Registered User
 
Posts: 24
Joined: Mon Jun 17, 2013 01:16 pm

Re: HELLP (or pre-e) and subsequent miscarriage

Postby caryn » Tue Jan 07, 2014 07:09 pm

by caryn (10111 Posts), Tue Jan 07, 2014 07:09 pm

So, I'm the one with the new daughter delivered at 39 weeks after a couple 12 week miscarriages, a son delivered at 34 weeks after sPE, and a 16 week miscarriage (fetal loss in week 13.) I'm 2 for 5, and this last pregnancy was tightly monitored and very high risk, but we sailed through with only a few complications and none of them required early delivery.

I'm inclined to agree that the balance of evidence in your case suggests that your recent miscarriage was triggered by failure of second-stage arterial invasion, and that is often a result of maternal-fetal conflict over the depth of implantation of the placenta. That's the way I'd explain my most recent 16 week loss. But clearly I don't agree that means it's going to keep happening earlier every time and so you shouldn't get pregnant - first of all, what you *should* do is your decision to make, which will, of course, be informed by input from your care providers, and secondly, interpregnancy interval matters a lot in the absence of underlying medical conditions.

If you have no underlying conditions that have been diagnosed which predispose you to preeclampsia, like chronic hypertension or APS, then it's probably straight-up genetic arguing between you and your partner over how much blood you're going to allow the placenta to draw down. Or so the science is indicating at the moment. An area of the uterus that has recently been remodeled to support a foreign placenta is easier for subsequent placentas to exploit. My m/c was in January and I got pregnant again in April; my daughter was 8 pounds 10 ounces and we were actually worrying about things preeclamptics hardly ever worry about, like my bp dropping too low with the spinal, and whether or not she was macrosomic. My preliminary assumption is that this pregnancy went well because her placenta could jack right into my bloodstream effectively.

I've got links for most or all of this, but I've also got a nursing 1.5 week old so let me know what I can source for you!
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? Lectures from researchers?
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
User avatar
caryn
Forum Moderator
 
Posts: 10111
Joined: Fri Jun 25, 2004 06:36 am

Re: HELLP (or pre-e) and subsequent miscarriage

Postby Mari2013 » Wed Jan 08, 2014 02:42 pm

by Mari2013 (24 Posts), Wed Jan 08, 2014 02:42 pm

Caryn, congratulations on your daughter! Thank you so much for taking the time to respond. After the first pregnancy, I do have chronic hypertension that is well controlled with meds.

Whenever you have a chance, will you please share the link about the failure of the second stage arterial invasion? Again, thank you for sharing your experience.
Mom to one amazing toddler girl, delivered at 28 weeks due to severe HELLP.
Mari2013
Registered User
 
Posts: 24
Joined: Mon Jun 17, 2013 01:16 pm

Re: HELLP (or pre-e) and subsequent miscarriage

Postby caryn » Wed Jan 08, 2014 09:16 pm

by caryn (10111 Posts), Wed Jan 08, 2014 09:16 pm

You know, I'm just not sure what to think about chronic hypertension, either - because technically, I was considered an unmasked chronic due to the length of time my postpartum recovery lasted with Oscar. I was still 160/100 on the max dose of meds at my six week followup and was only able to wean off labetalol four-ish months postpartum, with bp that was borderline high for another year plus.

During my fourth pregnancy, my bp spiked immediately in the fifth week to ~130/85 from ~100/60, and I viewed that as likely an immune response to a foreign placenta. So I wasn't terribly surprised, just sad, when there was no heartbeat at week 16. And then in pregnancy number five, my bp was a steady ~100/60 through week 37…

Here's one of the publicly accessible recent papers on trophoblast invasion. It's ugly reading, very technical, but periodically there are sentences in normal English. :D

http://www.reproduction-online.org/cont ... 3.full.pdf

"Traditionally, a view has been held that a high-resistance pattern in the first trimester represents normal physiology and that it is only when women have a persisting high- resistance pattern beyond the second trimester that it becomes significant or pathological. This tied in with initial theories of two stages of trophoblast invasion and remodelling (Pijnenborg et al. 1983), with an early shallow wave in the first trimester followed by a second wave of deep trophoblast invasion in the second trimester that is completed by 18–20 weeks and leads to the conversion of the uteroplacental circulation into a low-resistance bed. This view has been questioned (Lyall 2002), with suggestion that remodelling progresses as a dynamic and continuous process, which will vary between individuals due to interacting fetal and maternal factors."

I lean "dynamic and continuous" - it's just that you see a point where invasion has begun to deepen into the myometrium sometime after about 10-12 weeks, and it's handy to call that "second-stage invasion." If that doesn't happen normally, the oxygen flow that the fetus needs to establish in the second trimester never really materializes - which is what I assume happened in my fourth pregnancy. (Beautiful first-tri ultrasound, genetically normal fetus.) That's an immune-mediated response, but that's not the same thing as an autoimmune response - and it can vary tremendously depending on the environment, and the environment includes things like how well-controlled your hypertension is, the genes in the placenta, and how recently you've been pregnant/ how exploitable bits of the uterine environment are.

It's a really tricky thing to predict or negotiate - I think of it as a targeting problem (embed juuuust deeply enough) coupled to an arms race (conflict between maternal and paternal genes over depth of embedment.) I got lucky. But we do now have some epidemiological data that suggest you can bias the odds in your favor with a shorter interpregnancy interval. I want to be completely clear that this will not always work - again, I got lucky. But it's a useful thing to know when you are making your decisions about subsequent pregnancies.

I also liked this abstract, but don't read Dutch and need to find a translator: http://www.ncbi.nlm.nih.gov/pubmed/24330800

"Many doctors still tell some patients that a (subsequent) pregnancy is contraindicated. Aside from the fact that the desire to have a (or another) child is often extremely strong, which often results in ignoring the message, this type of advice may have serious negative consequences… Women may postpone a subsequent pregnancy out of fear of preeclampsia, while this in fact increases the recurrence risk."
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? Lectures from researchers?
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
User avatar
caryn
Forum Moderator
 
Posts: 10111
Joined: Fri Jun 25, 2004 06:36 am

Next

Return to Ask the Experienced

Who is online

Users browsing this forum: sam10 and 3 guests