Our experience in Mississippi, published approximately 10 years ago by Chris Sullivan and our team in the American Journal of Obstetrics and Gynecology, and recently corroborated in another center (SGI abstract) with similar numbers, is that the recurrence rate for HELLP syndrome is approximately one in four to one in five. The overall recurrence rate of any form of preeclampsia including HELLP was 40% in our experience. Lower numbers were derived by Sibai while in Memphis. Recent work by others investigating patients with acute fatty liver of pregnancy and atypical preeclampsia as HELLP syndrome suggests that there may be a genetic basis to these conditions involving long chain fatty acid synthesis. Whether or not a patient develops these conditions may depend on a number of factors, especially the interaction between fetal cells and the mother's tissues. There have been no studies to investigate how to reduce the risk of recurrence, but excellent nutrition seems reasonable as well as fairly close surveillance of a subsequent pregnancy by the OBGYN or MFM (baseline CBC, liver functions, repeats later in pregnancy if there is a question). Attention to self-monitoring by the patient in the second half of pregnancy is probably a good idea with regard to notifying her physician if she begins to notice a flu-like syndrome, develop GI problems, has nausea and/or vomiting, or experiences epigastric pain. In my experience, starting steroids early in the disease progression of HELLP syndrome improves the disease state and results in better maternal and perinatal outcomes. Of course, it is true that the majority of patients that had HELLP syndrome do not have a recurrence in the next pregnancy.
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