HELLP Max make a difference

Post On Wednesday, February 20, 2013 By angela

HELLP Max make a difference

Little did I know that my Thanksgiving break from the last month of nursing school would be spending admitted to the local hospital by my OB doctor. Looking back, fora few days I wasn't feeling well. Friday I had indigestion, so I thought. Saturday and Sunday I didn't feel right, not much of an appetite and I told my family I felt nauseous. Monday, I would get hot on and off and I thought I had heartburn.

The office staff had me go into the office when I called to tell them I was fine, but wanted them to know that yesterday i had the worst "heartburn" ever. I have never had it before so I didn't know what it was suppose to feel like. I told them what I did to try to relieve the pain, by taking tums. When I got in at 7 pm, I took a hot bath, again consumed more tums... and still I didn't feel well. By 9 pm I took ranitidine, the max strength that was on the sheet they gave me of approved meds in the beginning of my pregnancy to take at home.

I waited for it to kick in and it didn't resolve the pain I had under my sternum that was heartburn. I took more tums, another hot bath and at 10:30pm still was in pain. I managed through it, and at 3:30 am when I was getting ready to go to the E.R. fell asleep next to my 2 year old when she called, out of pure exhaustion and tears. I woke up and went along with my day feeling okay... I went in at 1:30pm to see the doctors. The medical assistant took my urine, BP and rechecked my BP. It was 160/118 with a 2+ of protein in my urine. 2 or more BP readings of 140/90 with protein in the urine classify preeclampsia as mild. Severe preeclampsia is labeled as 2 BP readings of 160/110.

She put me in a room and had me lay on my left side on the table while I waited another 5 mins so she could re-check my BP. The doctor came in and asked if I would drive across the street to the hospital because she wanted to monitor me since my BP was extremely high for myself. It usually runs about 90/60. Along with the protein in the urine this could be a sign of preeclampsia, even though I didn't fit the classic signs of being a first time mom, or having a new dad, being in the third trimester, or having it before. Yes , I had stress from school, but I didn't think anything more than similar work stress... they asked if I was having headaches, or had changes with my vision. No. I would have never thought it was my blood pressure. I felt... not 100% but, I figured it was from being tired from staying up studying and also taking care of the other children at home.

My husband left work to meet me as everything hit home really fast. He asked why I needed to go to the hospital and I told him what they suspected. He wondered what that meant, and as I looked it up on Google in my cell phone, I couldn't bring myself to tell him " it's fatal". I just said its "not good" and didn't want to scare him. I was trying to stay mainly in work mode, and not personal mode, so I didn't freak out. Overall, I was always very healthy, I get a cold now and then, but have no health problems, diseases,or disorders. I'm 5'0" tall and normally weigh about 105. My pregnancy weight right now was 112 and they say the baby is normal size and I'm doing good. We heard the heart beat at the office visit.

The nursing staff were getting me settled in at the hospital. They were very calm and professional while taking my urine, getting vital signs, and waiting for the doctor. The phlebotomist came to draw my blood. An ultrasound tech came in to check my gallbladder. I could hear my wonderful doctor outside my door informing staff that I had always been healthy and had never had a blood pressure problem. As my doctors did many tests to rule out things, they collected my urine for 24 hours, as it had protein in it, a +3; did a gallbladder ultrasound that came back negative for gallstones, took my blood pressure every 15 mins, started me on protonix, labetalol,and dilaudid, and drew labwork to test my ALT,AST ,BMP and infused 2 bags of lactated ringers.

On 11-20-12
my AST was 49 and high ( enzyme released into blood when the liver or heart are injured )
ALT was 33 and normal ( tests liver )
Red blood cell count was 3.59 which was low. ( tests for anemia )
Hemoglobin 11.8 low ( protein that carries oxygen to organs & tissues , shows anemia if low )
Hematocrit was 33.0 was low ( proportion of total blood volume composed of red blood cells )
Platelets were 104 which were low ( measures how many platelets are in blood. helps to clot the blood )

On 11-21-12
AST 45 high
ALT 30 ok
RBC count 3.44 low
Hemoglobin 10.7 low
Hematocrit 30.4 low
Platelets 76 low, with no platelet clumping seen and confirmed with slide estimate.

From the fluids my hands and feet swelled and looked like sausages. I couldn't move my wedding band and it hurt my feet to walk. At one point I know my b/p was 240/180. My liver enzymes were high, and I had low platelets . Along with hemolysis which is the break down of red blood cells they think it might be HELLP syndrome. In the morning, a doctor came in and said they would be transferring me to a high-risk hospital so I could be with specialists that knew more about HELLP syndrome. They also have a level 3 neonatal intensive care unit if needed. She reinterated that I didn't meet typical case guidelines for this syndrome and they were somewhat taken back by it all.

I then was transferred on Wednesday, November 21, 2012 at noon by ambulance with a nurse by side. I was given magnesium sulfate to reduce the risk of seizures from the severe preeclampsia.This made me feel like my whole body was on fire. I was transferred all for a rare life threatening condition known as HELLP syndrome. There were so many people there, including 2 RNs waiting for me. People were drawing blood. Doctors were coming in. I cried while they told me staff members would come in to tell me what to expect with this all with a preemie and if I had questions for them - to ask.

My husband finally arrived and a neonatologist came in to explain what could happen, and how to prepare our selves for the road ahead with health problems and disorders. Things we may need to expect with being under developed, such as immature lungs and eyes. A doctor came in and did an ultrasound of the baby. This showed absent end diastolic flow. This means there is fetal vascular stress and there is placental insufficiency. We were told he wasn't getting appropriate oxygen and nutrients. The baby was positioned in breech footling position. In this position, one or both of the baby's feet point downward and will deliver before the rest of the body so, a C-section was needed. With a classic C-section like I had, I would never be able to have another vaginal birth if more kids were in my future due to the risk of uterine rupture. This is also better, since the stress of labor may not be well tolerated by a baby of 26 weeks gestation. Once they decided I would immediately have a C-section, I called my mom and started crying, she came right away to be with me. She had an idea of what to expect because my mom had me 3 months early and I was premature. I needed to deliver my son unexpectedly by emergency classic c-section at 26 weeks gestation, to keep us both alive. Prior I was give an intramuscular injection in my gluteus of beta methadone which helps the surfactant, a protein that keeps small air sacs in the lungs from collapsing.

My husband stayed off work the rest of the week to stay with me in the hospital. He was just as scared as I was. He was the best support I could have. This was our family. Our baby, his son that we were preparing to bring into the world way to early. We weren't ready at home with car seats and clothes. He wasn't suppose to come into the world until February 2013, not November 2012. This was something we perfectly planned for February and now our plan was thrown off course and the world had other ideas for my body and baby. The best thing to do would be deliver the baby early, as the placenta was deteriorating because my blood supply was being shunted to my vital organs, and the uterus is not one of them. There is no known origin for HELLP syndrome. Nothing I did caused this. I did everything right and yet this situation was not right. I was ripped off of my pregnancy experience, I wouldn't get to grow a large tummy to cuddle and caress, I wouldn't get to let others feel kicks and punches, I wouldn't get to do pictures and molds like I planned.

I was wheeled back, just like for surgery, they intubated me, and prepared me to cut through my layers of skin and muscles into my warm cozy home of the uterus to remove my baby so I would survive. I felt like I was being crucified, my arms out, my clothes gone, and a sheet pulled up to towards the ceiling below my neck. 2 people were complaining, another 2 people were giggling, while my hair cover slide into my eyes, I was crying and I was alone. My husband was not allowed in with me. My husband tells me they immediately took our baby, our son, over to the children's hospital to be admitted to Neonatal Intensive Care unit. We had no names ready, but decided on Maxwell. He was born November 21, 2013 at 4:58 pm, he weighed 1 pound 8 ounces and was 12 inches long. He was a micro- preemie. He had a head full of black hair. He had respiratory distress syndrome and was given a breathing tube right away. He was small for his gestational age, but still in the normal range.

I wasn't allowed to see Max for 2 days until my blood pressure was improved, I could stand, and I was off of the magnesium sulfate I.V. My husband had seen him, I hadn't. Other guests had already seen, I had not; this was hard to swallow when I watched visitors go down from my mommy and baby room to see my son, when I still had not for the first time yet. Tears would come to my eyes as they left my room to travel the twists and turns to the NICU without me. When I did, I thought I knew what to expect, but I still lost control of my emotions shortly after being able to see my baby in his plastic pod isolette that would be his new womb until he was discharged into my arms. To see him so small, yet so strong amazes me. He breathes so fast, and fights so hard to stay in this world. Things in life are quickly put into perspective of what is important and not important now.

Our son Max, has since than, been taken off of his breathing ventilator, he has also, had a pic line inserted now, has an infection that the doctors can't find the source of, has had 3 attempts of a straight cath's without success, Friday, November 30,2012 had a spinal tap, and Sunday December 2,2012 had a blood transfusion. More blood transfusions have been done since than, he has moved to having his oxygen by nasal cannula. All internal lines have been removed now. He is fed by a tube until he is big enough to suck ,swallow,and breath on his own. He doesn't need any blood pressure meds, heart meds, or other meds. We are lucky, other preemies do. There is no word to when he is coming home. So , our visits consist of driving to Milwaukee and hanging out with him at the hospital while he grows and strengthens to come home.

2weeks after the birth my BP check was 130/90. Still high. 2 weeks after that it was within normal range, but not my normal range. Finally at my last visit the reading was 90/69, my normal. This is good. They say with future births you might have this again. They are still doing research through the Preeclampsia Foundation. So many things are unknown with HELLP syndrome. I was just one of the small percentages to go through it. HELLP syndrome is listed as a "rare disease" by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH). This means that HELLP syndrome, or a subtype of HELLP syndrome, affects less than 200,000 people in the US population.

The brilliant head of high risk OB there suggested still studying since I am different than the typical case, and maybe there is an underlying disease or disorder like lupus that triggered this. Of course, being in healthcare, I will do whatever I can so another family, mom and baby, can learn from this and possibly not have there pregnancy cut short and emotions stirred up. There may be nothing, which we would like, but if there is, we can link things together possibly. My OB doctors have been phenomenal; they didn't think I was crying wolf, had me go right in to check things out. My OB didn't question anything and was on top of all of the signs and sent me to be admitted. The ER doctor was on call at the hospital and was thorough by checking into other possibilities, and the on-call OB was supportive and encouraging by phone as my primary OB over the weekend. Not a lot of people know what HELLP syndrome is. Some professionals don't fully understand it either. If more awareness can be drawn to it and research h and education can be done, we will have a start to reducing morbidity and mortality of babies and moms.

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