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angieb
Junior Member
US
445 Posts |
 Posted - 11/12/2009 : 3:19:53 PM
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I am so confused. I will talk about this more with the MFM in a couple weeks, but I was hoping to get opinions from the genius members here. :)
I did not have high BP at all throughout my pregnancy (granted, throughout only means until 23 wks.) Even when I was experiencing class I HELLP, my bp wasn't high or even elevated. (I couldn't see the hourly numbers from the bed, but DH was keeping an eagle eye on it because his mom had had a stroke from pre-eclampsia 10+ years ago and so I know if it had been up even the slightest bit he would have been on the doctor.) My doctor confirmed it was never elevated.
I believe they only did dipstick tests on my urine--they asked for a sample and said it was clear and that was it. So I'm not sure how accurate that was, but as far as I know, my urine never had any sign of protein.
So, despite those things, my obgyn keeps saying I had severe pre-eclampsia. I think that in her mind, HELLP= severe pre-eclampsia and so she's basically saying pre-eclampsia instead of HELLP maybe thinking I'll understand her better.
But, does HELLP = severe pre-eclampsia, especially in my case when I don't even meet the diagnosing factors for pre-e?
I know that pre-eclampsia can develop into HELLP,but I don't see how that happened in my case.
I asked her about my bps and the pre-e, and she said that it simply hit my liver first, but if we had waited long enough, my bp would have went crazy and I probably would have came in seizing if I had waited much longer to go in. But, I'm not sure that I really believe that. It's not that I'm questioning that things would have went very, very badly and that it was a good thing we went in and ultimately delivered when we did, but I don't think my bp was a factor. Maybe my liver or placenta would have ruptured, maybe my platelets would have dropped below 47k, but my bp stayed pretty level, always.
When I made my appointment with the MFM, the nurse seemed to consider pre-eclampsia and HELLP two different things, because she asked, "So you had HELLP AND preeclampsia?" and so I wasn't sure what to tell her. (I said that my doctor said I definitely had HELLP and also considered me pre-eclamptic but I never had high bp/protein so I wasn't sure if they would consider it both.)
I realize that for my next pregnancy, I'm much more likely to get preeclampsia than HELLP, statistically, but I'm not sure how my history will factor into it.
On that note, if there is no high blood pressure, isn't the magnesium sulfate unnecessary? (I mean, I understand they were taking all precautions at the time. They were going to make certain not to lose me after we lost our daughter. I'm thinking of more for the future right now, not so much dwelling on the past.) From what I understand, the purpose of magnesium sulfate is to prevent seizures, but the seizures would be caused by high blood pressure. The mag had me so miserable that I could barely hold up my head, I'm pretty sure that if anything, it slowed my levels from recovering, which made my doctor make me stay on it longer.
Anyone have any insight/opinions on this? Thanks! |
Me-26, Him-29
9/28/09-Our angel Olivia Caetlyn was born.
Class I HELLP at 23 + 2 weeks.
PCOS
12/09- TTC again |
Edited by - angieb on 11/12/2009 3:28:22 PM |
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Caryn
Ask the Experienced Moderator
USA
8903 Posts |
Posted - 11/12/2009 : 4:06:45 PM
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What's going on is that our understanding of this syndrome is changing so quickly that the terminology isn't keeping up. :-)
Technically the research definition of preeclampsia is: two readings of either of 140/90 six hours apart, plus a 24-hour proteinuria of +300 mg. Technically HELLP requires Hemolysis, Elevated Liver enzymes (often in the thousands), Low Platelets. IIRC the subclassing of HELLP categories just tracks platelets; platelets below 100K means Class III, below 75K means Class II, below 50K means Class I.
So using those research definitions, you had Class I HELLP but not preeclampsia.
But.
They're tempted to regroup all of these conditions under the umbrella term "maternal-fetal conflict", ie. breakdown of maternal tolerance for the foreign placenta. Some of us lose our tolerance along a particular biochemical pathway that leads to HELLP syndrome first, and some of us lose our tolerance along a particular biochemical pathway that leads to PE first.
The reason they're thinking of it this way has to do with the levels of some soluble factors they find in the maternal bloodstream related to maternal immune tolerance for the foreign, demanding placenta. Relative to the population of normal pregnant women, both HELLP and PE patients have elevated levels of two chemicals: soluble fms-like tyrosine kinase (sFlt-1, or soluble Flt) and soluble endoglin (sEng.) The link in my .sig to the New Yorker article goes into this in a bit more detail as well.
As I understand it all pregnant women have measurably elevated levels of both of these chemical proteins -- pregnancy generally is an inflammatory state -- but the population of women with PE and/or HELLP has levels elevated above normal pregnancy levels. The PE patients have higher sFlt levels than sEng levels, and the HELLP patients have higher sEng levels than sFlt levels.
It's also probably true that once you've hit some quantitative threshold -- sEng above some particular number, for example -- that regardless of the ratio between the two factors, you're a HELLP patient. Or at least this is how I currently understand the explanation of why it is that women with severe PE often progress to HELLP.
As for seizures -- they aren't caused by hypertension. They just accompany it. They're caused by something that goes along with this form of maternal-fetal conflict (IUGR is another likely form of maternal-fetal conflict, hence the discussion about how to change the terminology to reflect this sort!) that we don't entirely understand yet. Something about preeclampsia/HELLP affects the way the brain works leading to seizure, and magnesium sulfate makes seizure less likely, but our Expert clinicians have all treated women who weren't diagnostic but who have seized. So they're pretty aggressive about putting women with severe disease on mag regardless of the type of severe disease they're presenting.
Does that make some sense? It's a *weird* disease. |
Science is getting us closer to finding a cause, and even a cure. 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?
Caryn, 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 |
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angieb
Junior Member
US
445 Posts |
Posted - 11/12/2009 : 4:48:39 PM
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Thank you, that does make a lot of sense. (And I have read that article...and made several other people read it too because it's so informative.)
And also good to know I wasn't needlessly on that crappy mag. |
Me-26, Him-29
9/28/09-Our angel Olivia Caetlyn was born.
Class I HELLP at 23 + 2 weeks.
PCOS
12/09- TTC again |
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HELLP vs. pre-eclampsia
