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HELLP Syndrome/eclampsia

Last post 09-16-2011 6:31 PM by Aubre. 2 replies.
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  • 09-15-2011 6:10 AM

    HELLP Syndrome/eclampsia

     I just had my first case of HELLP syndrome/eclampsia recently and was wondering if anyone has heard of a similar case.  26 y.o. G 3 P2 with an uneventful birth (20 minutes after I arrived which is par for the course with my Mennonite ladies).  I took no blood pressure at all for this woman during labor or postpartum.  Recovery uneventful.  She later told me she was up to the couch in the living room by lunch time where she ate her lunch and made phone calls telling everyone she never felt better after having a baby & invited her sisters to come over.  At 4 pm I get a call from her sister that she has a severe back ache between her shoulder blades that is getting worse--she can hardly move and is moaning in pain. This from a woman that gave birth a few hours ago without so much as a groan.  I arrive at the house 45 minutes later and she looks terrible, moaning and sweating.  Now the pain has moved to the epigastric area.  No headache, no swelling, no classic signs of preeclampsia other than the epigastric pain.  BP 160/80 (normal for someone in such pain).  I was clueless.  We head off to the ER in my car.  On admission platelets 126,000.  Nine hours after birth, 3 hours after arriving in the ER,  grand mal seizure!  After admission to the ICU, platelets went down as far as 36,000!  Have you ever heard of such a sudden onset of HELLP syndrome?  I keep kicking myself for not doing a BP postpartum, but I keep going back to the one BP I DID take being 160/80, which wasn't even a red flad to me because of her pain level.  When she was discharged from the hospital (by one of the great OB's around here very supportive of home birth) he told her, "I guess you'll be staying with us when you have your next baby."  I can't say as I would be opposed to that, but my patient wants to know if it would be possible to have a home birth.  This is only her 3rd baby, and being Mennonite, it seems she probably wants many more. The research is all over the place about the recurrence of HELLP/eclampsia. 

  • 09-15-2011 6:47 AM In reply to

    Re: HELLP Syndrome/eclampsia

    I had a case that was almost daughter in law.

    First baby, 18 y/o. BPs in the 110/70  range through out pregnancy. She and my son were living with me so I was monitoring her diet, which improved greatly after moving in with me. She woke me up at 8:30 am, complaining of "cramping". Listen to baby, take bp, 110/70, and contractions seem mild so I suggested she go back to bed and try to sleep. I made coffee, checked on her, she was sound asleep at 9 am, snoring, even. At 9:20 I hear her hollering for me, says she feels like pushing, and sure enough, she's complete and +2! baby born at 9:46! Lovely little boy....take  BP about 30 minutes PP, it's 138/86...ok, super fast, intense labour, give her a minute to recover. Baby nurses, placenta delivered, mod blood loss. She says she feels like she's getting a headache..take BP again.....150/ clonus, no swelling, no back or epigastric pain. 1 1/2 hours pp recheck and good lord it's 180/100! Call my back up, bring her in, by the time we get there (20 minutes) her bp is 210/112! She gets admitted to CICU, put on mag sulfate and another medication that I forget but it was a cardiac med, liver enzymes all over the place. She didn't seize (I don't know HOW she didn't have a seizure with those BPs!) Anyway, she ended up staying on CICU for 8 days while they tried to get her BP under control. She was able to pump a wee bit of colostrum and milk when it came in, but the baby was mostlry formula fed for those 8 days. We were all a bit worried she wouldn't  be able to nurse, but when she came home and held him, she began dripping milk. she put him to breast and he latched like a champ...and we threw out the formula when it was clear she had a great supply and he is still nursing at 2 1/2 years.

    I think her baby knew it was about to blow and that's why she had such a fast labour.....get the baby out NOW sort of labour. Her BPs remained high (140/80 range) and she was on medication for about 2 months after the birth when she was able to wean off them and they have remained stable (and normal) since. She is NOT trying to have another baby anytime soon.....she was freaked out by how quickly she got sick afterwards.


  • 09-16-2011 6:31 PM In reply to

    • Aubre
    • Top 25 Contributor
    • Joined on 02-14-2009
    • Posts 75

    Re: HELLP Syndrome/eclampsia

     This is the "scary" (besides the obvious) thing about preeclampsia and HELP syndrome...the sudden, acute onset.  Especially when it is so severe.  I have noticed, after many years as a L&D RN (thankfully that part of my life is over!) that when women have preeclampsia, gestatioanl HTN, etc., they seem to birth relativley quickly.  I think the point about the baby knowing that the time is over is a valid observation.

    Aubre Tompkins, CNM
    Wishing you Shade and Sweetwater
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