HELLP Syndrome

What is HELLP Syndrome?

HELLP Syndrome usually occurs during the third trimester, but around a third of cases occur after the baby is born, rarely it can occur before 21 weeks of pregnancy; it is a rare liver and blood clotting disorder that affects around 1 in 125 women during pregnancy or after giving birth. It is a serious and potentially life threatening condition so please contact your care provider if you exhibit the signs or symptoms.

What is HELLP Syndrome?

HELLP stands for:

H – haemolysis (the red blood cells break down)

EL – elevated liver enzymes (proteins) (a high number of enzymes in the liver is a sign of liver damage)

LP – low platelet count (platelets help the blood to clot)

Symptoms of HELLP Syndrome

The symptoms of HELLP Syndrome are very similar to the symptoms observed with pre-eclampsia (the two conditions are often related). You may experience one or more of these symptoms:

  • Headache
  • Nausea/vomiting/indigestion with pain after eating
  • Abdominal or chest tenderness and/or upper right side pain (from liver distention)
  • Shoulder pain
  • Pain when breathing deeply
  • Bleeding
  • Changes in vision
  • Swelling/weight gain

Your midwife or doctor will check for the following signs during your antenatal appointments:

  • High blood pressure
  • Protein in the urine

The most common reason for HELLP becoming fatal is liver rupture or stroke (cerebral oedema or cerebral haemorrhage), which can usually be prevented when caught in time.

How HELLP Syndrome affects babies

If a baby weighs at least two pounds at birth, they have the same survival rate and health outcome of non-HELLP babies of the same size. Unfortunately, the outcome for babies weighing less than two pounds at birth is not as good; these babies may need longer hospital stays and will have a higher chance of needing ventilator care because their lungs did not have enough chance to develop in the womb. Around 1 in 10 babies born to women with HELLP will pass away and this is often link to their prematurity.

Treatment of HELLP Syndrome

With treatment, the mortality rate of women with HELLP Syndrome is around 1 in 100, although complications can occur in about 1 in 4 women. The only way to treat the condition is for the baby to be born as soon as possible. Many women suffering from HELLP syndrome will also require a transfusion of some form of blood product (red cells, platelets or plasma).

What can I do to prevent HELLP Syndrome?

Unfortunately, there’s currently no way to prevent this illness. Things that could help to make sure it’s diagnosed early are:

  • Regular antenatal check-ups during pregnancy
  • Inform your midwife about any previous high-risk pregnancies or family history of HELLP Syndrome, pre-eclampsia, or other hypertensive disorders
  • Understand the warning signs and talk to your midwife or Doctor immediately
  • Trust yourself when “something just doesn’t feel right”.

Antiphospholipid (Hughes) Syndrome

Antiphospholipid syndrome, also known as Hughes Syndrome, is an autoimmune disorder which causes an increased risk of blood clots. People with this condition are at an increased risk of developing:shutterstock_53224042_height-400.jpg

  • Deep vein thrombosis
  • Arterial thrombosis
  • Blood clots in the brain
  • Pregnant women have an increased risk of miscarriage or stillbirth

What causes antiphospholipid syndrome? 

With antiphospholipid syndrome the immune system attacks healthy tissue; abnormal antibodies are produced which target proteins attached to fat molecules, making the blood more likely to clot.

Diagnosing antiphospholipid syndrome

Blood tests are used to diagnose antiphospholipid syndrome; these tests look for antibodies responsible antiphospholipid syndrome.

How antiphospholipid syndrome is treated

Antiphospholipid syndrome cannot be cured; however, it can be managed successfully. Blood thinning injections, such as fragmin can be self-administered and aspirin can also be taken to help thin the blood. These medications can also improve a pregnant woman’s chance of having a successful preEIS05000.jpggnancy.

Pregnancy 

Antiphospholipid syndrome can cause recurrent miscarriage or stillbirth, as well as other pregnancy complications. At least 15% of recurrent miscarriages occur as a result of antiphospholipid syndrome, and with prompt treatment, the pregnancy success rate has risen from 20% before 1990 to over 80% today.

Pregnant ladies are usually treated daily with low dose (75mg) aspirin, and if a previous loss has occurred in the second or third trimesters they may also be given fragmin injections.

Pregnancies can be affected in a number of ways:

Early pregnancy loss

Most miscarriages occur during the first 13 weeks; antiphospholipid antibodies can cause early miscarriages by preventing the embryo from embedding properly in the womb. Early miscarriages are common, and there are many possible causes. Therefore, women will not be tested for antiphospholipid antibodies until they have three consecutive early miscarriages.

Late pregnancy loss

In most pregnancies foetal death in the second and third trimesters is rare; however, it is strongly associated with antiphospholipid syndrome and therefore women with a late pregnancy loss should be tested for antiphospholipid antibodies. Women with antiphospholipid syndrome can develop clots in the placenta or around the cord which reduces the baby’s oxygen supply.

Pre-eclampsia 

Pre-eclampsia is twice as likely to occur in women with antiphospholipid syndrome.

Intrauterine growth restriction 

Intrauterine growth restriction (IUGR) are babies with a very low birthweight and they usually weigh less than 90% of babies at the same gestational age. With antiphospholipid syndrome the reduced blood flow to the placenta can cause the baby to be small for dates.

Research

What is being done to treat Antiphospholipid (Hughes) Syndrome? And what research is in place to find things to help someone with this condition? I recently came across ‘The London Bridge Hospital’ website, they are a private hospital which specialises in treating Lupus and Hughes syndrome as well as conducting clinical research.

From The London Bridge Hospital website ‘In 1983, our group described a condition in which there was an increased tendency to blood clotting. Such clots can occur at any time, and can affect veins or arteries anywhere in the body. During pregnancy, clotting of the placenta results in a tendency to miscarriage – some women suffering a dozen or more miscarriages before correct diagnosis and treatment. Features include leg and arm clots (DVTs), headache and migraine (leading in some to stroke), memory loss, chest pain, cold circulation. We initially reported the condition in a group of lupus patients but soon recognised that it could occur in individuals without any evidence of lupus’

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Clinical Studies for Antiphospholipid (Hughes) Syndrome Research

Units throughout the world are researching Antiphospholipid Syndrome; The unit at St Thomas’ obtains some funding from the Hughes Syndrome Foundation and publishes up to 40 research papers each yeaaps3r; and The London Bridge hospital is now carrying out studies with groups in America, Argentina, Brazil, France, Italy, Japan, Portugal and Spain. The International Antiphospholipid Syndrome meeting (Dr Hughes first started this in 1985) is now in its 12th meeting, and it attracts up to 1000 doctors and researchers. The discovery of Antiphospholipid Syndrome in obstetrics has meant that the odds of carry a baby to term has increased dramatically; before the discovery patients only had a 20% chance of a successful pregnancy but treatment patients now have an 80% chance.

General treatments

The aim of treatment is to ‘thin’ the bloody so that the tendency to clot is reduced, this is achieved with anticoagulant medication. There are currently three main anticoagulant medications (aspirin, heparin or warfarin) and for most patients one low dose aspirin (75mg) a day is enough to stop the blood from clotting. Heparin (such as Fragmin) is a very effective anticoagulant and is offered in injection form. It cannot be used for long term treatment due to an increased risk of osteoporosis. It is, however, used in some Antiphospholipid Syndrome pregnancies, as warfarin is potentially toxic to the developing baby.

Aspirin 

  • aps5Low dose aspirin (baby aspirin) – at a dose of between 75mg to 100mg a makes the blood platelets less sticky.
  • Side effects are rare (indigestion; allergy especially in asthmatics)
  • Safe in pregnancy

Heparin

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  • Newer “low molecular weight” heparin (such as Fragmin) has replaced older preparations
  • Only available as injection
  • Used to treat thrombosis, prior to warfarin use
  • Safe in pregnancy

Warfarin (Coumadin)

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  • Warfarin is a safe and effective medicine; despite being dismissed as ‘rat poison’ by some journalists
  • Side effects are rare – the only vital issue is to keep the dosage correct
  • The thinning of the blood achieved by warfarin is measured on an ‘International’ scale called ‘INR’ ‘Normal’ is “1” – half thick blood is “2” and one third blood is “3”
  • Not allowed in pregnancy

Placental Abruption

Overview

The placenta is the baby’s lifeline during pregnancy, it’s an organ which grows in the womb and is connected to the baby via the umbilical cord; it provides baby with Oxygen and nutrients which pass from your blood supply into the placenta and are then carried to your baby via the umbilical cord; carbon dioxide and other waste products are also carried away from the baby by the umbilical cord to the placenta and then into your bloodstream for disposal. Hormones produced by the placenta help your baby grow and develop; It offers your baby protection against bacterial infections while in the womb, and towards the end of pregnancy it passes antibodies from you to your baby which should give him or her immunity for about three months after birth. However, it only passes on antibodies that you already have.

In 2013 the NCBI (National Center for Biotechnology Information) published a study which found that placental abruption affects 0.7% – 1% of pregnancies; however, according to Tommy’s it is suspected that this figure may be higher as abruption isn’t always diagnosed. This is a serious condition in which the placenta begins to detach from the uterus, meaning that the baby can become starved of oxygen and nutrients.

Causes and Risk Factors

Very often the cause of abruption is unknown; however, there are factors that can increase the risk. These are:

  • Abdominal trauma – maybe from a fall or a car accident
  • Previous placental abruption
  • High blood pressure
  • Smoking
  • If your waters have broken prematurely
  • Blood-clotting disorders
  • Multiple pregnancy – the delivery of the first baby can cause changes in the uterus that trigger placental abruption before the other baby or babies are delivered.
  • Maternal age – women over 40
  • Using drugs (especially cocaine) in pregnancy
  • Previous caesarean birth
  • History of recurrent miscarriages

Symptoms

Placental abruption occurs most frequently in the last trimester of pregnancy (especially in the last few weeks) and symptoms include:

  • Vaginal bleeding
  • Abdominal pain
  • Back pain
  • Uterine tenderness
  • Rapid uterine contractions, often coming one right after another

Abdominal pain and back pain often begin suddenly and the amount of bleeding can vary. If the blood becomes trapped inside the uterus by the placenta it is also possible to have a severe placental abruption with no visible bleeding. In some cases, placental abruption develops slowly. If this happens, you might notice light, intermittent vaginal bleeding. Your baby might not grow as quickly as expected, and you might have low amniotic fluid (oligohydramnios) or other complications

If you notice any of the symptoms then please get medical help immediately because they may signify an emergency.

Treatment

The treatment for placental abruption will depend on the severity and gestation. Women under 34 weeks with a minor placental abruption are usually monitored closely in hospital, your care provider will ensure that baby is growing correctly, and will also look for any signs of preterm labour. If there is a risk of your baby not growing properly then labour may be induced. If the abruption is more severe, you are losing lots of blood and the baby is in distress or at risk of not growing properly you may need to have your labour induced or have an emergency caesarean.

Complications

Placental abruption can cause life-threatening problems for both mother and baby.

Mother

  • Shock due to blood loss
  • Blood clotting problems (disseminated intravascular coagulation)
  • The need for a blood transfusion
  • Failure of the kidneys or other organs
  • Hysterectomy

Baby

  • Oxygen and nutrient deprivation
  • IUGR
  • Premature birth
  • Stillbirth

The study showed that:

19% of cases were stillborn, 11% of new born baby’s had an apgar score under 7 at 5 minutes, 34% of newborn baby’s had weight less than 2500g (2.5kg or 5lb 8oz) and 40% of newborn babies were admitted to NICU.

Have you suffered with placental abruption? Please feel free to share your story