Conditions that threaten women’s lives in childbirth & pregnancy

Blood pressure disorders: pre-eclampsia and HELLP

Pregnant women routinely have their blood pressure monitored throughout their pregnancy. Doctors are on the lookout for symptoms of hypertensive (blood pressure) disorders that can sometimes develop during pregnancy. These include pre-eclampsia and HELLP syndrome.

Pre-eclampsia is a condition where women develop high blood pressure, fluid retention (oedema or swelling) and protein in their urine. While mild pre-eclampsia can be monitored with blood pressure and urine tests at regular antenatal appointments or by the GP, more serious cases need to be monitored in the hospital. Treatment focuses on lowering blood pressure but the only way to cure pre-eclampsia, if it is severe, is to deliver the baby. If it is not treated pre-eclampsia can lead to serious complications. Mild pre-eclampsia affects up to 5-10% of pregnancies, severe pre-eclampsia 1% of pregnancies*.
 
HELLP syndrome is a rare complication related to pre-eclampsia. HELLP syndrome is a combined blood clotting and liver disorder that can affect pregnant women. The letters in the name, HELLP, stand for each part of the condition' Haemolysis (red blood cells in the blood break down), EL (elevated or raised liver enzymes) and LP (low number of platelets in the blood, which affects the blood’s ability to clot). The only way to cure the condition is to deliver the baby. The main danger to the baby is if it is premature or if the mother becomes extremely ill. Acute fatty liver of pregnancy is another rare condition related to high blood pressure.
We interviewed several women who experienced severe pre-eclampsia or HELLP syndrome.
 
Symptoms
Doctors or midwives can pick up early signs of pre-eclampsia or HELLP syndrome through monitoring women’s blood pressure and testing for protein in their urine. Sometimes women will be monitored for a while because the longer the pregnancy can continue the better it is for the baby. But if symptoms become severe the baby needs to be delivered quickly for the sake of the mother’s health.
The women we spoke to who developed HELLP syndrome had high blood pressure and doctors also measured their liver functions. These women had their babies early.
Delivering the baby
The women were closely monitored, and if their or their baby’s condition deteriorated, doctors decided that they needed to deliver the baby quickly. Sometimes women became ill very rapidly. Julie was overdue and had started to develop high blood pressure and headaches. She was monitored over a period of 2-3 days. Samantha started to develop high blood pressure when she was 24 weeks pregnant, her baby was born at 29 weeks.
Helen was monitored for a few days as her blood pressure was borderline, before she was admitted to hospital where doctors diagnosed HELLP syndrome. Her baby was delivered early, just under 33 weeks gestation.
If the baby has to be delivered several weeks before the expected birth date, women may feel emotionally unprepared for birth. At 36 weeks, Kate developed high blood pressure and severe pains in her chest and she went to her local hospital where her baby had to be delivered during the early hours of the morning by emergency caesarean. The suddenness of the birth left her feeling “just completely mind blown.” Often women didn’t realise how seriously ill they were.
In some cases, where they had to be delivered early to save their mothers life, babies needed to spend time in special care. Sometimes, if clinicians are aware that the mother’s condition may lead to a premature birth, they are able to prepare parents for their baby needing to be in special care (SCBU). When she was admitted to hospital doctors came to talk to Samantha and her husband about what would happen if their daughter was born at 29 weeks gestation.
Often the mothers who had experienced hypertensive disorders were discharged before their babies. The daily travelling to the hospital and spending hours at their baby’s cot-side was very tiring. Especially as many women were recovering from surgery or severe illness themselves. Some talked about the difficulties of transport, as they often could not drive after surgery. Samantha, whose daughter was born at 29 weeks, took cabs for a few days and then felt strong enough to go on the bus.
Helen, whose baby was in special care for three weeks, decided she needed to be well enough to care for her baby when he did come home, so she spent some of the day at the hospital with her son but not all of it. Making use of the facilities in the parent’s room helped to make her time visiting the hospital less tiring. The night before their baby came home Samantha and her husband stayed in a flat next to the special care unit which was especially for parents.
 
Follow up and future pregnancies
After experiencing a blood pressure disorder in one pregnancy, some women were pleased to have the opportunity to discuss with doctors future pregnancies and the risks of developing the disorder again. Helen had a follow up appointment with a professor of medicine who explained to her the chances of her developing HELLP syndrome again. Samantha, who had pre-eclampsia, was grateful that the consultant invited her to come back and talk to her if she was considering another pregnancy.
*The Oxford Handbook of Obstetrics and Gynaecology, Eds. Collins S, Arulkumaran S, Hayes K, Jackson S, Impey L. 2nd Edition, 2008, OUP, Oxford

Last reviewed April 2016.
Last updated April 2016.

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