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.

Julie’s baby was overdue. She had high blood pressure which was being monitored by the midwives…

Age at interview 34

Gender Female

Age at diagnosis 32

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Samantha was being monitored for high blood pressure, but also developed headaches and…

Age at interview 32

Gender Female

Age at diagnosis 31

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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.

Helen had a normal pregnancy but her GP was concerned when she started to develop high blood…

Age at interview 31

Gender Female

Age at diagnosis 31

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After a ‘model pregnancy’, Kate developed a pain in her ribs which she thought was indigestion. Her blood pressure went up and she felt swollen, so she went into hospital.

Age at interview 35

Gender Female

Age at diagnosis 34

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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.

Doctors were monitoring Julie’s blood pressure and tried to induce her labour. She describes…

Age at interview 34

Gender Female

Age at diagnosis 32

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Samantha had an emergency caesarean because she had developed pre-eclampsia and very high blood…

Age at interview 32

Gender Female

Age at diagnosis 31

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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.

Helen developed HELLP syndrome and her son was delivered early by caesarean. She and her partner…

Age at interview 31

Gender Female

Age at diagnosis 31

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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.

Kate developed pains in her side and high blood pressure. Doctors diagnosed HELLP syndrome and…

Age at interview 35

Gender Female

Age at diagnosis 34

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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.

Michael and his partner had met doctors and talked through what would happen if their son was…

Age at interview 32

Gender Male

Age at diagnosis 32

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Samantha and her husband appreciated meeting with paediatricians who explained what would happen…

Age at interview 32

Gender Female

Age at diagnosis 31

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Samantha was keen to see her daughter as soon as possible, but had to wait several hours because…

Age at interview 32

Gender Female

Age at diagnosis 31

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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 described the exhaustion of travelling to the hospital every day to visit her son, while…

Age at interview 31

Gender Female

Age at diagnosis 31

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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.

Two years after her first child was born early, when she had pre-eclampsia, Julie now feels ready…

Age at interview 34

Gender Female

Age at diagnosis 32

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Samantha felt her 6-week check with the GP was a bit brief given what she had been through, but…

Age at interview 49

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*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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