Thoughts from a Student Midwife

Preeclampsia and HELLP Syndrome

By: Theresa Blahut, Student Midwife, MMCI

The most serious complication of pregnancy-induced hypertension is eclampsia, which is servere preeclampsia complicated by seizures or coma.  Eclampsia occurs in approximately .2% of pregnancies and terminates one in 1,000 pregnancies.  Preeclampsia occurs in approximately five to eight percent of all pregnancies in the United States and is one of the most common causes of perinatal morbidity and mortality resulting in an estimated 35-300 deaths per 1,000 births.

Signs and symptoms of  preeclampsia include:  hypertension (high blood pressure) defined as a diastolic blood pressure of at least 90mm Hg or a systolic blood pressure of at least 140 mm Hg; ( these blood pressures must be manifested on at least two occasions six hours or more apart), water retention leading to puffiness of the feet, ankles, hands and face, and protein in the urine.  Preeclampsia is the development of hypertension with proteinuria (presence of 300 mg or more per liter).  This level of proteinuria should produce a 2+ reaction on a standard urine dip stick in at least two random urine  specimens collected six hours or more apart.   Water retention or edema is a generalized accumulation of fluid of greater that 1+ pitting which can result in a weight gain of five pounds or more in one week.

Additional signs and symptoms of severe preeclampsia include; headaches, visual disturbances (blurring or inability to tolerate bright light), lethargy, nausea and vomiting, pain in the right upper abdomen and shortness of breath.  If undiagnosed, preeclampsia can progress to HELLP syndrome and eclampsia.

The HELLP syndrome is seen in up to twelve percent of mothers with preeclamptic symptoms.  HELLP syndrome consists of hemolytic anemia (the H is hemolysis), elevated liver enzymes, and low platelets (HELLP). Hemolysis refers to those broken cells that were damaged when they traveled through the narrow, clogged vessels.

The exact causes of preeclampsia are not known, although some researchers suspect poor nutrition, high body fat, or insufficient blood flow to the uterus as possible causes.  The only cure for preeclampsia and eclampsia is to deliver the baby.  If the baby is not close to term, bed rest and careful observation with a fetal heart rate monitor and frequent ultrasounds may be ordered as well as medicines to lower the blood pressure.