HELLP moms

kelly321

Have any of you had a discussion with your doctors about what sort of monitoring will be done in subsequent pregnancies? Or for those who had HELLP and have already had another pregnancy- what sort of monitoring was done?

I'm now pregnant with my 2nd (well, my 2nd pregnancy was a m/c, so this is the 3rd pregnancy), and because I'm out of the country, I'll see my OB for the first time at 17 weeks (I'm getting prenatal care now, just not with him). I remember him saying that he would start doing doppler ultrasounds around 16 weeks and then more often if it looked like there was a reason for concern (I assume cord notching?). What else are your doctors doing / will they do? 

I'm thinking about asking him whether we can monitor my platelets / liver enzymes on a regular basis so we maybe get a heads up when or if the numbers start to move towards HELLP. Have any of you had that done?

Is there any other kind of monitoring I should be asking about?

lwmooney87

I didn't have HELLP ( to my knowledge) but I did have severe pre-e and my platelets were starting to drop when I delivered at 29w1d.

I just recently saw a MFM (high risk OB) to discuss risks for a future pregnancy and their plan for any future prenatal care. They said that I would see only them (MFM) and I would have appts every 2 weeks until 20 weeks and then every week. I would have frequent 24 urine proteins done and NSTs and growth ultrasounds monthly. They want me to take a baby aspirin daily and I may even have to have blood thinner injections daily. I think the monitoring is pretty similar with HELLP. (to my knowledge) I would imagine that you would have frequent visits, blood draws to check liver function and platelets and frequent growth scans to check for IUGR.

Have you seen a MFM? That would definitely be the direction I would be heading if I were you, at least for a consult. I think obviously the sooner the better if possible.

Good luck and congrats on your pregnancy!

kelly321

Thanks! Since I'm currently in the US but usually live in Germany, I'm sort in limbo with my care. I'm seeing an OB here in the States, but only until 17 weeks, when I fly back and go to my regular OB. I think he'll probably send me to an MFM at the university hospital in the town where I live, but I hadn't gotten to talk to him in detail yet about the treatment. So I will be getting on that as soon as I get back, but until then am just waiting things out.

damabo80

I had a liver baseline test earlier (16w? 20w?) something like that. 

Starting at 28w, I have weekly appointments and a biophysical ultrasound where they check placenta, growth, cord flow of the baby.

Im also on lovenox (for a separate issue), but that is also one of the first line defense drugs of HELLP.

And of course, I'm on strict orders to call my dr immediately if I start to get any symptoms of HELLP coming back. 

damabo80

Oh, one more thing:

My anatomy scan was done at the Mfm office. They checked for uterine notching (which is an indicator of pre-e/HELLP to come). I had it with DD, but not with this current pg. 

kelly321

Both of you have mentioned Lovenox. What I don't understand is that Lovenox is contraindicated by low platelet counts. From their website:

LOVENOX? should not be used in patients who are actively bleeding or who have a low count of blood cells called platelets, which aid in clotting. 

So why would it be given as prevention for HELLP? I guess I don't understand why they would give you a drug to lower your platelet count to counteract a syndrome that lowers your platelet count. Aren't you then just starting out with a lower count to begin with, thereby making the HELLP progress faster?

And my doctor did talk about u/s checking for notching. Like I said - this will all be discussed in more detail when I finally see him in 4.5 weeks, but I wanted to prepare myself for what monitoring I should be asking for if he doesn't think of it on his own.

ShanaNChris

Just lurking from TTGP (with #3).

I had HELLP with my first pregnancy and was really concerned about another baby and actually met with the MFM before we decided to have another. 

Basically I was totally monitored. Bloodwork right away to have baseline everything in my chart. Blood work done routinely during pregnancy (platelets, liver enzymes, uric acid, etc.). I had lots of ultrasounds to look for IUGR again. Just tons of monitoring. 

I wrote in my blog about the plan from the get-go to get me further along for the 2nd pregnancy.

I did not have pre-e or HELLP the 2nd time around. Just bedrest started at 32 weeks and I delivered at 39 weeks.

Good luck! I wish you a very healthy pregnancy.