In honor of my due date and the amazing health of Nugget, I am going to post some of the warning signs that you need to look out for in Preeclampsia and HELLP Syndrome.
Preeclampsia
No Symptoms
Preeclampsia is a serious condition of pregnancy, and can be particularly dangerous because many of the signs are silent while some symptoms resemble “normal” effects of pregnancy on your body. Many women suffering from preeclampsia don’t feel sick, and may be surprised or become frustrated when they are admitted to the hospital or prescribed bed rest since they still feel well.
High blood pressure is an important sign of preeclampsia. The disease is sometimes referred to as a silent killer because most people can’t “feel” their blood pressure going up. As a result, patient awareness of the warning signs is one of the most important tools we have to successfully help women receive the care they need. We encourage you to familiarize yourself with signs and symptoms included here to empower yourself and/or others during pregnancy.
What you can do...
Proper prenatal care is essential so don’t miss your appointments. Weighing in, checking your blood pressure and testing your urine for protein, each important for detecting preeclampsia, should take place at every prenatal visit. Do not be afraid to question your caregiver if any of these tests are omitted.
A good prenatal diet full of vitamins, minerals and the basic food groups are important for any pregnancy, as is reducing consumption of processed foods, refined sugars and caffeine. Eliminating alcohol and any medication not prescribed by a physician is essential. Report all medications prescribed by other doctors to your prenatal care provider so that these products can be checked regarding their safe use during pregnancy. Speak with your health care professional before taking any nutritional supplement – herbal or otherwise. Although there is no evidence that these healthy behaviors and choices impact preeclampsia, they do optimize your health for the best pregnancy possible.
Hypertension (High blood pressure) (CHECK)
High blood pressure is traditionally defined as blood pressure of 140/90 or greater, measured on two separate occasions six hours apart. This is one of the most important indicators that preeclampsia may be developing. However, during pregnancy, a rise in the diastolic (lower number) of 15 degrees or more, or a rise in the systolic (upper number) of 30 degrees or more might be cause for concern, warranting closer observation, even though it is not, by itself, a criterion for preeclampsia. This relative rise may have added significance if you have other symptoms of the disease, as well.
What you can do...
Know your blood pressure prior to pregnancy, particularly if it is normally considered low. Ask, "What is my blood pressure?" during each visit with your health care provider.
You can buy your own blood pressure monitor at most pharmacies, and some of these stores have a monitor available for your use, though these are not always reliable. Keep a log of your blood pressure, taken at the same time each day and in the same position. For accuracy, blood pressure readings should be taken in a sitting position, with the cuff positioned on the left arm at the level of the heart. Share your log with your health care provider at each visit.
If you own your own monitor, have it calibrated with those used in the provider’s office. If you are monitoring your pressures elsewhere, notify your healthcare provider immediately should you find any significant rise.
Please note that home monitors are not always as accurate as those used in clinics or hospitals. Home readings should therefore not replace prenatal visits, nor should a "normal" reading mean you can ignore other symptoms of preeclampsia.
If you are diagnosed with preeclampsia, many health care providers will recommend bed rest, even though evidence has not shown it to make a difference in outcomes. Some believe this helps limit potential stressors that could contribute to elevated blood pressures. During late pregnancy, it may be suggested that you lie on your left side, because lying flat on your back might cause the pregnant uterus (and the weight of the baby) to restrict the vein that supplies the heart. Lying flat on your back may also make it difficult for your kidneys to excrete salt, which could lead to further swelling and also increases in your blood pressure. Health care providers do not always agree on the benefits of lying on one’s side, but there is no evidence of harm.
If you’ve had preeclampsia previously, or if you have chronic high blood pressure, it may be preferable to be cared for by a specialist in high-risk OB, such as a maternal-fetal medicine (MFM) specialist, or when such care is not readily available, to choose a physician who readily consults with such experts or with internists specializing in hypertension during pregnancy. A resource that can help you locate an MFM near you who focuses on care of hypertensive diseases in pregnancy is the Physician Locator tool on the Society for Maternal Fetal Medicine’s website. All these situations are highly variable and are best discussed first with your primary caregiver.
Proteinuria (Protein in your urine) (CHECK—well after 2 24 hour urines)
Proteinuria, another sign of preeclampsia, is the result of proteins, normally confined to the blood by the filtering role of your kidney, spilling into your urine. This is because preeclampsia temporarily damages this “filter.” A simple dipstick test of your urine at each prenatal check-up can screen for proteinuria, though more sophisticated equipment that can be set up in clinics and medical offices may be used in the future.
What you can do...
During each prenatal visit, ask your health care provider for the results of your urine test. A nurse will have dipped a reagent strip into a sample of your urine. A reading of trace protein is relatively common and is usually not a cause for concern. However, if the reading is 1+ or greater, it may signify the onset of preeclampsia, even if your blood pressure is below 140/90. If you are concerned, or have had preeclampsia before, you can buy reagent strips at some pharmacies or online. Should you record a reading of 2+ or greater at home, call your health care provider that very same day.
Sometimes health care providers will have you collect your urine for 24-hours to determine the exact quantity of protein in the urine. While this is not a particularly convenient task, be sure to follow your provider’s directions and make every effort to be accurate.
Dark yellow urine is usually the result of low fluid intake and may be associated with dehydration. However, urine that looks dark, reddish or the color of cola may indicate a problem. If you observe this, contact your health care provider.
Edema (Swelling) (BIG CHECK)
A certain amount of swelling is normal during pregnancy. For example, your feet may swell making it difficult to wear your regular shoes throughout pregnancy. Edema is the accumulation of excess fluid, and is more of concern when it is observed in the face, around the eyes, or hands.
What you can do...
If you feel your face is getting excessively puffy, find a picture of yourself from just before pregnancy to share with your health care provider. If the swelling in your extremities becomes severe, you may notice “pitting edema” (when you press your thumb into your skin, an indentation remains for a few seconds) or discoloration of your legs. If you suspect pitting edema, notify your health care provider, put your feet up every day (but avoid sitting for extended periods).
Dull or severe, throbbing headaches, often described as migraine-like that just won't go away are cause for concern.
What you can do...
If you have tried taking over-the-counter medication without relief, if the headache is very painful, you have light sensitivity, or if your headache is accompanied by vision changes (please read the section below on "Changes in Vision") call your provider immediately and ask to see him/her that day
Nausea or Vomiting (Didn’t realize this was a CHECK until much later.)
Nausea or vomiting is particularly significant when the onset is sudden and after mid-pregnancy. “Morning sickness” should disappear after the first trimester and the sudden appearance of nausea and vomiting after mid pregnancy may be linked to preeclampsia.
What you can do...
Call your care provider. Nausea or vomiting can be confused with the flu or gallbladder problems, so insist on getting your blood pressure checked and checking your urine for proteinuria.
Abdominal (stomach area) and/or Shoulder Pain (This was the biggest warning sign I had toward the end of my pregnancy)
This type of abdominal pain, often called epigastric pain or upper right quadrant (URQ) pain, is usually under the ribs on the right side. It can be confused with heartburn, gallbladder problems, flu, indigestion or pain from the baby kicking. Shoulder pain is often called “referred pain” because it radiates from the liver under the right ribs. Lower back pain is different from muscle strain common to pregnancy, because it is usually more acute and specific. Shoulder pain can feel like someone is deeply pinching you along the bra strap or on your neck, or it can be painful to lie on your right side. All of these pain symptoms may be a sign of HELLP Syndrome or a related problem in the liver.
What you can do...
Pain in this area should be taken very seriously; do not dismiss it and go to bed. Call your health professional immediately.
Lower back pain is a very common complaint of pregnancy. However, sometimes it may indicate a problem with the liver, especially if it accompanies other symptoms of preeclampsia.
What you can do...
Read also Stomach and Right Shoulder Pain (above) and mention this symptom to your health care provider. If this pain accompanies one or more of the other symptoms, you should call your health care provider immediately.
Sudden Weight Gain (Amazingly enough, I didn’t gain a pound while pregnant)
Weight gain of more than 2 pounds in a week may be an indicator of preeclampsia. Damaged blood vessels allow more water to leak into and stay in your body's tissue and not to pass through the kidneys to be excreted.
What you can do...
Do not try to lose weight during pregnancy by restricting your diet. Eating a healthy, balanced diet, including fresh raw fruit and vegetables, your prenatal vitamin, and a folic acid supplement is important for all pregnancies. Avoid excessive salt. Prior to getting pregnant, achieve a healthy weight (a BMI of 30 or less) since obesity has been shown to increase the chances of getting preeclampsia.
Given that preeclampsia is a complex disease, women will develop it for different reasons. A healthy, balanced diet and optimal weight may make a significant difference for some women. However, we urge caution when considering diets designed for weight-loss or claiming to prevent preeclampsia that encourage large amounts of protein. Excessive dietary protein may cause problems in women with underlying kidney disease.
Be sure to drink sufficient amounts of fluid, usually dictated by your normal thirst sensations, and to perform moderate amounts of exercise regularly. During your prenatal visits do not attempt to disguise weight gain by skipping breakfast, using diet pills or fasting for the day. An accurate weight is vital for a proper diagnosis.
The Preeclampsia Foundation recognizes the importance of a good diet, however we do not recommend any particular diet or juice product.
Vision changes are amongst the most serious symptoms of preeclampsia, usually requiring immediate evaluation by a certified health care provider. Changes in vision may be associated with central nervous system irritation, or an indication of cerebral edema (general swelling of the brain). Vision changes include temporary loss of vision, sensations of flashing lights, auras, light sensitivity, and blurry vision or spots.
What you can do...
If you experience any of these changes in vision, you should contact your care provider immediately or go directly to the hospital. We stress that these symptoms are potentially very serious and they should not be left unattended to until the next morning, or particularly not until the end of the weekend. With preeclampsia, it is better to err on the side of caution, than to take a chance that might become life-threatening to you or your baby.
Hyperreflexia (CHECK--- this played a major role later when deciding whether to deliver me or not)
Hyperreflexia is when your reflexes are so strong that when your knee is tapped by a rubber “hammer”, your leg bounces back hard. This sign is generally measured by a health care provider and otherwise difficult for you to observe yourself.
Racing pulse, mental confusion, heightened sense of anxiety, shortness of breath, sense of impending doom (I was in the hospital for 10 days…. OF course I was sensing impending doom)
If these symptoms are new to you, they could indicate an elevated blood pressure, or more rarely, fluid collecting in your lungs (pulmonary edema).
What you can do...
Contact your health care provider if these symptoms are new. If these conditions are not new for you, be sure to mention them to your care provider during your next visit so he/she can monitor them throughout your pregnancy.
When we urge women to trust themselves, we are referring to the intuitive feeling that preeclamptic women often have that “something is not right.” While these feelings may be nothing, it is important for women to report any concerns and for care providers to be diligent, particularly if accompanied by other signs or symptoms.
The most important thing to remember is to never be afraid to call and discuss anything unusual with your caregiver. No matter how busy, he or she does not mind (or should not) being bothered for what at first may seem unimportant. The worst outcomes of preeclampsia are best avoided by early recognition.
HELLP Syndrome
- H -- hemolysis (the breakdown of red blood cells) (CHECK)
- EL -- elevated liver enzymes (CHECK)
- LP -- low platelet count (CHECK)
To make a long story short, these conditions are nothing to mess around with. I almost died, Nugget and I are very lucky to be alive. I want to educate you all in the seriousness of these; I wouldn’t wish what I went through on my worst enemy. Please, if you’re pregnant or are trying to get pregnant, check out these--- not to scare yourself but to educate yourself and know the warning signs. If I had known then what I know now, I don’t know if things would have turned out differently but I would have been better equipped to handle it. Perhaps one day I will go into detail about everything that happened but for right now, I just want everyone who reads or will read my blog to take a moment and educate yourself in these conditions.
Sources: The Preeclampsia Foundation
