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Preeclampsia Again

After severe pre eclampsia and/or HEELP syndrome

What is the chance of getting HELLP syndrome or preeclampsia AGAIN in the next pregnancy?  The answer is based on a woman’s medical history, some blood tests done when she is Not pregnant and the details of what happened in the previous pregnancy. (HELLP syndrome is: H-hemolysis: breakdown of red blood cells, EL- elevated liver enzymes: liver function, LP-low platelets counts: platelets help the blood clot).

  • There is a 8% chance that Any woman in Any pregnancy may have elevated blood pressure in pregnancy. Elevated blood pressure in pregnancy is above 140 systolic and above 90 diastolic (140/90).
  • There is a 15-25% chance of a woman with elevated blood pressure in pregnancy may develop preeclampsia.
  • There is a great than 10% chance of any woman with a twin pregnancy getting preeclampsia.
  • After HELLP syndrome there is less than 5% chance of getting HELLP again. Published articles suggest a range of 2-19%, but Dr. Baha Sibai says 5%. He is the USA’s #1 expert!
  • A woman who gets HELLP in Not her first pregnancy has a higher chance of getting it again.
  • After HELLP syndrome there is a 20% chance of developing preeclampsia in a next pregnancy. Published articles suggest a range of 16-52%, but Dr. Baha Sibai says 20%.
  • There is a 40% chance of getting preeclampsia again if it developed before 30 weeks of pregnancy in a first pregnancy.

Special Situations

  • Women with diabetes are twice as likely to develop preeclampsia.
  • There is a 20% chance that a woman with hypertension before pregnancy will develop preeclampsia.
  • Women with kidney disease have a greater than 10% chance of getting preeclampsia.

Thrombophilia’s and AntiPhospholipid Antibodies

Thrombophilias (abnormality of blood coagulation) and Antiphospholipid (when your immune system mistakenly attacks some of the normal proteins in your blood) antibodies can cause abnormal blood clotting. These conditions are diagnosed with blood tests. Maternal physiology can affect some of the results, so these tests should be ordered between pregnancies. Abnormalities can cause blood clots in the placenta, blood clots in the mother, and lead to poor fetal growth, fetal death before labor and early onset preeclampsia.

  • Anti thrombin III – (Antithrombin III is a protein in the blood that naturally blocks abnormal blood clots from forming) the MOST thrombogenic. Tests for the gene mutation.
  • Protein C deficiency – should be measured in the Non-pregnant state.
  • Protein S deficiency – should be measured in the Non-pregnant state.
  • Factor V Leiden – A gene test is used to determine whether you have Factor V Leiden, which is a mutation of one of the clotting factors in the blood called factor V (V stands for five)
  • Homocysteine level – Homocysteine is a non-protein α-amino acid.
  • Prothrombin Gene (G20210) – A gene test is used to determine whether you have Prothrombin gene mutation, which is a genetic variant that approximately doubles or triples the risk of forming blood clots in the veins
  • DRVVT – dilute Russel Viper Venom test, looks for a special clotting problem.
  • ACA – Anti Cardiolipin Antibodies (IgG and IgM – which are immunoglobulins)

Blood thinning medication can prevent blood clots, but it does not prevent preeclampsia. Blood thinning medicines include aspirin, heparin shots and warfarin pills. There are “levels” of blood thinning, too: enough to prevent a clot OR enough to dissolve a clot. There are significant risks with blood thinning, so it must be carefully considered.

Prenatal care for women with any of these blood abnormalities is more complex. We do extra monitoring for proper baby growth and well being, blood pressure problems and kidney function.

More about Preeclampsia

Preeclampsia is a complication of pregnancy, diagnosed when high blood pressure is combined with kidney or liver or blood clotting problems.  It can happen any time after 22 weeks, but generally occurs around the due date and onset of labor. Toxemia and PIH are old names for preeclampsia.  Preeclampsia affects pregnant mothers directly, and babies indirectly…[read more]