HELLP Syndrome Diagnosis – A Life-Threatening Variant of Preeclampsia

HELLP Syndrome is a serious, rare condition that left undiagnosed can result in life threatening consequences. Cristie was diagnosed with HELLP in her 38th week of pregnancy.

Dr. James Haley of Cherokee Women’s Health Specialists diagnosed her with HELLP when she was 38 weeks pregnant. A variant of preeclampsia, HELLP can be hard to diagnosis as symptoms are similar to preeclampsia. Thankfully, Dr. Haley recognized the symptoms and took immediate action, which resulted in Cristie delivering a healthy baby boy. If not for the early diagnosis, there may have been a much different outcome.

It all started when Cristie began to feel a dull pain in her abdomen. She suspected it was just indigestion or heartburn. She had no idea that within just a few days, at 38 weeks pregnant, she would be diagnosed with HELLP Syndrome.

Within days, Cristie would undergo two platelet transfusions, a plasma transfusion and deliver her baby boy Jack — with no epidural.

This was Cristie’s second pregnancy, as she and her husband Jason had had a healthy baby girl named Charlotte just two years earlier, after enduring some fertility issues. Other than being diagnosed with gestational diabetes during both pregnancies — which she controlled with her diet and experienced no issues — this second pregnancy was going smoothly, just like her first one.

When she began having upper abdominal pains, she assumed it was just heartburn or indigestion, as it first happened after dinner. However, the pain continued for the next few days, and she started experiencing nausea and fatigue as well.

“Something’s Not Right”

On day four, the pain got so severe, Cristie was reduced to tears. It was a Saturday night and she told her husband that she just knew something wasn’t right, so they called the after-hours number at Cherokee Women’s Health. When she explained the situation, the nurse told her to head to the hospital, as she may be going into labor.

Admitted to the Hospital

Once in Labor and Delivery, Cristie was given antacids and monitored for an hour. At this point, her cervix was only one centimeter dilated.

Dr. James Haley of Cherokee Women’s was on call that night and after evaluating Cristie, decided to admit her. He told her he would give her some time to go into labor on her own, but if she hadn’t progressed by 5 a.m. he would start Pitocin to induce her labor.

An Extremely Low Platelet Count

Cristie had planned on an epidural when the time came, so Dr. Haley ran labs to prepare. One of the items checked were her platelet count. The primary role of platelets is to aid in clot formation to prevent bleeding. Although a woman’s platelet count may drop some during pregnancy, a normal platelet count in the third trimester would be approximately between 150,000 to 300,000.

When they received the results, the nurse told Cristie that she thought there was a mistake because her platelet level was only 46,000. However, her records indicated that all were at normal levels just two weeks prior when she had the test done at the office.

Cristie’s labs were repeated and this time the platelet count was even lower. The tests also revealed that her liver enzymes were very elevated.

Diagnosed with HELLP, a Serious Variant of Preeclampsia

Dr. Haley came in to discuss the results with Cristie and Jason and explained to them that she had developed a condition called HELLP syndrome. HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a life-threatening pregnancy complication that is a very uncommon variant of preeclampsia.

Up until four days before she ended up in the hospital, Cristie had no symptoms. When she did develop symptoms, they were just abdominal pains and nausea. Throughout her pregnancy, she had no abnormal bloodwork either.

Both HELLP and preeclampsia usually occur during the later stages of pregnancy or soon after childbirth. HELLP syndrome is rare, only occurring in approximately 1 to 2 out of 1,000 pregnancies. Early diagnosis is critical because serious illness and even death can occur in about 25% of cases.

HELLP can be difficult to diagnose because of the already existing symptoms of preeclampsia,
such as high blood pressure and loss of protein in the urine.

HELLP Symptoms

Symptoms of HELLP syndrome include:

• Upper right abdominal or midline abdominal pain
• Nausea, vomiting or indigestion with pain after eating
• A headache that won’t go away
• Shoulder pain or pain when breathing deeply, difficulty breathing
• Bleeding
• Changes in vision including blurred vision, seeing double or flashing lights or auras
• Swelling, especially of the face or hands.

An Epidural Was Off the Table

Dr. Haley told Cristie that she would need a platelet transfusion and that an epidural was off the table since her platelets were too low. Dr. Haley then assured her and her husband that he would call the blood bank and set everything up. Between midnight and 5 a.m., Cristie had two platelet transfusions. This brought her platelet level up to a safer level, but still not in the normal range.

It’s Time!

It was important that Cristie deliver soon so she was started on Pitocin later that morning. Dr. Haley had ended his shift, and now Dr. Peahen Gandhi was on call and came in to take over. At 9 a.m. things weren’t progressing enough, so Dr. Gandhi explained to Cristie that she needed to break her water to speed things along. Within 45 minutes baby Jack was born, on Father’s Day! It was a rough 45 minutes though, since Cristie had to deliver naturally. At one point, Cristie told Dr. Gandhi she couldn’t do this and wanted to go home but Dr. Gandhi assured her she could.

Cristie says she screamed so loud during the labor that the nurse from the room next door came over to tell them that her patient had planned to deliver naturally until she heard Cristie, she then changed her mind and requested an epidural!

“Jason was there supporting me, holding my hand and doing what he could, but I couldn’t have done it without Dr. Gandhi. She was everything I needed. She was my birth coach, my doula, my mom figure and my doctor.”

– Christie

Cristie needed further transfusions, and also required continued monitoring of her blood pressure, platelets and assessment of her liver so she stayed in the Labor and Delivery unit for another 24 hours after Jack was born.

After 24 hours, Cristie safely moved to the postpartum area, where she stayed for four more days since her platelet level had to go back to normal before she could be released.

Forever Grateful to Dr. Haley and Dr. Gandhi

Throughout the experience, Jason and Cristie really didn’t grasp how very serious the situation was. Looking back on it now, they realize all that could have happened and are so thankful to Cherokee Women’s Health.

“We are so grateful that Dr. Haley diagnosed me so quickly and then immediately coordinated all that needed to be done. He really set up us for success. And I can’t thank Dr. Gandhi enough for keeping Jack and me safe.”

– Cristie

The family is now healthy, happy and enjoying time together at home, with Charlotte enjoying being a big sister. Cristie sums it up by saying, “Cherokee Women’s Health is the best OB/GYN in Cherokee County. I am forever dedicated to them.”