"...The recurrence rate for HELLP is probably between 10 and 25%..."

Q: Hello. I had a baby at 30w 4d gestation in 2004 due to Class 1 HELLP syndrome, and would like more information regarding HELLP syndrome and risk of recurrence, what tests I need to have done before another pregnancy, etc. I would love to have another baby, but my husband does not - he is afraid for me to go through that again. While our daughter is healthy and happy, he feels like we would be

tempting fate by trying for another baby. We were so incredibly lucky with our daughter, and my recovery. Any information that you could provide would be wonderful. I keep getting conflicting information from my doctors, my daughter's doctors and what I can find online. Thanks.

A: The recurrence rate for HELLP is probably between 10 and 25%.  This does not mean it would necessarily be as early.  You could also get preeclampsia without full-blown HELLP.

There are a range of tests that might be done. I would wait until at least 6-12 months after delivery to do the testing.  These could include:

Assessment of renal function
   * 24 hour urine for creatinine clearance and protein
Assessment of blood pressure
   * attention paid to modest elevations in the context of baseline proteinuria
Assessment of thyroid function
   * for hyper and hypo thyroidism
Assessment for autoimmune disease
   * ANA (antinuclear antibodies)
   * ESR (erythrocyte sedimentation rate)
Assessment of clotting tendencies
   * lupus anticoagulant of particular importance
   * many centers have a thrombophilia screen
Assessment for glucose intolerance (Type II diabetes)
   * 75 g glucose  tolerance test
Assessment of lipid profile
   * cholesterol, LDL, HDL

Not all perinatologists would order all of these.  I would not order all of these in every patient. In general, the list screens for known associations with preeclampsia and adult cardiovascular disease. Some of the tests would result in specific treatment; some would be associated with conditions that are associated with health issues outside pregnancy.

                                       Thomas Easterling M.D.
                                      University of Washington
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