From the lab to the delivery room: speedy tests saved Kate and her babies’ lives

It all started with a bad case of heartburn. Kate Kathigitis was 24 weeks pregnant and suffering from terrible acid reflux when she went to her doctor for a check-up. Until then, Kate had enjoyed a smooth pregnancy without any complications.

After pathology tests showed liver inflammation, low platelet count and a large amount of protein in her blood, it was clear to doctors that Kate had HELLP syndrome –  without a moment’s delay she was transferred by ambulance to the Women’s and Children’s Hospital in Adelaide.

HELLP syndrome is a life-threatening pregnancy complication usually considered to be a more serious variation of pre-eclampsia. It normally occurs in the later stages of pregnancy, and sometimes after birth.

HELLP syndrome is named after its characteristics:

H (haemolysis, which is the breaking down of red blood cells)
EL (elevated liver enzymes)
LP (low platelet count)

Platelets are needed for effective clotting of the blood and red blood cells carry oxygen and nutrients to the organs including the brain.

HELLP syndrome places mother and baby at risk. The flow of nutrients to the baby in utero can be affected, meaning the baby’s growth can be delayed. The mother is also at risk of organ damage, liver rupture and stroke.

Most often, the definitive treatment for women with HELLP Syndrome is the delivery of their baby however this was not possible for Kate due to the low platelet count of her blood, preventing it from clotting during birth. The only solution was to monitor her blood for 24 hours which required pathology testing every hour. Thanks to the speedy work of the hospital’s pathology team, her results were ready within 30 minutes.

At one point, Kate’s complications took a turn for the worse; not only was her liver failing but her kidneys were shutting down which led doctors to consider a blood transfusion. Much to everyone’s relief, Kate’s blood platelets eventually returned to a safer level and she was rushed into theatre for an emergency C-section to deliver her son, Theo.

“As soon as Theo was born my condition began to improve. I was admitted to the high-dependency unit while Theo was being monitored in the NICU. Luckily, his signs were good and doctors were confident he was going to make it – and so was I.”

Two years later, Kate was pregnant with her second child. She knew she had a 50/50 chance of developing HELLP syndrome again. At 24 weeks, doctors were performing blood tests every two days. After one of her tests revealed HELLP syndrome, Kate was admitted to hospital within half an hour. A combination of close monitoring, corticosteroids and further tests ensured a safe delivery for Kate’s daughter Tessa. Like her brother, Tessa weighed less than 600 grams, and after 6 months in the NICU, Kate was able to bring her home to meet the family.

Today, Kate enjoys a happy life with her Partner Simon and their three children in Mount Barker, SA. She looks back on her time in hospital with a mixture of awe and gratitude: “I will always be grateful to the amazing pathology teams at the Women’s and Children’s Hospital in Adelaide who saved mine and both my babies’ lives. With my bloods taken hourly in the lead up to both deliveries, pathology was one of the most important factors in the birthing process.”

HELLP syndrome, symptoms and diagnosis

 HELLP syndrome may be associated with other signs of pre-eclampsia, such as high blood pressure, protein in the urine and swelling of the hands, feet or face. However, this is not always the case, and this may make diagnosis more difficult. Women with HELLP syndrome often complain of a pain in the upper abdomen below the ribs, which is indicative of a tender liver. There may also be heartburn, vomiting and headache. The upper abdominal pain of HELLP syndrome can be very severe, and is not relieved by simple remedies such as antacids, which would be the case if heartburn, for example, was the cause of the pain.

The diagnosis of HELLP syndrome can be made by blood tests which examine liver enzymes, red blood cells and platelets. As with typical pre-eclampsia, delivery is required to cure HELLP syndrome, irrespective of the stage of the pregnancy and maturity of the baby.

HELLP syndrome can be associated with a bleeding tendency secondary to a deficiency of platelets, so it may be necessary to administer platelet transfusions. This can be particularly important before undertaking any surgery, such as a Caesarean section.

While this is a very dangerous condition, with early detection via pathology testing and quick treatment, the outcome can be fine for mother and baby.