The pandemic further makes it clear who in our “non-system” for “broken health care” receives a higher level of medical care and support, says Dr. med. Joia Crear-Perry, president and founder of the National Birth Equity Collaborative, told SELF.
McIntyre believes that Isaac was inadequately cared for and that she should be alive today. In response to inquiries from SELF, the Montefiore Health System addressing Isaac that HIPAA’s privacy laws prohibited them from commenting on details of Isaac’s case and reiterated a statement released shortly after Isaac’s death: “Ninety-four percent of our shipments are of minority mothers, and Montefiore̵
McIntyre tells SELF that he believes Amber Isaac had HELLP syndrome, a condition the American College of Obstetricians and Gynecologists (ACOG) calls a “medical emergency.” Low platelet counts during pregnancy, which McIntyre said was reported by Isaac, can be benign – but can also be linked to life-threatening conditions like HELLP.
“HELLP syndrome is a disorder characterized by hemolysis, elevated liver enzymes, and low blood platelets, hence the acronym HELLP,” says Dr. med. Brittany Robles to SELF. (Hemolysis is the destruction of red blood cells.)[[[[Editor’s Note: The doctors and other experts cited in this article were not involved in Isaac’s care and speak broadly about the health conditions and problems described in this article.]”It is believed to represent the most severe spectrum of preeclampsia,” explains Dr. Robles. Preeclampsia is a serious pregnancy-related condition that typically develops in the third trimester, according to the US National Library of Medicine. It happens when someone has high blood pressure and damages important organs like the liver or kidneys. Symptoms can include nausea, vomiting, upper abdominal pain, persistent headache, and difficulty breathing, ACOG says. The condition can also be asymptomatic, which makes catching difficult. “Many women have high blood pressure and feel perfectly well,” says Dr. Robles.
According to the ACOG, if preeclampsia is diagnosed before it turns into HELLP syndrome, doctors usually recommend seeing more frequent (weekly or twice weekly) visits, measuring blood pressure at home, and possibly delivering the baby early. If preeclampsia goes undetected or worsens despite medical treatment, the pregnant person may develop “severe characteristics” that suggest she is developing into HELLP syndrome. HELLP moves quickly and treatment options are limited. “If women get HELLP, they can get sick very quickly. They therefore have to be admitted to the hospital and usually have to give birth to a child within a few days, ”says Dr. Alison Stuebe, gynecologist and head of the 4th trimester project SELF. “About 1 in 100 women with HELLP die.”
We still don’t know exactly what the ACOG says is causing the preeclampsia that underlies HELLP syndrome. “The problem is, there are no drugs that we know can stop [HELLP]Mary Jane Minkin, MD, a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale University School of Medicine, tells SELF.
However, doctors can examine signs of HELLP syndrome with management in mind and understand that management can be difficult and depends on a variety of different factors. Experts say that a patient with a low platelet count entering her third trimester of pregnancy should have additional tests and very close monitoring, which McIntyre said was not given by his partner.
When a pregnant person with HELLP syndrome is at least 34 weeks old – Isaac was 34 weeks old at the time of their caesarean section – doctors often recommend having the baby as soon as possible. If it’s earlier than 34 weeks, doctors could try to delay delivery while giving corticosteroids to mature the baby’s lungs, along with medications to lower blood pressure and lower the risk of seizures, according to ACOG.
When it comes to giving birth in these circumstances, a vicious circle plays a role: high blood pressure during pregnancy can increase the risk of needing a caesarean section. However, research has found that having a cesarean delivery – like Isaac’s – may be riskier for people with a low platelet count due to an increased risk of bleeding. Some women with HELLP need a blood transfusion due to excessive bleeding, says Dr. Stuebe.