Hellp Syndrome
Hellp Syndrome
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HELLP Syndrome
HELLP Syndrome is a series of symptoms that make up a syndrome that can affect pregnant women. HELLP syndrome is thought to be a variant ofpreeclampsia, but it may be an entity all on its own. There are still many questions about the serious condition of HELLP syndrome. The cause is still unclear to many doctors and often HELLP syndrome is misdiagnosed. It is believed that HELLP syndrome affects about 0.2 to 0.6 percent of all pregnancies.
H- hemolysis ( breakdown of red blood cells) EL- elevated liver enzymes (liver function) LP- low platelets counts (platelets help the blood clot)
It is often assumed that HELLP Syndrome will always occur in connection with preeclampsia, but there are times when the symptoms of HELLP will occur without a diagnosis of preeclampsia being made. About 4-12% of women with diagnosed preeclampsia will develop HELLP syndrome. Unfortunately since the symptoms of HELLP syndrome may be the first sign of preeclampsia, this is what can often lead to a misdiagnoses. The symptoms of HELLP may cause misdiagnoses of other conditions such as hepatitis, gallbladder disease, or idiopathic/thrombotic thrombocytopenic purpura (ITP, which is a bleeding disorder.)
Headaches Nausea and vomiting that continue to get worse (this may also feel like a serious case of the flu.) Upper right abdominal pain or tenderness Fatigue or malaise
A woman with HELLP may experience other symptoms that often can be attributed to other things such as normal pregnancy concerns or other pregnancy conditions. These symptoms may include:
Visual disturbances High blood pressure Protein in urine Edema (swelling) Severe headaches Bleeding
Abnormal peripheral smear Lacatate dehydrogenase >600 U/L Bilirubin > 1.2 mg/dl
Low Platelets
Platelet count
The treatment of HELLP Syndrome is primarily based on the gestation of the pregnancy, but delivery of the baby is the best way to stop this condition from causing any serious complications for mom and baby. Most symptoms and side effects of HELLP will subside within 2-3 days of delivery. If the pregnancy is less than 34 weeks gestation, doctors usually try to evaluate lung function of baby to see how well delivery would be handled. Treatments that may be used to manage HELLP until baby is delivered include:
Bed rest and admission into a medical facility to be monitored closely Corticosteroid ( to help babies lungs develop more rapidly) Magnesium Sulfate ( to help prevent seizures) Blood transfusion if platelet count gets too low Blood pressure medication Fetal monitoring and tests including biophysical tests, sonograms, non stress tests and fetal movement evaluation
If pregnancy is over 34 weeks gestation or the symptoms of HELLP begin to worsen, delivery is the recommended course of treatment. In the past, Cesarean delivery was the most common way for delivery of babies whose moms were dealing with HELLP syndrome. But it is now recommended that women, who are at least 34 weeks gestation and have a favorable cervix, should be given a trial of labor (TOL). HELLP syndrome does not cause reason for an automatic cesarean and in some situations, operative surgery may cause more complications due to the possibility of blood clotting problems related to low platelet counts. If a cesarean delivery is necessary and the platelet count is
Previous pregnancy with HELLP Syndrome (19-27% chance of recurrence in each pregnancy)
Preeclampsia or pregnancy induced hypertension Women over the age of 25 Caucasian Multiparous (given birth two or more times)
Placental Abruption Pulmonary Edema ( fluid buildup in the lungs) Diseminated intravascular coagulation (DICblood clotting problems that result in hemorrhage) Adult Respiratory distress syndrome (lung failure) Ruptured liver hematoma Acute renal failure Intrauterine Growth restriction (IUGR) Infant respiratory Distress syndrome (lung failure) Blood transfusion
The maternal mortality rate is about 1.1% with HELLP syndrome. The infant morbidity and mortality rate is anywhere from 10-60% depending on many factors such as gestation of pregnancy, severity of symptoms and the promptness of treatment.
Compiled using information from the following sources: American Family Physician (AAFP), http://www.aafp.org/ Childrens Medical Center, http://www.childrens.com/ Danforths Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 16. Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 19. Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 33. [Medline] Martin JN, Rose CH, Briery CM. Understanding and managing HELLP syndrome: The integral role of aggressive glucocorticoids for mother and child. American Journal of Obstetrics and Gynecology. 2006; 195(914-34). [Medline]