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 of
preeclampsia, 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 pregnancy.
HELLP Syndrome Definition
The name HELLP stands for:
* H- hemolysis ( breakdown of red blood cells)
* EL- elevated liver enzymes (liver function)
* LP- low platelets counts (platelets help the blood clot)
The HELLP syndrome is a recognized complication of
preeclampsia and eclampsia (toxemia) of pregnancy, occurring in 25%
of these pregnancy.
Common symptoms in women with the HELLP syndrome include a general
feeling of feeling unwell (malaise), nausea and/or vomiting, and pain in
the upper abdomen. Increased fluid in the tissues (edema) is also
frequent. Protein is measurable in the urine of most women with the
HELLP syndrome. Blood pressure may be elevated. Occasionally, coma can
result from seriously low blood sugar (hypoglycemia).
The first order of treatment of HELLP syndrome is management of the
blood clotting issues. Urgent delivery is required if the growth of the
fetus is restricted, Delivery is also required if the syndrome develops
after 34 weeks' gestation, if the fetus' lungs are mature, or if the
mother's health is in jeopardy.
After delivery, the mother's status is monitored closely. The HELLP
syndrome can be complicated by liver rupture, anemia, bleeding, and
death.
The HELLP syndrome can also develop during the early period after
delivery of a baby.
Women with a history of HELLP syndrome are considered at increased risk
for complications in future pregnancies.
Common Misspellings: hellp syndrone
HELLP Syndrome Symptoms
The most common symptoms of HELLP syndrome include:
1) Tiredness
2) Abdominal pain
3) Nausea
4) Vomiting
5) Blood in urine
6) Blood in stools
7) Increase in weight
8) Swelling
9) Cerebral disturbance
10) Pulmonary edema
11) Jaundice
12) Reduced urination
13) High blood pressure
14) Excess protein in urine
15) Low blood platelet level
16) Reduced prothrombin time
17) Headache
18) Blurred vision
19) Malaise
20) Increased liver enzymes
21) Seizure.
HELLP Syndrome Diagnosis
The diagnosis of HELLP syndrome (hemolysis, elevated
liver enzymes, and low platelet count) is based upon the presence of the
characteristic laboratory findings in patients of appropriate
gestational age. Imaging tests, particularly CT or MRI scanning, are
useful when complications such as hepatic infarction, hematoma, or
rupture are suspected.
The diagnosis is established by the presence of
preeclampsia and the following criteria:
1) Microangiopathic hemolytic anemia with characteristic schistocytes on
blood smear
2) Platelet count <100,000 cells/µL
3) Serum lactate dehydrogenase >600 IU/L or total bilirubin >1.2 mg/dL
4) Serum aspartate aminotransferase (AST) >70 IU/L
How is HELLP Syndrome Treated ?
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.
Treatment’s 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 <75,000, general
anesthesia will likely be recommended.
What Causes HELLP Syndrome ?
Doctors are still unclear on what exactly causes HELLP
syndrome. Although it is more common in women who have
preeclampsia or
pregnancy induced hypertension, there are still a number of women who get
it without previously showing signs of preeclampsia.
The following is a list of factors that are believed to increase the risk
of a woman developing HELLP syndrome:
* 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)
What are the Risks and Complications ?
If HELLP syndrome is undiagnosed or untreated, it can
result in life threatening complications for both mother and baby. The
most serious complications and risks of HELLP syndrome include:
* Placental Abruption
* Pulmonary Edema ( fluid buildup in the lungs)
* Diseminated intravascular coagulation (DIC—blood 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.
How can HELLP Syndrome be Prevented ?
Because there is not a known cause for HELLP syndrome, there is also no
identified way to prevent it. Early identification and treatment is the
best way to keep HELLP syndrome from getting serious.
Since HELLP syndrome is believed to be related to preeclampsia, staying
vigilant about diet, exercise and a healthy blood pressure can only help
things!