Study note
Obstetrics & GynecologyHypertensive Disorders in Pregnancy

HELLP syndrome: presentation, management and complications

THE CONTEXT
HELLP syndrome is a complication of pre-eclampsia that may occur even without maternal hypertension.

Clinical and laboratory findings

•
Microangiopathic hemolytic anemia is the hallmark of HELLP syndrome. The passage reports HELLP in 10–15% of pre-eclampsia cases.
•
Manifestations include nausea, vomiting and epigastric or right upper quadrant pain, accompanied by biochemical and hematological abnormalities.
•
Peripheral blood smear abnormalities include schistocytosis and burr cells.
•
Liver parenchymal necrosis produces elevated hepatic enzymes: AST and ALT above 70 IU/L, LDH above 600 IU/L, and bilirubin above 1.2 mg/dL.
•
Subcapsular liver hematoma can be diagnosed by CT scan. Liver rupture may cause hemoperitoneum and sudden hypotension.

Management and monitoring

•
Management follows the principles used for pre-eclampsia and eclampsia. Magnesium sulfate is started for antiseizure prophylaxis, and maternal and fetal assessment is followed by delivery.
•
Corticosteroids improve maternal and perinatal outcomes. Cesarean section is the common mode of delivery.
•
The passage states that epidural anesthesia can be used safely when the platelet count exceeds 70,000/mm³, and platelet transfusion should be given when the count is below 50,000/mm³.
•
Intensive care management continues until platelet count, urine output, blood pressure and liver enzymes improve.
•
Selective expectant management before 34 weeks has included bed rest, plasma volume expansion with 5–25% albumin, antithrombotic agents, steroids and fresh frozen plasma.
•
Multiorgan dysfunction requires urgent delivery. The reported recurrence risk is 3–19%.

Maternal and perinatal complications

•
Maternal complications include abruptio placentae, DIC, acute renal failure, severe ascites, pulmonary edema, pleural effusions, cerebral and laryngeal edema, stroke, retinal detachment, subcapsular liver hematoma, infarction, ARDS, sepsis and death.
•
The passage reports DIC in 15% and pulmonary edema in 8%. It also reports perinatal mortality of 5–60% and maternal mortality potentially reaching 25%.
•
Perinatal morbidity and mortality increase because of preterm delivery, prematurity, RDS and sepsis.
Explore this chapter
NEETx
Learn. Practise. Remember.
HomeSubjectsPapersStudy notesQuick quiz