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Tiny Tip: HELLP Syndrome

If you encounter a pregnant woman with hypertension in the emergency department, be on the look out for signs of haemolysis (the peripheral blood smear and elevated LDH are your clues), elevated AST and ALT, and thrombocytopaenia. Clinical symptoms of acute hypertensive disease, including epigastric or right upper quadrant pain, headache, paraesthesias, and blurred vision may contribute to the clinical picture. Prolonged prothrombin time and low fibrinogen level are indicators of severity, and uric acid is used as an adjunct used for diagnosis in some centers. The only cure for HELLP syndrome is delivery, but patients may be temporized with fluids, antihypertensive agents, and platelet…

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 Preeclampsia & HELLP

HELLP is a manifestation of preeclampsia (not a separate disorder). It's a thrombotic microangiopathy which may be closely related to atypical hemolytic uremic syndrome. HELLP is a subset of preeclampsia. Therefore, patients with HELLP also have preeclampsia. Magnesium infusion is indicated in HELLP syndrome, as these patients are at risk for seizure. If hypertension is present, it should be treated in the same fashion as preeclampsia in general.

Articles of Interest

A Case Report on Managing Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP Syndrome) During a Rapid Response Code

The common differential diagnoses for HELLP syndrome include fatty liver of pregnancy, thrombotic thrombocytopenic purpura, pregnancy-related hemolytic uremic syndrome, and systemic lupus erythematosus.

Diagnosis of HELLP Syndrome: A 10-Year Survey in a Perinatology Centre

It is evident that the wide variety of possible clinical presentations of HELLP syndrome makes the clinical symptoms unreliable diagnostic criteria. Not only is it difficult to assess whether the severity of the patient’s condition can be predicted based on their subjective complaints, HELLP syndrome in its clinical presentation is similar to other conditions, such as benign thrombocytopenia of pregnancy, acute fatty liver of pregnancy, viral hepatitis, and others.

HELLP Syndrome

There is clear overlap between pre-eclampsia and HELLP syndrome, and it is unclear whether the latter is a primary or secondary disease process.

HELLP Syndrome - Podcast

HELLP syndrome - Another great masquerader that requires a high suspicion for diagnosis. Check out the show notes and listen to the podcast.

HELLP Syndrome: Recognition and Perinatal Management

HELLP, a syndrome characterized by hemolysis, elevated liver enzyme levels and a low platelet count, is an obstetric complication that is frequently misdiagnosed at initial presentation. Many investigators consider the syndrome to be a variant of preeclampsia, but it may be a separate entity.

HELLP!!! Pregnancy Complications in the Postpartum Period

Also on the spectrum of pre-eclampsia/eclampsia is hemolysis, elevated liver enzymes, and low platelet count — or what is more commonly called HELLP syndrome. It too can present in the postpartum period, typically 48 hours to 7 days after delivery, and can be seen in women who had uncomplicated, normotensive pregnancies. These patients may be asymptomatic with abnormal labs or present with right upper quadrant pain (secondary to periportal or subcapsular hemorrhage) and other nonspecific symptoms, like nausea and malaise.

Intensive Care Unit issues in eclampsia and HELLP syndrome

HELLP syndrome is a life-threatening condition frequently associated with severe preeclampsia-eclampsia and is characterized by three hallmark features of hemolysis, elevated liver enzymes and low platelets.

Modified Mississippi protocol for HELLP/partial HELLP syndrome occurring in the periviable period: A report of three cases

The only definitive treatment for HELLP syndrome is termination of pregnancy. However, an obstetrician will face the dilemma of decision-making regarding the optimal timing for delivery of the foetus and the placenta in the management of HELLP syndrome remote from term, especially in the periviable period.

Preeclampsia, Eclampsia & HELLP – Treatment

Seizure Prophylaxis - When to start: Any patient with preeclampsia with severe features, HELLP or eclampsia.

The HELLP syndrome: Clinical issues and management. A Review

The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.

The management of preeclampsia complicated by HELLP syndrome

Preeclampsia complicated by HELLP syndrome is one of the causes of maternal mortality. Until recently, all patients with a diagnosis of severe pre-eclampsia/HELLP syndrome were thought to need immediate delivery. Within the last several years, expectant management of such patients has been reported with good success. The goal for managing pre-eclampsia/HELLP syndrome is ultimately to protect the mother and foetus and to prevent disease progression to eclampsia. It is universally agreed that a pregnancy from 32-34 weeks should be delivered. Before 32-34 weeks, expectant management is generally possible in a tertiary referral hospital, to improving the condition of the mother and the foetus with conservative treatment.

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Physiopedia

The presentation can be variable and can include malaise, epigastric and/or right upper quadrant pain, and nausea and vomiting. Some may have non-specific viral-like symptoms. The symptoms continuously progress. Hypertension and proteinuria (classic symptoms of pre-eclampsia) may be absent or slight.