HELLP syndrome is a life threatening disorder that occurs in pregnancy. It affects about 1 percent of all pregnancies worldwide.
HELLP Syndrome is one of the causes of maternal and fetal deaths in pregnancy. It is a complex of symptoms and clinical signs.
What is the meaning of HELLP?
The Word HELLP is an acronym with
H– Which Means hemolysis. Haemolysis is breakdown of red blood cells
EL– Which Means elevated liver enzymes
LP– Which means low platelets.
Quick treatment is vital in women with eclampsia or preeclampsia. This is because HELLP syndrome complicates pregnant women with eclampsia or preeclampsia.
What is preeclampsia?
Preeclampsia is the presence of high blood pressure in a woman after 20 weeks of pregnancy.with large amounts of protein in urine. You can learn more about preeclampsia.
What is eclampsia?
This is the presence of convulsion in a woman that has preeclampsia.
HELLP syndrome was first renamed by Louis Weinsteinin in 1982. It complicates 5 percent of severe preeclampsia. Also, 60 percent of women that develop HELLP syndrome loss their baby. This is even higher in countries with poor health centers.
Many experts believe HELLP syndrome is a disease on its own. However, most cases of HELLP syndrome occur in preeclampsia women.
Who are at risk of developing HELLP syndrome in Pregnancy?
HELLP syndrom is a grave illness. These are risk factors that increase chances of developing the disease:
- Preeclampsia in past pregnancy
- Eclampsia in previous pregnancy
- Number of babys delivered by the woman. HELLP syndrome is common in women that has delivered more than twice.
- HELLP syndrome in previous pregnancy
- Caucasian women that are more than 25 years.
What are the symptoms and signs of HELLP syndrome?
- Bleeding– This results from low blood platelets. Low platelet is a component of HELLP syndrome. Platelets are important for clothing and wound healing. Therefore, Women with low platelets will experience bleeding.
- Swelling of the ankle, hands and face
- Vomiting and nausea
- Blurring of vision
- Pain in the upper abdomen
- High blood pressure– This is blood pressure that is ≥140/90mmHg. This type of blood pressure in common in women with gestational hypertension.
- Protein in urine– This is detected by urine test. The test is urinalysis. Urine sample are collected over 24 hours. Presence of protein ≥ 300mg is abnormal. In addition, urine dipstick test can be done. Urine dipstick test ≥1+ is abnormal.
What tests are done in HELLP syndrome?
- Complete blood count. This test will reveal number of blood cells. These include red blood cells, white blood cells, platelets and many others. Low platelets, which is a component of HELLP syndrome, can be visualized.
- Liver function test. This is also elevated in HELLP syndrome.
- Clotting profile or bleeding time. This test is important to evaluate blood clotting problems in hellp syndrome women. It is the time taken for healing to take place. Bleeding time is a simple bed side procedure that is done by your doctor. It involves pricking the finger tip and timing when bleeding stops. There are different methods. However, normal values are between 3 to 10 minutes.
- Serum electrolytes. This is to evaluate the number of sodium, bicarbonates, potassium and others.
- Abdominal ultrasound. This test will evaluate the age of the baby, the expected delivery date, fetal distress. It will help to rule out fetal death.
- Urea and creatinine.
What causes HELLP syndrome in pregnancy?
The cause of HELLP syndrome is unknown. Experts believe that It is a disease entity without correlation to preeclampsia or eclampsia.
However, It is widely accepted that it occurs in women with eclampsia or preeclampsia. The chances of recurrence is high.
How is HELLP syndrome classified?
The university of Mississippi classification is widely used. There are 3 main types.
Class 1. This is the most severe form. The platelets are ≤50,000 cell/ul
Class 2. This is the modeare form of the disease. Platelets count is more than 50000 cell/ul to ≤100000 cells/ul.
Class 3. This is the mild form of HELLP syndrome. The amount of platelets is more than 100000 cells/ul.
What is the treatment of HELLP syndrome?
HELLP syndrome is a grave illness that requiers quick treatment. The cure to HELLP syndrom in pregnancy is delivery of baby and placenta.
Some treatment modalities include:
- Use of steroids. This will help the immature lungs of the baby. Because HELLP syndrome require urgent treatment, care to premature lungs is vital for survival.
- Blood transfusion. Reduced platelet and blood cells will require urgent blood and blood products.
- Blood pressure lowering drugs. Lowering blood pressure is an important part of treatment. Common drugs used include nifedipine, hydralazine and lebatalol.
- Drugs to prevent seizure. The drug of choice is magnesium sulphate.
- Vaginal delivery except where not indicated
- Cesarean section is an option. However, women with HELLP syndrome have bleeding problems. This is due to low blood platelets.
What are the complications of HELLP syndrome in pregnancy?
- Death of the baby. More than 60 percent of women will loss their baby.
- Death to the woman.
- Growth restriction of the baby. This will result to small baby.
- Premature delivery. Because of risk to the mother and baby, urgent action is require with delivery of premature babies.
- Neonatal respiratory distress syndrome. This is due to immature lungs of the premature baby. This is common with babies delivered before 32 to 34 weeks.
- Liver failure
- Kidney failure
- Blood transfusion reactions
- DIC. It complicates women with HELLP syndrome and results to widespread bleeding.
- Abruptio placenta.
How is HELLP syndrome prevented?
There is no known prevention for the disease. But some of these will help prepare you:
- Early and regular prenatal visits
- Blood pressure check
- Inform your doctor of any problem in previous pregnancies. Problem like high blood pressure, diabetes, or HELLP syndrome.
- Low salt intake
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Are you a doctor? let us know about your experiences.