HELLP Syndrome: Symptoms, Causes, Diagnosis, Prevention, Classification, Complications and Treatment

It is a life-threatening complication of pregnancy that is generally considered a variant of preeclampsia.

HELLP syndrome is a life-threatening liver disorder that is thought to be a type of severe preeclampsia . It is characterized by hemolysis ( destruction of red blood cells ), elevated liver enzymes (indicating liver damage) and low platelet count.

Causes

This syndrome is usually related to preeclampsia . About 10% to 20% of women who have severe preeclampsia develop HELLP. In most cases, this occurs before 35 weeks of pregnancy, although it can also develop immediately after delivery.

It often occurs without warning and can be difficult to recognize. It can occur without the signs of preeclampsia (which are usually a large increase in blood pressure and protein in the urine)

symptom

Pregnant women who develop HELLP syndrome reported experiencing one or more of these symptoms:

  • Headache.
  • Sickness.
  • Vomiting
  • Indigestion with pain after eating.
  • Abdominal or chest sensitivity.
  • Pain in the upper right part (due to hepatic distension).
  • Pain in the shoulder or pain when breathing deeply.
  • Changes in vision
  • Swelling.

The signs to look for include high blood pressure and protein in the urine. The most common reasons for mothers to become seriously ill or die are a ruptured liver or a stroke (cerebral edema or cerebral hemorrhage).

Diagnosis

The early recognition of the HELLP syndrome begins with a close look at the history, vital signs and findings of the physical examination.

Intravenous fluids should be administered with caution. Patients with HELLP syndrome may be overloaded with volume and present edema, but in fact they are depleted intravascularly.

A complete physical examination may reveal signs of dehydration, including dry mucous membranes, sunken eyes, weakness, and imbalance secondary to dizziness from excessive vomiting. Vital signs may reveal tachycardia , tachypnea and hypertension .

The generalized findings may include the following:

  • Fatigue or weakness
  • Anguish due to pain.
  • Jaundice .

The findings in the head, ears, eyes, nose and throat may include the following:

  • Signs of dehydration including sunken eyes.
  • Edema that leads to swollen eyes.
  • Dry mucous membranes.

Prevention

We can help reduce cases of HELLP syndrome by diagnosing and treating preeclampsia properly and quickly.

Unfortunately, there is currently no way to prevent this disease. The best thing you can do is:

  • Get in good physical shape before getting pregnant.
  • Have regular prenatal visits during pregnancy.
  • Inform your care providers about previous high risk pregnancies or a family history of HELLP syndrome, preeclampsia or other hypertensive disorders.
  • Understand the warning signs and report them to your doctor immediately. Trust yourself when something does not go well.

How is HELLP syndrome classified?

The severity of the HELLP syndrome is measured according to the platelet count in the mother’s blood and is divided into three categories, according to a system called “Mississippi classification.”

  • Class I (severe thrombocytopenia): platelets smaller than 50,000 / mm3.
  • Class II (moderate thrombocytopenia): platelets between 50,000 and 100,000 / mm3.
  • Class III (AST> 40 IU / L, mild thrombocytopenia): platelets between 100,000 and 150,000 / mm3.

Complications

Maternal complications of HELLP syndrome may include the following:

  • Hematologic: ICD, hemorrhage, hematoma.
  • Cardiac: cardiac arrest, myocardial ischemia.
  • Pulmonary: pulmonary edema, respiratory insufficiency, pulmonary embolism, adult respiratory distress syndrome (ARDS).
  • CNS: hemorrhage / cerebrovascular accident, cerebral edema, central venous thrombosis , seizures, retinal detachment.
  • Renal: acute renal failure, chronic renal failure requiring dialysis.
  • Hepatic: hepatic hematoma (usually subcapsular) with possible rupture, ascites , nephrogenic insipidal diabetes.
  • Infection.

Neonatal complications of HELLP syndrome may include the following:

  • Precocity.
  • Delay of intrauterine growth (39%).
  • Thrombocytopenia (one third of newborns born to patients with HELLP, 4% of these children will have intraventricular hemorrhage.

How does HELLP syndrome affect babies?

If a baby weighs at least 2 pounds (more than 1000 grams) at birth, he or she has the same survival rate and health outcome for non-HELLP babies of the same size. Unfortunately, babies under 2 pounds at the time of delivery do not fare so well.

Treatment

The treatment of HELLP syndrome begins with the early and immediate recognition of the diagnosis. Patient stabilization begins in the prehospital context. If there are seizures and hypertension , both should be controlled on the way to the hospital.

The management of the emergency department includes the prophylaxis of attacks, the control of hypertension, the repletion of blood products, as indicated, and the general stabilization of the patient’s condition.