HELLP Syndrome

HELLP syndrome is a series of life – threatening obstetric complications that are considered as a variant of pre – eclampsia. As a matter of fact, about 4 – 12% of women who are diagnosed with pre – eclampsia has developed the syndrome.

In line with this, there are approximately about 0.2 – 0.6% pregnant women acquire the following symptoms [abbreviated symptoms which make up the name] are considered to be affected:

  • H – hemolysis (rupturing of the red blood cells)
  • EL – elevated liver enzymes (injured and/or inflamed liver cells)
  • LP – low platelet count (thrombocytopenia)

This group of symptoms usually occurs within 48 hours of child delivery however, the syndrome is likely to be evident after a week.

Contributing factors

  • Women with a history record of HELLP syndrome has 19 – 27% chance of recurring in a succeeding pregnancy
  • Pre – eclampsia toxemia – this contributing factor is linked to HELLP syndrome since its symptoms serve as a 1st indicator of pre – eclampsia
  • Women ages 30 and above
  • Caucasian women
  • Multiparous
  • Poor diet
  • Diabetes
  • Had previous pregnancies

Causes of the HELLP Syndrome

Until the present time, the causes of HELLP syndrome are still unclear to the majority of medical practitioners. With that being said enlisted below are the contributing factors which are believed to trigger the said group of symtpoms:

Common causes

Pregnancy week by week
  • Operative surgery – refers to medical procedures [like cesarean delivery and the like] cause complications like a potential blood clotting problems that is linked to low platelet counts
  • Various viral illnesses
  • Pregnancy – induced hypertension
  • Gallbladder disease
  • Hepatitis
  • Idiopathic thrombocytopenic purpura (ITP)
  • Lupus flare
  • Thrombotic thrombocytopenic purpura

Complications caused by the HELLP syndrome

  • Placental abruption (abruptio placentae) – pregnancy complication where the placenta peels off of the uterine wall
  • Postoperative bleeding [such as reactionary hemorrhage] – refers to the complications caused by a cesarean delivery section
  • Pulmonary edema – fluid buildup inside the lungs
  • Disseminated intravascular coagulation (DIC) – blood clotting complications which result to hemorrhage, 20% of which are affected
  • Maternal mortality (commonly known as death) – about 1.1% of which are affected
  • Infant morbidity and mortality rate – this complication depends on the gestation of pregnancy, severity of the symptoms, and the timeliness of the treatment
  • Blood transfusion – to treat anemia
  • Acute respiratory distress syndrome (ARDS)
  • Spontaneous liver hematoma and hepatic rupture
  • Acute kidney failure
  • Intrauterine growth restriction (IUGR)
  • Neonatal respiratory distress syndrome
  • Liver rupture and hemorrhage that could lead to failure
  • Excessive bleeding during gestation
  • Extensive liver destruction
  • Stroke

Symptoms of the HELLP syndrome

The symptoms of the HELLP syndrome usually taper off within 2 – 3 days after child delivery. With that being said, enlisted here are the following symptoms to expect:

Common symptoms

  • Epigastric pain – stomach pain in the mid part and/or upper right quadrant of the abdomen, 90% of which are affected
  • Certain illnesses – 90% of which are affected
  • Nausea and vomiting – which becomes worst overtime, 50% of which are affected
  • [Severe] headache – 30% of which are affected
  • Paresthesia – tingling sensation in the extremities due to peripheral nerve damage
  • Acute renal failure – about 84% are affected
  • Over – fatigue
  • Fluid retention
  • Unintentional weight gain
  • Nose bleeding

Other symptoms

A woman affected with HELLP may experience other symptoms that are related to pregnancy and its potential complications such as:

  • Edema (pregnancy swelling) including pulmonary edema where 6% are affected
  • Pulmonary embolism
  • Arterial hypertension
  • Vaginal bleeding
  • Indigestion
  • Acid refluxes
  • Shoulder pain
  • Seizures and convulsions (rare)
  • Visual disturbances [or blurred eyesight]
  • Hypertension (high blood pressure)
  • Proteinuria (protein content in urine)
  • Painful respiration

 Clinical help for the HELLP Syndrome

The clinical help for the HELLP syndrome varies from woman to woman. The treatment solely depends on the severity of the symptoms and how close an expectant mother is to her estimated due date.

Physical examination

  • Abdominal pain in the mid part and/or upper right corner
  • Hepatomegaly (engorged liver)
  • Blood pressure measurement to check if she suffers from hypertension (high blood pressure)

Diagnosis

Since the symptoms of HELLP syndrome are very much alike with other pregnancy conditions and complications. With that being said, a medical practitioner [particularly physician] will perform the following procedures for an accurate diagnosis:

Blood tests

A blood test involves collecting a sample of blood via the veins in the arm as a part of pregnancy screening (prenatal care). A physician will perform a blood test routinely for the following purposes:

  • Assess blood type – either she is type A, B, AB, and O
  • Assess if she is immune to rubella
  • Check Rh factor – whether she is Rh negative or positive
  • Determine the levels of glucose, iron, and hemoglobin
  • To determine if any sexually transmitted diseases is positive
  • To determine if she is affected with toxoplasmosis infection
  • Diagnose various genetic errors such as familial hypercholesterolaemia, cystic fibrosis, sickle – cell anemia, Mediterranean anemia, and Tay – Sachs disease

Urine tests

A urine test (urinalysis in medical terms) involves collecting a sample of midstream urine in a sterile specimen cup, and then a chemical analysis test strip is dipped into the sample to assess the following:

  • Assess if there are any bladder infections
  • Assess if there are any kidney infections
  • Determines if she is affected with diabetes
  • Determines if she suffers from pre – eclampsia
  • Determine the levels of sugar, proteins, bacteria, and ketones
  • To know if she suffers from dehydration

Pulmonary function test

A pulmonary function test involves evaluating the function of the fetus’s lungs. It is usually performed on women who are less than 34 weeks pregnant. This test is used to foresee how well the labor and delivery would be.

CT scan

Computerized tomography scan (widely known as CT scan) is an x – ray procedure that combines numerous x – ray images to generate cross – sectional and 3 – dimensional views of the internal organs and body structures.

A CT scan also determines the condition of the liver.

Liver function test

Liver function test (also called as liver enzyme testing) includes the following:

  • Alkaline phosphatase
  • True liver function tests (LFTs)
  • Alanine transaminase (ALT)
  • Aspartate transaminase (AST)
  • Albumin and bilirubin test
  • Prothrombin time (PT)

Misdiagnosis

On the contrary, HELLP syndrome is [often] led to misdiagnoses of the following conditions:

  • Hepatitis
  • Gallbladder disease
  • Idiopathic and/or thrombotic thrombocytopenic purpura – an excessive bruising and bleeding disorder

HELLP treatment options

Primarily, the treatment options for the HELLP syndrome are based on the gestation of pregnancy. In line with this, enlisted below are the ways to help treat the HELLP syndrome:

Maternal and fetal monitoring

During the treatment, first and foremost, a medical practitioner will monitor an expectant mother to determine the following:

  • Platelet count
  • Amount of red blood cells
  • Liver enzyme levels

The fetus on the other hand will be monitored in the following fields:

  • Biophysical tests
  • Fetal non – stress test
  • Fetal movement evaluation
  • Ultrasound test

Corticosteroid medication

Corticosteriod (widely known as steroids) is an anti – inflammatory medicine which aid in the rapid development of the fetus’s lungs.

Magnesium sulfate

Magnesium sulfate is an inorganic salt which helps prevent the occurrence of seizures.

Antihypertensive medication

  • Labetalol
  • Hydralazine
  • Nifedipine

Blood transfusion

Blood transfusion is the transferring blood products into another’s nerve circulation.

Blood pressure medication

Blood pressure medications come with the following forms:

  • Beta blockers
  • Angiotensin II receptor blockers
  • Angiotensin converting enzyme (ACE) inhibitors
  • Calcium channel blockers
  • Renin inhibitors

Bed rest

Bed rest, specifically being admitted into a medical facility, is a must for newborn mothers. This type of peaceful treatment gives her the access to be monitored closely.

Child delivery

HELLP women who are less than 34 weeks pregnant are recommended to deliver the baby in the following methods:

  • Labor induction (induced labor)– the artificial way to stimulate the onset of labor
  • Cesarean delivery – this is considered as the most common way to deliver the child of a HELLP woman
  • Trial of labor (TOL) – TOL is a conduction of natural labor in a moderate level of cephalopelvic disparity. It is performed on women who are at least 34 weeks pregnant and have a auspicious cervix

Disseminated intravascular coagulation

The disseminated intravascular coagulation (DIC) accompanied with a fresh frozen plasma is used to replace coagulation proteins.

Intravenous fluids

Intravenous fluids (IV fluids) are required to use during the early signs of the HELLP syndrome.

Embolization

Embolization is the artificial or natural formation and development of an embolus. This treatment is performed on women who suffer from life – threatening bleeding disorders such as Hepatic hemorrhage.

Prevention

HELLP syndrome cannot be prevented in most cases because the root cause of this condition is still unknown. Despite that, enlisted below are the preventive measures to lower the risk:

  • Maintain a healthy lifestyle
  • Engage in moderate exercises
  • Eat a healthy diet which consist of whole wheat grain, fruits, vegetables, and lean protein

Results

Hemolysis (red blood cells)

  • Abnormal peripheral blood smear
  • Lactate dehydrogenase >600 units per liter
  • Bilirubin blood test result >1.2 milligrams per deciliter

Elevated liver enzyme levels

  • Serum aspartate aminotransferase >70 units per liter
  • Lactate dehydrogenase >600 units per liter
  • Platelet count <100,000 units per liter

Prognosis

Prognosis refers to the outlook of the syndrome. A lot of women will recover immediately if the condition is promptly treated.

In line with this, the severity of the symptoms also improves significantly. As a matter of fact, most of the HELLP symptoms and side effects will taper off within 2 – 3 days after child delivery.

However, the aftermath of the syndrome may have a big impact on the soon – to – be baby. The majority of which are premature babies (babies who are born before the 37th week of pregnancy). With that being said, premature babies are monitored carefully before they are able to go out in the hospital.