HELLP Syndrome

Published on 30/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 30/05/2015

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Chapter 210 HELLP Syndrome

INTRODUCTION

Description: Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a variant of pregnancy-induced hypertension (PIH) and preeclampsia, which are dominated by hepatic and hematologic changes.
Prevalence: Six percent to eight percent of pregnancies, up to 20% of patients with severe pre-eclampsia.
Predominant Age: Reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Unknown. Genetic, endocrine/metabolic (including altered prostaglandin production), uteroplacental ischemia, immunologic.
Risk Factors: Nulliparity, age older than 40 years, African American race, family history of pregnancy-induced hypertension, renal disease, antiphospholipid syndrome, diabetes mellitus, multiple gestation. Chronic hypertension increases the risk of pregnancy-induced hypertension.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Pre-eclampsia or eclampsia with hemolysis, thrombocytopenia, elevated hepatic transaminase levels (any or all; blood pressure may be normal in up to 20% of patients). (The degree of thrombocytopenia is predictive of the severity of disease and the likelihood of poor outcome.)
• Right upper quadrant or epigastric pain

DIAGNOSTIC APPROACH

Differential Diagnosis

• Pre-eclampsia or eclampsia
• Secondary hypertension
• Improper blood pressure measurement (wrong cuff size, position, technique) resulting in false elevation of readings
• Multiple pregnancy
• Molar pregnancy
• Primary hepatic disease

Associated Conditions: Intrauterine growth restriction, prematurity.

Workup and Evaluation

Laboratory: Liver and renal function studies (e.g., enzymes, renal clearance, 24-hour urinary protein), platelet counts, clotting studies. (Platelet counts of >50,000/mm3 generally are not associated with spontaneous bleeding.)
Imaging: Ultrasonography to monitor fetal growth (frequently restricted).
Special Tests: Assessment of fetal lung maturation may be performed, but if maternal disease is severe, management is based on maternal factors and not fetal maturation.
Diagnostic Procedures:

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