Hellp syndrome

hellp syndrome

1. Subject - Obstetrics By- Ashok Patidar Group- 4017 Topic – Hellp Syndrome During Pregnancy KARAGANDA STATE MEDICAL UNIVERSITY

2. Definition:- HELLP syndrome  is a group of  symptoms  that occur in pregnant women who have : H: hemolysis (the breakdown of red blood cells) EL: elevated liver enzymes LP: low platelet count HELLP syndrome occurs in about 1 to 2 out of 1,000 pregnancies. In women with preeclampsia or eclampsia, the condition develops in 10% to 20% of pregnancies. Most often HELLP develops during the third trimester of pregnancy (between 26 to 40 weeks gestation). Sometimes it develops in the week after the baby is born. HELLP  syndrome is a life-threatening pregnancy complication usually considered to be a variant of preeclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth. HELLP syndrome was named by Dr. Louis Weinstein in 1982 after its characteristics:

3. Causes The cause of HELLP syndrome has not been found. It is considered to be a variant of preeclampsia. Sometimes the presence of HELLP syndrome is due to an underlying disease such as antiphospholipid syndrome. In some cases, HELLP symptoms are the first warning of preeclampsia. The condition is sometimes misdiagnosed as: Flu or other viral illness Gallbladder disease Hepatitis Idiopathic thrombocytopenic purpura (ITP) Lupus flare Thrombotic thrombocytopenic purpura

4. Symptoms Fatigue or feeling unwell Fluid retention and excess weight gain Headache Nausea and vomiting that continues to get worse Pain in the upper right or mid part of the abdomen Blurry vision Nosebleed or other bleeding that will not stop easily (rare) Seizures or convulsions (rare) Signs : High blood pressure Protein in the urine The most common reasons for mothers to become critically ill or die are liver rupture or stroke (cerebral edema or cerebral hemorrhage). These can usually be prevented when caught in time. If you or someone you know has any of these symptoms, please see a healthcare provider immediately.

5.   Prevention Unfortunately, there's currently no way to prevent this illness. The best thing to do is: Get yourself in the good physical shape before getting pregnant Have regular prenatal visits during pregnancy Inform your care providers about any previous high-risk pregnancies or family history of HELLP syndrome, preeclampsia, or other hypertensive disorders Understand the warning signs and report them to your healthcare provider immediately Trust yourself when "something just doesn't feel right"

6.   Classification The severity of HELLP syndrome is measured according to the blood platelet count of the mother and divided into three categories, according to a system called "the Mississippi classification .“ Class I (severe thrombocytopenia): platelets under 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

7. Affect on Babies If a baby weighs at least 2 pounds (over 1000 grams) at birth, he or she has the same survival rate and health outcome of non-HELLP babies of the same size . Unfortunately, babies under 2 pounds at delivery don't fare as well. Several studies have suggested these babies will need longer hospital stays and will have a higher chance of needing ventilator care. Unfortunately, right now doctors can't predict the scope of the medical problems that these small babies will encounter at birth and later in life . In developed countries, the stillbirth rate (in utero death of the baby after 20 weeks) is 51 out of every 1,000 pregnancies. This rate is higher than both severe preeclampsia and eclampsia . Overall perinatal mortality from HELLP Syndrome (stillbirth plus neonatal death) ranges from 7.7 to 60%. Most of these deaths are attributed to abruption of the placenta (placenta prematurely separating from the uterus), placental failure with intrauterine asphyxia (fetus not getting enough oxygen), and extreme prematurity.

8. Exams and Tests During a physical exam, the health care provider may discover: Abdominal tenderness, especially in the right upper side Enlarged liver High blood pressure Swelling in the legs Liver function tests (liver enzymes) may be high. Platelet counts may be low. A CT scan may show bleeding into the liver. Excessive protein may be found in the urine. Tests of the baby's health will be done. Tests include fetal non-stress test and ultrasound, among others.

9. Treatment The main treatment is to deliver the baby as soon as possible, even if the baby is premature. Problems with the liver and other complications of HELLP syndrome can quickly get worse and be harmful to both the mother and child . Your provider may induce labor by giving you medicines to start labor, or may perform a  C-section . You may also receive : A blood transfusion if bleeding problems become severe Corticosteroid medicines to help the baby's lungs develop faster Medicines to treat high blood pressure Magnesium sulfate infusion to prevent seizures Most often, the definitive treatment for women with HELLP Syndrome is the delivery of their baby. During pregnancy, many women suffering from HELLP syndrome require a transfusion of some form of blood product (red cells, platelets, plasma). Corticosteroids can be used in early pregnancy to help the baby's lungs mature. Some healthcare providers may also use certain steroids to improve the mother's outcome, as well. 

10. Outlook (Prognosis) Outcomes are most often good if the problem is diagnosed early. It is very important to have regular prenatal checkups. You should also let your provider know right away if you have symptoms of this condition . When the condition is not treated early, up to 1 of 4 women develop serious complications. Without treatment, a small number of women die . The death rate among babies born to mothers with HELLP syndrome depends on birth weight and the development of the baby's organs, especially the lungs. Many babies are born prematurely (born before 37 weeks of pregnancy ). HELLP syndrome may return in up to 1 out of 4 future pregnancies .

11. Complications There can be complications before and after the baby is delivered, including: Disseminated intravascular coagulation (DIC). A clotting disorder that leads to excess bleeding (hemorrhage ). Fluid in the lungs (pulmonary edema ) Kidney failure Liver hemorrhage and failure Separation of the placenta from the uterine wall (placental abruption ) After the baby is born, HELLP syndrome goes away in most cases.

12. Risk of Getting HELLP in Future Pregnancies Women with a history of HELLP syndrome are at increased risk of all forms of preeclampsia in subsequent pregnancies. The rate of preeclampsia in subsequent pregnancies ranges from 16 to 52%, with higher rates if the onset of HELLP syndrome was in the second trimester. The rate of recurrent HELLP syndrome ranges from 2 to 19% depending upon the patient population studied.

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