1.5 Help Syndrome

Question 1

Define

Answer 1

Haemolysis
Elevated Liver Enzymes
Low Platelets

Severe complication of P-Eclampsia

Maternal mortality ~1%
Fetal Mortality - high
(d/t prem delivery)

Presentation
80% antenatal
Majority before 36/40

20% Postnatal

Question 2

Clinical Features and Lab Findings a/w HELLP

Answer 2

1. Generalsed Malaise
   Viral Symptomse
   N+V
2. RUQ tenderness
   Peripheral Oedema
   Weight Gain

NB HTN and Preoteinuria not prereq for Dx

3. Plt <100 x 10^9
4. Hepatic FUnction
   Deteripration
   Clotting, albumin , ast and alt
5. Evidence of Haemolysis
   Bili and LDH
   Blood smear

Question 3

Management Aims of HELLP

Answer 3

1. CCM on Dx
2. Detail explanation
   counselling risks and delivery
3. Plan early delivery usually
   before deterioration
4. Some evidence - high dose steroids
   Plt count and Birth weight
5. Fluid balance

Question 4

Fluid balane

Answer 4

1. Avoid APO 2nd to Fluid O/L
   Maintain perfusion to vital organs
   (incl. placental perfusion)
2. Challenging
   High risk of haemorrhage require fluid resus / products

Leaky capillaries
2nd to system vasoconstrict and inflammatory cascade
Promoting tissue oedema

Deranged hepatic function
coagulopathy and exacerbating haemorrhage

3. ?Early RRT
   avert APO
   need for I+V
4. Convulsion Rx as for PET
   Mg
   Ruling out other organic causes