[20] HELLP Syndrome Flashcards
What is HELLP syndrome?
A complication of pregnancy
Who does HELLP syndrome present in?
Usually in women who have pre-eclampsia or eclampsia
What is HELLP syndrome characterised by?
- Haemolysis
- Elevated liver enzymes
- Low platelet count
What causes HELLP syndrome?
Unknown
What is HELLP syndrome a disorder of?
The placenta
What are the pathological features of HELLP syndrome similar to?
Early-onset pre-eclampsia
What debate surrounds HELLP syndrome?
As to if it is a severe form of pre-eclampsia, or it’s own disease entity
What % of pregnancies does HELLP syndrome occur in?
0.5-0.9%
What % of cases of severe pre-eclampsia does HELLP syndrome occur in?
10-20%
What are the risk factors for HELLP syndrome?
- Age >35
- Nulliparity
- Previous gestational hypertension
- Multiple pregnancy
- Previous HELLP syndrome
- Caucasian race
- Antiphospholipid syndrome
When can HELLP syndrome present?
At any time in the last half of pregnancy, or after delivery
What % of cases of HELLP syndrome present before delivery?
70%
When is the peak incidence of HELLP syndrome?
27-37 weeks gestation
When does HELLP syndrome present postpartum?
Usually within 48 hours of delivery
What are the symptoms of HELLP syndrome?
- Headache
- Visual symptoms
- Malaise
- Fatigue
- RUQ or epigastric pain
- Nausea
- Vomiting
- Flu-like symptoms
What are the symptoms of HELLP syndrome characterised by?
Exacerbation of symptoms at night and relief during the day
What may be found on examination in HELLP syndrome?
- Hepatomegaly
- Easy bruising/purpura
- Oedema
- Hypertension
- Proteinuria
- Tenderness over liver
What investigations should be done in HELLP syndrome?
- Blood film
- LDH and bilirubin
- LFTs
- Platelets
What will be found on blood film in HELLP syndrome?
Haemolysis with fragmented red cells
What will happen to LDH and bilirubin in HELLP syndrome?
Raised
Why are LDH and bilirubin raised in HELLP syndrome?
Because of destruction of RBCs
What will happen to LFTs in HELLP syndrome?
Raised, with AST or ALT level >70IU/L
Why are LFTs raised in HELLP syndrome?
Due to liver injury
What will happen to platelets in HELLP syndrome?
Decreased
Why are platelets decreased in HELLP syndrome?
Due to activation and increased consumption
What are the differential diagnoses of HELLP syndrome?
- Acute fatty liver of pregnancy
- Thrombotic thrombocytopenic purpura
- ITP
- Haemolytic uraemic syndrome
- SLE
- Viral hepatitis
- Cholangitis
What is the definitive treatment for HELLP syndrome?
Delivery of the fetus
When is delivery of the fetus advised in HELLP syndrome?
After 34 weeks gestation, if multi-system disease if present
What other things might be involved in the management of HELLP syndrome?
- Transfusion of blood products as clinically indicated
- Blood pressure control
How can postpartum HELLP syndrome be treated?
Plasma exchange
What may be required for women with HELLP syndrome with severe liver damage?
Liver transplantation
What % of women with HELLP syndrome develop serious complications if not treated early?
25%
What are the maternal complications of HELLP syndrome?
- Eclampsia
- Placental abruption
- DIC
- AKI
- Severe ascites
- Cerebral oedema
- Liver rupture
What are the fetal complications of HELLP syndrome?
- Perinatal death
- Intrauterine growth restriction
- Pre-term delivery
- Neonatal thrombocytopenia
