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4: Y4 - Obstetrics [13] > [20] HELLP Syndrome > Flashcards

[20] HELLP Syndrome Flashcards

1
Q

What is HELLP syndrome?

A

A complication of pregnancy

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2
Q

Who does HELLP syndrome present in?

A

Usually in women who have pre-eclampsia or eclampsia

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3
Q

What is HELLP syndrome characterised by?

A
  • Haemolysis
  • Elevated liver enzymes
  • Low platelet count
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4
Q

What causes HELLP syndrome?

A

Unknown

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5
Q

What is HELLP syndrome a disorder of?

A

The placenta

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6
Q

What are the pathological features of HELLP syndrome similar to?

A

Early-onset pre-eclampsia

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7
Q

What debate surrounds HELLP syndrome?

A

As to if it is a severe form of pre-eclampsia, or it’s own disease entity

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8
Q

What % of pregnancies does HELLP syndrome occur in?

A

0.5-0.9%

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9
Q

What % of cases of severe pre-eclampsia does HELLP syndrome occur in?

A

10-20%

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10
Q

What are the risk factors for HELLP syndrome?

A
  • Age >35
  • Nulliparity
  • Previous gestational hypertension
  • Multiple pregnancy
  • Previous HELLP syndrome
  • Caucasian race
  • Antiphospholipid syndrome
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11
Q

When can HELLP syndrome present?

A

At any time in the last half of pregnancy, or after delivery

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12
Q

What % of cases of HELLP syndrome present before delivery?

A

70%

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13
Q

When is the peak incidence of HELLP syndrome?

A

27-37 weeks gestation

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14
Q

When does HELLP syndrome present postpartum?

A

Usually within 48 hours of delivery

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15
Q

What are the symptoms of HELLP syndrome?

A
  • Headache
  • Visual symptoms
  • Malaise
  • Fatigue
  • RUQ or epigastric pain
  • Nausea
  • Vomiting
  • Flu-like symptoms
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16
Q

What are the symptoms of HELLP syndrome characterised by?

A

Exacerbation of symptoms at night and relief during the day

17
Q

What may be found on examination in HELLP syndrome?

A
  • Hepatomegaly
  • Easy bruising/purpura
  • Oedema
  • Hypertension
  • Proteinuria
  • Tenderness over liver
18
Q

What investigations should be done in HELLP syndrome?

A
  • Blood film
  • LDH and bilirubin
  • LFTs
  • Platelets
19
Q

What will be found on blood film in HELLP syndrome?

A

Haemolysis with fragmented red cells

20
Q

What will happen to LDH and bilirubin in HELLP syndrome?

A

Raised

21
Q

Why are LDH and bilirubin raised in HELLP syndrome?

A

Because of destruction of RBCs

22
Q

What will happen to LFTs in HELLP syndrome?

A

Raised, with AST or ALT level >70IU/L

23
Q

Why are LFTs raised in HELLP syndrome?

A

Due to liver injury

24
Q

What will happen to platelets in HELLP syndrome?

A

Decreased

25
Q

Why are platelets decreased in HELLP syndrome?

A

Due to activation and increased consumption

26
Q

What are the differential diagnoses of HELLP syndrome?

A
  • Acute fatty liver of pregnancy
  • Thrombotic thrombocytopenic purpura
  • ITP
  • Haemolytic uraemic syndrome
  • SLE
  • Viral hepatitis
  • Cholangitis
27
Q

What is the definitive treatment for HELLP syndrome?

A

Delivery of the fetus

28
Q

When is delivery of the fetus advised in HELLP syndrome?

A

After 34 weeks gestation, if multi-system disease if present

29
Q

What other things might be involved in the management of HELLP syndrome?

A
  • Transfusion of blood products as clinically indicated

- Blood pressure control

30
Q

How can postpartum HELLP syndrome be treated?

A

Plasma exchange

31
Q

What may be required for women with HELLP syndrome with severe liver damage?

A

Liver transplantation

32
Q

What % of women with HELLP syndrome develop serious complications if not treated early?

A

25%

33
Q

What are the maternal complications of HELLP syndrome?

A
  • Eclampsia
  • Placental abruption
  • DIC
  • AKI
  • Severe ascites
  • Cerebral oedema
  • Liver rupture
34
Q

What are the fetal complications of HELLP syndrome?

A
  • Perinatal death
  • Intrauterine growth restriction
  • Pre-term delivery
  • Neonatal thrombocytopenia

4: Y4 - Obstetrics [13] (61 decks)

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