HELLP UTD Flashcards
What does HELLP stand for?
Hemolysis, Elevated Liver enzymes, Low Platelet count
When does HELLP syndrome typically present?
Between 28–37 weeks of gestation, but it can also present postpartum
Is HELLP always associated with hypertension or proteinuria?
No, up to 15–20% of patients have no prior hypertension or proteinuria
What is the prevalence of HELLP syndrome in normotensive pregnancies?
About 0.1%
What is the most common risk factor?
Multiparity
Does nulliparity increase risk for HELLP syndrome?
No, unlike preeclampsia
What pathological process underlies HELLP syndrome?
Microangiopathy and intravascular coagulation
What role does the liver play in HELLP?
Hepatic inflammation and injury are central, possibly exceeding that seen in preeclampsia
What fetal enzyme deficiency is associated with maternal HELLP?
Long-chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) deficiency
What is the most common symptom of HELLP?
Right upper quadrant or epigastric pain
What lab values are typically elevated?
AST, ALT, LDH, and bilirubin
What is a typical platelet count in HELLP syndrome?
Often <100,000/microL
What three lab findings are required for diagnosis?
Hemolysis, elevated liver enzymes, low platelets
What lab signs indicate hemolysis?
Schistocytes on smear, LDH ≥2× ULN, low haptoglobin, bilirubin ≥1.2 mg/dL
What defines elevated liver enzymes?
AST or ALT ≥2× upper limit of normal
What platelet count confirms thrombocytopenia in HELLP?
Less than 100,000/microL
What is the definitive treatment for HELLP syndrome?
Delivery of the baby
What medication is given to prevent seizures?
Magnesium sulfate
When is prompt delivery recommended?
At ≥34 weeks or <34 weeks with serious complications
How long can delivery be delayed for corticosteroids if stable?
Up to 48 hours
What are some maternal complications of HELLP?
Liver rupture, DIC, acute kidney injury, pulmonary edema, stroke, death
What is the estimated maternal mortality rate?
Around 1%
What fetal complications are associated with HELLP?
Preterm birth, fetal growth restriction, stillbirth, neonatal death
What is the perinatal mortality rate?
7–20%
