HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It usually occurs during the third trimester of pregnancy. But it also can develop in the first week after childbirth

1. HELLP SYNDROME
MOGS – DR. N.A.PURANDARE TEACHING PROGRAM
BY LTMMC & SION HOSPITAL
10TH DECEMBER,2023

2. Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital
President, MOGS (2022-2023)
Joint Treasurer, FOGSI (2021-2025)
Organising Secretary, AICOG Mumbai 2025
Treasurer, AFG (2023-2024)
Member Oncology Committee, SAFOG (2021-2023)
Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses
Editor-in-Chief, FEMAS, JGOG & TOA Journal
73 publications in International and National Journals with 178 Citations
National Coordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-2022)
Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16)
Member, Oncology Committee AOFOG (2013-2015)
Coordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at
L.T.M.G.H (2010-16)
Member, Managing Committee IAGE (2013-17), (2018-20), (2022-2023)
Editorial Board, European Journal of Gynaec. Oncology (Italy)
Course Coordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS)
at LTMGH (2018-19)
DR. NIRANJAN CHAVAN
MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP,
DIPLOMA IN ENDOSCOPY (USA)

3. OVERVIEW
• INTRODUCTION
• INCIDENCE
• RISK FACTORS
• ETIOLOGY & PATHOGENESIS
• SIGNS AND SYMPTOMS
• DIAGNOSTIC CRITERIA AND INVESTIGATIONS
• MANAGEMENT
• COMPLICATIONS
• COMMON DIFFERENTIAL DIAGNOSIS
• TAKE HOME MESSAGE

4. • The term ”HELLP” syndrome was coined by Dr. Louis Weinstein in
1982 to denote a syndrome consisting of Hemolysis, Elevated Liver
enzymes, and Low Platelet count (thrombocytopenia).
• HELLP develops during gestation and typically occurs during the third
trimester, between 29-37 weeks.
• Although it has long been believed that HELLP is a complication of
severe preeclampsia, recent research supports that HELLP may be a
different condition since 15-20% of those who develop HELLP do not
have either hypertension or proteinuria.
INTRODUCTION

5. INCIDENCE
• HELLP Syndrome - 0.5 to 0.9% of all pregnancies.
• Pre-eclampsia – 5 to 7% of all pregnancies.
• Sibai et al reported a 20% incidence of HELLP in women with pre-eclampsia.
• 70% of cases were diagnosed in the antenatal period while 30% after delivery.

6. RISK FACTORS

7. ETIOLOGY &
PATHOGENESIS

9. SIGNS AND SYMPTOMS
90%
50%

10. DIAGNOSTIC CRITERIA

12. INVESTIGATIONS
• HEMATOLOGICAL CHANGES
• Destruction of red blood cells by hemolysis causes increased serum lactate
dehydrogenase (LDH) levels and decreased hemoglobin concentrations.
• Peripheral Smear shows the following changes:
• Spherocytosis
• Schistocytes
• Reticulocytosis
• Anisocytosis
• Triangular cells
• Burr cells

13. Anisocytosis Triangular cell
Schistocytes Burr cells

14. • Low haptoglobin concentration can be used to diagnose hemolysis and is
the preferred marker of hemolysis.

15. LIVER LESIONS
• There is periportal or focal parenchymal necrosis in which fibrin-like material is
deposited.
• Obstruction of hepatic blood flow
• Periportal necrosis
• Intra hepatic hemorrhage
• Subcapsular hematoma
• Eventual rupture of Glisson's capsule

16. Identification based on clinical features and investigations
Admission to tertiary care centre with facilities of
Blood Bank
• Stabilisation
• I.V. Line
• Cross match
• Catheterisation, Strict Input/Output
Charting
• Respiratory Assessment
Fetal Assessment (NST, BPP Doppler )
MANAGEMENT

17. FOGSI 2007

18. 1. Corticosteroids
FOR FOETAL LUNG MATURITY
• accelerate foetal lung maturity
• reduce the risk of IVH and NEC in selected cases of the
HELLP syndrome.
FOR MATERNAL CONDITION
• Proposed mechanism -diminishes oedema, inhibits
endothelial activation and reduces endothelial dysfunction.
OTHER MEASURES

19. 2. Platelet transfusion
• It is required either before or after delivery, or in the
presence of bleeding from any site.
• If the platelet count is <40,000/µl, 6-10 units of random
donor platelet is required.
3. Fresh frozen plasma transfusion may be required if
there is a presence of coagulopathy.

20. 4. Exchange transfusion
Considered in situations of progressive elevation of bilirubin or falling
Hb or platelets and ongoing deterioration in maternal condition.
5. Antithrombin and glutathione
• correct hypercoagulability
• stimulate prostacyclin production
• regulate thrombin-induced vasoconstriction
• improve fetal status
• It is better than heparin in that it does not increase the risk of
bleeding

21. COMPLICATIONS
PULMONARY
EDEMA & ARDS
SUBCAPSULAR
HEMATOMA OF LIVER
ACUTE KIDNEY INJURY CEREBRAL
HAEMORRHAGE
RETINAL
DETACHMENT

22. DIFFERENTIAL DIAGNOSIS

24. TAKE HOME MESSAGE
• To reduce the risk of potentially serious complications, early
delivery is indicated when the HELLP syndrome develops
after 34 weeks of pregnancy.
• In deliveries between 24 and 34 weeks gestation, a standard
corticosteroid course is usually recommended after
stabilization of maternal condition followed by delivery.
• A well-designed multicenteric study testing the benefit of
antithrombin to counteract DIC in the HELLP syndrome
should be encouraged.

26. THANK YOU!