2. Definition
Can be used to describe preeclampsia in association with
HEMOLYTIC ANEMIA
ELEVATED LIVER ENZYMES
LOW PLATELET COUNT
Any patient diagnosed with HELLP syndrome should be considered to have severe
preeclampsia
3. HELLP triad
HEMOLYSIS
Abnormal peripheral smear results with burr cells and schistocytes
ELEVATED LIVER ENZYMES
LOW PLATELET COUNT/ THROMBOCYTOPENIA
Less than 100000 /mm3
4. CLINical features
Most cases are vague and are missable
SYMPTOMS
RUQ pain or pain around stomach
Nausea
Headache
Malaise
Signs
RUQ tenderness
Increased BP
Proteinuria
Edema
6. Risk factors
Age
Older than 34
Multiparity
White race/ Europeans
Poor pregnancy outcome history
7. Severity classification
I severe
Platelets <50000 mm3
Altered liver enzymes
Evidence of hemolysis
II moderate
Platelets 50000-10000
III mold
Platelets 100000-150000
8. Differentials
Can be confused with many medical conditions
Biliary colic and cholecystitis
ITP
GERD and Peptic ulcer disease
Acute fatty liver of pregnancy
Appendicitis
Cerebral hemorrhage
10. MANAGEMENT PLAN
Identification - clinical features
- lab findings
- D/D from other condition
Admission to hospital Stabilization
•IV line ,Cross match
•Catheterization
•Respi assessment
Fetal assessment
(NST,BPP,Color doppler )
Transport to tertiary
care centre or latency
for 24-48 hrs
Termination of
pregnancy
Conservative approach for 48-72
hrs (<32wks POG, Partial
HELLP,Tertiary health cenre)
Rebound / Resolution ●Monitor by lab Ix
●Stop MgSO4 24 hrs of delivery
●Continue antihypertensive & steroid
11.
12. Conservative management
Mild to moderate
Control of BP
Prevent eclamptic fits
Give magnesium sulfate
Prevents HELLP progression (decreases platelet and RBC effects)
Corticosteroids to improve platelet and liver function
Fluid therapy
Ringer’s lactate with glucose and saline at 100ml/h
Platelet transfusion
13. Conservative management continued
Platelet transfusion
Needed before or after delivery
Replenish blood loss from bleeding sites , that is, from
Puncture sites
Wounds
Intraperitoneal bleeding
14. Postpartum care
If discovered postpartum, admit to obstetric ICU
Control bp (diastolic less than 1000mm/hg
Urine output >100ml/h
Platelet increase and LDH decrease
Clinical improvement in any cases