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HELLP syndrome
| HELLP syndrome | |
|---|---|
| Specialty | Obstetrics |
| Symptoms | Feeling tired, retaining fluid, headache, nausea, upper abdominal pain, blurry vision, seizures[1] |
| Complications | Disseminated intravascular coagulation (DIC), placental abruption, kidney failure, pulmonary edema[1] |
| Usual onset | Last 3 months of pregnancy or shortly after childbirth[1] |
| Types | Complete, incomplete[2] |
| Causes | Unknown[1] |
| Risk factors | Preeclampsia, eclampsia, previously having HELLP, mother older than 25 years |
| Diagnostic method | Blood tests[2] |
| Differential diagnosis | Viral hepatitis, thrombotic thrombocytopenic purpura, cholangitis, hemolytic uremic syndrome[2] |
| Treatment | Delivery of the baby as soon as possible, management of blood pressure[1][2] |
| Prognosis | <1% risk of death (mother); 7.3% to 11.9% risk of death (child)[3] |
| Frequency | ~0.7% of pregnancies[2] |
HELLP syndrome is a complication of pregnancy; the acronym stands for hemolysis, elevated liver enzymes, and low platelet count.[1] It usually begins during the last three months of pregnancy or shortly after childbirth.[1] Symptoms may include feeling tired, retaining fluid, headache, nausea, upper right abdominal pain, blurry vision, nosebleeds, and seizures.[1] Complications may include disseminated intravascular coagulation, placental abruption, and kidney failure.[1]
The cause is unknown.[1] The condition occurs in association with pre-eclampsia or eclampsia.[1] Other risk factors include previously having the syndrome and a mother older than 25 years.[1] The underlying mechanism may involve abnormal placental development.[4] Diagnosis is generally based on blood tests finding signs of red blood cell breakdown (lactate dehydrogenase greater than 600 U/L), an aspartate transaminase greater than 70 U/L, and platelets less than 100×109/l.[2] If not all the criteria are present, the condition is incomplete.[2]
Treatment generally involves delivery of the baby as soon as possible.[1] This is particularly true if the pregnancy is beyond 34 weeks of gestation.[2] Medications may be used to decrease blood pressure and blood transfusions may be required.[1]
HELLP syndrome occurs in about 0.7% of pregnancies and affects about 15% of women with eclampsia or severe pre-eclampsia.[5][2] Death of the mother is uncommon (< 1%).[1][3] Outcomes in the babies are generally related to how premature they are at birth.[1] The syndrome was first named in 1982 by American gynaecologist Louis Weinstein.[2]
- ^ a b c d e f g h i j k l m n o p "HELLP syndrome". Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. 2018. Retrieved 5 October 2018.
- ^ a b c d e f g h i j Haram K, Svendsen E, and Abildgaard U (February 2009). "The HELLP syndrome: clinical issues and management. A Review". BMC Pregnancy Childbirth. 9: 8. doi:10.1186/1471-2393-9-8. PMC 2654858. PMID 19245695.
- ^ a b Odze, Robert D.; Goldblum, John R. (2009). Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas. Elsevier Health Sciences. p. 1240. ISBN 9781416040590.
- ^ Cohen, Hannah; O'Brien, Patrick (2015). Disorders of Thrombosis and Hemostasis in Pregnancy: A Guide to Management. Springer. p. 305. ISBN 9783319151205.
- ^ "Preeclampsia and Eclampsia". Merck Manuals Consumer Version. March 2018. Retrieved 5 October 2018.
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