Pregnancy Complications: HELLP Syndrome

Definition and Incidence

• HELLP syndrome: a pregnancy complication characterized by Hemolysis (H), Elevated Liver enzymes (EL), and Low Platelets (LP)
• Incidence: 0.2-0.8% of pregnancies, 10-20% of severe preeclampsia cases

Causes and Risk Factors

• Preeclampsia: the primary underlying condition leading to HELLP syndrome
• Genetic predisposition: familial history of preeclampsia and HELLP syndrome
• Multiple pregnancy: increased risk due to excessive placental mass
• Advanced maternal age: increased risk with increasing age
• Pre-existing medical conditions: hypertension, diabetes, and kidney disease

Clinical Features

• Non-specific symptoms: nausea, vomiting, headache, and right upper quadrant pain
• Abdominal tenderness and guarding
• Elevated blood pressure and proteinuria (in preeclamptic cases)
• Laboratory findings:
  • Hemolysis: schistocytes, high lactate dehydrogenase (LDH), and bilirubin
  • Elevated liver enzymes: aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
  • Thrombocytopenia: low platelet count

Diagnosis

• Clinical suspicion: based on symptoms and laboratory results
• Laboratory tests:
  • Complete Blood Count (CBC): platelet count, hemoglobin, and white blood cell count
  • Liver Function Tests (LFTs): AST, ALT, and bilirubin
  • Coagulation studies: prothrombin time (PT), partial thromboplastin time (PTT), and fibrinogen
  • Urinalysis: proteinuria and hematuria

Management and Treatment

• Stabilization: maternal and fetal monitoring, fluid management, and pain control
• Delivery: expedited delivery, preferably via cesarean section, to prevent maternal and fetal complications
• Supportive care: platelet transfusions, antihypertensive medications, and corticosteroids (for fetal lung maturity)
• Intensive care unit (ICU) admission: for close monitoring and management of complications

Complications and Prognosis

• Maternal complications: acute kidney injury, pulmonary edema, and disseminated intravascular coagulation (DIC)
• Fetal complications: growth restriction, prematurity, and perinatal mortality
• Recurrence risk: 5-20% in subsequent pregnancies
• Prognosis: dependent on prompt diagnosis, management, and fetal outcome

Definition and Incidence

• HELLP syndrome is a pregnancy complication characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets
• Occurs in 0.2-0.8% of pregnancies, and 10-20% of severe preeclampsia cases

Causes and Risk Factors

• Preeclampsia is the primary underlying condition leading to HELLP syndrome
• Familial history of preeclampsia and HELLP syndrome increases risk
• Multiple pregnancy increases risk due to excessive placental mass
• Advanced maternal age increases risk
• Pre-existing medical conditions like hypertension, diabetes, and kidney disease increase risk

Clinical Features

• Symptoms include nausea, vomiting, headache, and right upper quadrant pain
• Abdominal tenderness and guarding are present
• Elevated blood pressure and proteinuria are present in preeclamptic cases
• Laboratory findings include hemolysis, elevated liver enzymes, and thrombocytopenia

Diagnosis

• Based on clinical suspicion and laboratory results
• Laboratory tests include Complete Blood Count, Liver Function Tests, Coagulation studies, and Urinalysis

Management and Treatment

• Stabilization involves maternal and fetal monitoring, fluid management, and pain control
• Expedited delivery via cesarean section is preferred to prevent complications
• Supportive care includes platelet transfusions, antihypertensive medications, and corticosteroids
• Intensive care unit admission is necessary for close monitoring and management of complications

Complications and Prognosis

• Maternal complications include acute kidney injury, pulmonary edema, and disseminated intravascular coagulation
• Fetal complications include growth restriction, prematurity, and perinatal mortality
• Recurrence risk is 5-20% in subsequent pregnancies
• Prognosis depends on prompt diagnosis, management, and fetal outcome