hellp
Table of Contents
HELLP syndrome in pregnancy
introduction
- HELLP is an acronym for the 3 main features:
- it is a potentially life threatening complication of pregnancy
- occurs in ~ 1 in 300 pregnancies, and in up to 12% of cases of pre-eclampsia and eclampsia (mainly older women with preeclampsia)
- usually occurs between 27 weeks gestation up to the immediate post-partum period
- 15% to 30% of cases presenting postpartum
- it is extremely rare prior to 20wks although cases have been recorded as early as 16wks.
- recurrence rate in subsequent pregnancies is 2-27%
risk factors
- maternal age > 34yrs
- multiparity
- Caucasian
- PH poor pregnancy outcome
- PH HELLP
clinical features
- malaise, nausea, vomiting, RUQ pain with RUQ tenderness are very common
- headache very common
- peripheral oedema and weight gain, or, signs of dehydration
- over 80% have proteinuria
- 80% have hypertension
- visual changes in 10-20%
- jaundice in 5%
- SOB if acute pulmonary oedema (APO)
- may have bruising
Mississippi staging classification
- divides HELLP syndrome into 3 classes
| class I (severe) | class 2 (moderate) | class 3 (mild) | |
|---|---|---|---|
| platelet count | ≤50,000/µL | 50,000-100,000/µL | 100,000-150,000/µL |
| AST or ALT | ≥70 IU/L | ≥70 IU/L | ≥40 IU/L |
| LDH | ≥600 IU/L | ≥600 IU/L | ≥600 IU/L |
| incidence of bleeding | 13% | 8% | no increased risk |
complications
- intracranial haemorrhage due to coagulopathy and hypertension is the most common cause of maternal death
- cerebral venous thrombosis
- retinal detachment
- rarely, large vessel vasculopathy causing hepatic infarction and hepatic subcapsular haematoma
- cardiovascular disease
- maternal mortality 1-3%
- perinatal mortality ~9-24% (usually due to placental abruption, maternal death or prematurity)
DDx
ED Mx
- iv access and take bloods for:
- FBE, U&E, LFTs, coagulation studies, fibrinogen
- group and hold
- cautious iv fluid Mx
- fetal assessment via urgent CTG
- imaging as indicated
- antihypertensives, corticosteroids and magnesium sulphate as per pre-eclampsia and eclampsia
- admit and expedite delivery as per O&G
hellp.txt · Last modified: 2024/06/15 09:22 by gary1