HELLP Syndrome

Chapter 210 HELLP Syndrome



INTRODUCTION



Description: Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a variant of pregnancy-induced hypertension (PIH) and preeclampsia, which are dominated by hepatic and hematologic changes.

Prevalence: Six percent to eight percent of pregnancies, up to 20% of patients with severe pre-eclampsia.

Predominant Age: Reproductive.

Genetics: No genetic pattern.


ETIOLOGY AND PATHOGENESIS



Causes: Unknown. Genetic, endocrine/metabolic (including altered prostaglandin production), uteroplacental ischemia, immunologic.

Risk Factors: Nulliparity, age older than 40 years, African American race, family history of pregnancy-induced hypertension, renal disease, antiphospholipid syndrome, diabetes mellitus, multiple gestation. Chronic hypertension increases the risk of pregnancy-induced hypertension.


CLINICAL CHARACTERISTICS



Signs and Symptoms



• Pre-eclampsia or eclampsia with hemolysis, thrombocytopenia, elevated hepatic transaminase levels (any or all; blood pressure may be normal in up to 20% of patients). (The degree of thrombocytopenia is predictive of the severity of disease and the likelihood of poor outcome.)

• Right upper quadrant or epigastric pain


DIAGNOSTIC APPROACH



Differential Diagnosis



• Pre-eclampsia or eclampsia

• Secondary hypertension

• Improper blood pressure measurement (wrong cuff size, position, technique) resulting in false elevation of readings

• Multiple pregnancy

• Molar pregnancy

• Primary hepatic disease


Associated Conditions: Intrauterine growth restriction, prematurity.


Workup and Evaluation



Laboratory: Liver and renal function studies (e.g., enzymes, renal clearance, 24-hour urinary protein), platelet counts, clotting studies. (Platelet counts of >50,000/mm3 generally are not associated with spontaneous bleeding.)

Imaging: Ultrasonography to monitor fetal growth (frequently restricted).

Special Tests: Assessment of fetal lung maturation may be performed, but if maternal disease is severe, management is based on maternal factors and not fetal maturation.

Diagnostic Procedures:

Related posts:

  1. Anemia
  2. Toxic Shock Syndrome
  3. Uterine Anomalies: Bicornuate, Septate, and Unicornuate Uterus
  4. Cervical Cancer

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on HELLP Syndrome

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