HELLP syndrome

HELLP Syndrome is a health problem that is characterized by the presence of hemolysis, increased liver enzymes and low platelets.

HELLP Syndrome is a problem that occurs during pregnancy and is responsible for a considerable number of maternal and perinatal deaths. This syndrome, which is considered by many experts to be a variant of preeclampsia , affects one or two women in every 1000 pregnancies.

HELLP syndrome usually affects women who are between the 28th and 36th week of pregnancy. This syndrome occurs due to a trophoblastic invasion that puts the fetal tissue in contact with the mother’s immune system, causing an immunological rejection.

The disease has three classic laboratory signs: hemolysis, increased levels of liver enzymes, and a low platelet count (thrombocytopenia). This triad gave the disease its name: H-hemolysis, EL-elevated liver and LP-low plateler count.

Symptoms of HELLP syndrome vary greatly from patient to patient, but abdominal pain, epigastric pain (most frequent symptom), nausea, vomiting, headache, fatigue, and malaise are commonly seen . These symptoms, because they are not very specific, are often confused with the symptoms of preeclampsia.

To make the diagnosis, some laboratory tests are performed. For the disease to be confirmed, the tests must show:

– Hemolytic anemia, confirmed by a blood smear;

– Platelet value equal to or less than 100,000 cells/µl;

– LDH equal to or greater than 600UI/l or total bilirubin equal to or greater than 1.2mg/dL;

– Serum concentration of AST (aspartate aminotransferase) equal to or greater than 70 IU/l.

Once the diagnosis is made, it is essential to carry out tests to know the conditions in which the baby is and to stabilize the mother’s condition. It is important to initially maintain blood pressure with medication. In case of bleeding, very low platelet count values ​​or the need for cesarean section, platelet transfusion is recommended.

The normal procedure in case of HELLP Syndrome is the interruption of the pregnancy with the delivery. However, this will mainly depend on the gestational age. In women 34 weeks or older, delivery is indicated. In women with a lower gestational age, it is recommended to use corticosteroids for fetal lung maturation and wait at least 48 hours. It is worth noting that the type of delivery to be performed must be analyzed with the doctor, who will verify the conditions of the mother and baby. This topic is still a matter of debate among physicians.

Early diagnosis is essential for the establishment of an efficient treatment, avoiding possible complications. Among the most common complications of HELLP syndrome, disseminated intravascular coagulation, placental abruption, acute renal failure, hepatic subcapsular hematoma, pulmonary and cerebral edema, and multiple organ failure stand out . Liver rupture is one of the most important problems as it is related to many deaths of mothers and babies.

Therefore, it is essential that all pregnant women carry out a careful prenatal care, as this is the only way to check pregnancy problems early and establish a correct procedure.

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