Hellp syndrome is a rare and serious condition of pregnancy that affects the blood and liver. It is often described as a severe form of preeclampsia or a complication of this condition. And as with preeclampsia, this syndrome can develop during pregnancy or after delivery.
The initials HELLP are the English initials of:
- H: Hemolysis: Hemolysis, which means red blood cells are injured or destroyed.
- EL: Elevated Liver Enzymes: Elevated liver enzymes, which is a sign that the liver is not working well.
- LP: Low Platelets: Low platelet count, which means you don’t have enough platelets in your blood to clot.
Hellp syndrome is a medical emergency. Without prompt treatment, it can be fatal for you and your baby.
Hellp syndrome is a pregnancy complication that usually occurs during the later stages of pregnancy or after childbirth. It is considered a variant of preeclampsia, since in hellp syndrome , unlike the second, the half-life and structural integrity of platelets decrease more. Also, this syndrome is more difficult to diagnose. Especially when blood pressure and urine protein are not present.
What are the symptoms:
Pregnant women who developed hellp syndrome experienced one or more of these symptoms. In particular, headache , Nausea , vomiting, indigestion with pain after eating. Also abdominal or chest tenderness and upper right upper side pain. Also, shoulder pain or pain when breathing deeply Bleeding, changes in vision, swelling, high blood pressure, and protein in the urine.
What is the treatment:
The definitive treatment for women with this condition is to remove the baby from the uterus, anticipating birth. During pregnancy, many women suffering from Hellp syndrome require a transfusion of some type of blood product. Corticosteroids can be used in early pregnancy to help the baby’s lungs mature. Some healthcare providers may also use certain steroids to improve the mother’s condition.
Who is at risk?
Women who develop preeclampsia are the most likely to develop hellp syndrome. In addition, statistics indicate that white women, older than 25 years of age, nulliparous women with a history of hypertension, and multiparous women also have clinical signs of hypertension, or the same syndrome or complications in previous pregnancies.
It mainly has maternal and fetal complications. Among the maternal complications, the main ones are renal failure , liver failure , sepsis, stroke , pulmonary edema , DIC. Also bleeding at the level of the brain is usually one of the most important causes of maternal death and directly correlates with the increase in systolic blood pressure. Actually not so much from diastolic, which would change the paradigm of putting so much emphasis on diastolic BP values. Especially as an action level for starting antihypertensive treatment.
There are already experimental studies in rats, still in the process of publication. These suggest that factors circulating in the plasma of women increase the permeability of the blood-brain barrier. In response to a selective endothelial dysfunction at this level, being responsible for neurological complications. The most serious complications are usually seen in patients with class I hellp syndrome with up to 40% morbidity.
Complications and risks of more severe hellp syndrome include:
- placental abruption.
- Pulmonary edema (accumulation of fluid in the lungs).
- Disseminated intravascular coagulation (DIC blood clotting problems resulting in bleeding).
- Adult respiratory distress syndrome (lung failure).
- Broken liver hematoma.
- Acute renal failure .
- Intrauterine growth restriction.
- Neonatal respiratory distress syndrome (lung failure).
- Blood transfusion.
How can hellp syndrome be prevented?
Unfortunately, there is currently no way to prevent this disease. The best that can be recommended is:
- Be in good physical shape before getting pregnant.
- Make regular prenatal visits during your pregnancy.
Tell your doctor or provider about any previous high-risk pregnancies. Also pregnancy and family history with
- Hellp syndrome , preeclampsia or other hypertensive disorders.
- Understand the warning signs and tell your doctor right away.
How it can be diagnosed:
Lab tests are crucial. In fact, with a simple blood draw, this is possible. The analysis consists of evaluating the blood count with platelet count, hepatogram, haptoglobin and LDH.
Some criteria to consider are:
- Evaluate the presence of hemolysis with hemoglobin levels below 10 g%. Decreased haptoglobin
- Bilirubin that increases in 60% of cases.
- Elevated liver enzymes such as TGO and LA TGP
- LDH increased 3 times or more.
The severity of hellp syndrome is measured according to the mother’s blood platelet count and divided into three categories. According to a system called “Mississippi Ranking”.
- Class I (severe thrombocytopenia): platelets below 50000/mm 3
- Level II (moderate thrombocytopenia): platelets between 50,000 and 100,000 / mm 3
- Class III (AST>40 IU/L, mild thrombocytopenia): platelets between 100,000 and 150,000/mm 3
How does it affect babies?
Babies who weigh less than 1 kg and those who are less than 37 weeks are the most likely to have the syndrome. In addition to dealing with its long-term effects such as: Delayed growth or complications associated with premature birth.