How does preeclampsia affect the baby? (HELLP Syndrome)

HELLP Syndrome

HELLP is the medical term for one of the most serious complications of pre-eclampsia, in which there is a combined liver and blood clotting disorder.

H stands for Haemolysis (rupture of the red blood cells);

EL stands for Elevated Liver enzymes in the blood (reflecting liver damage);

LP stands for Low blood levels of Platelets (specialised cells which are vital for normal clotting)

How does preeclampsia affect the baby?

Prematurity

Preeclampsia is responsible for 15% of premature births in the US each year. It is the leading known cause of preterm birth. According to the March of Dimes, in 2001, 476,250 infants were born prematurely…over half from unknown causes. Preeclampsia represents 30% of the known causes of prematurely--or approximately 70,000 premature births.

HELLP Syndrome

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Preeclampsia and HELLP Syndrome (HELLP Syndrome)

HELLP Syndrome

The etiology and pathogenesis of preeclampsia and HELLP syndrome remain unclear. Some theories center on the explanation that abnormal placentation results in placental ischemia and the production of a circulating toxin that causes endothelial cell injury.[5] The injury is believed to cause vascular constriction within multiple organ systems, activation of the coagulation system, increased capillary permeability, and platelet activation with platelet consumption in the microvasculature, all resulting in hypertension, proteinuria, edema, and thrombocytopenia. Why certain women with severe preeclampsia develop HELLP syndrome is unclear, but it has been postulated that these women may have more endothelial injury with greater activation of the coagulation system. Immunologic factors have also been proposed as the underlying initiator of preeclampsia and HELLP syndrome. Maternal cell-mediated immune response to pregnancy with cytokine-mediated endothelial damage may be an important factor.

HELLP syndrome occurs across all ethnicities, races, socioeconomic classes, and age ranges. It is seen in both primigravidas and multiparous patients. Presenting symptoms include epigastric or right upper quadrant pain (65%), nausea and vomiting (50%), malaise (90%), and nonspecific viral syndrome-like symptoms; some patients may present with hematuria or gastrointestinal bleeding.[3] Hypertension and proteinuria may be absent or only slightly abnormal. The differential diagnosis is vast and includes acute fatty liver of pregnancy, appendicitis, gallbladder disease, gastroenteritis, hemolytic uremic syndrome, hepatic encephalopathy, systemic lupus erythematosus, thrombotic thrombocytopenic purpura, and viral hepatitis.

HELLP Syndrome

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HELLP Syndrome Diagnosis (HELLP Syndrome)

Hellp Syndrome

There is also considerable debate regarding the definition, diagnosis, incidence, etiology, and management of HELLP syndrome. It is a multisystem disease that is characterized by microangiopathic hemolytic anemia, hepatic dysfunction, and thrombocytopenia. Sibai estimated it to affect 2% to 20% of patients labeled with severe preeclampsia and 10% of women with eclampsia. It is often insidious in onset and not accompanied by the usual signs of preeclampsia, hypertension, and proteinuria, and therefore is easy to miss in its earlier, milder form. Criteria to establish the diagnosis of HELLP syndrome generally accepted are as follows:

• Hemolysis: abnormal peripheral smear, increased bilirubin <> 600 IU/L;
• Elevated liver enzymes: aspartate aminotransferase (AST) ≥ 72 IU/L, lactate dehydrogenase (LDH) > 600 IU/L; and
• Thrombocytopenia: platelet count <>Hellp Syndrome

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Symptoms and Treating of HELLP Syndrome (HELLP Syndrome)

HELLP Syndrome

Symptoms of HELLP Syndrome
HELLP syndrome is often accompanied by a number of different symptoms. It is important that you be aware of these symptoms and seek medical help immediately if you develop any of them. Symptoms include:

• nausea
• vomiting
• severe headaches
• pain in the upper right side of the abdomen, just under the ribs
• edema, or water retention
• high blood pressure
• convulsions
• low blood platelet count
• elevated liver enzyme count

Sometimes the pain caused by HELLP syndrome can be confused with heartburn. If your heartburn does not radiate up your chest or does not subside after taking antacids, visit with your health care provider for an examination.

Treating HELLP Syndrome
There is no easy cure for HELLP syndrome. The only sure way to control the syndrome is by delivering the baby. If your baby is older than 34 weeks, it is likely that she will be delivered immediately, probably by cesarean section. Typically, symptoms disappear within a week of delivery.

If your baby is under 34 weeks and your symptoms are less severe, your health care provider may recommend bed rest and close monitoring until your baby reaches 34 weeks. You may be given medications to control your high blood pressure, along with increased fluids. You may receive intravenous corticosteroids, which will help your baby’s lungs to grow and develop more quickly.

HELLP Syndrome

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Facts About HELLP Syndrome (HELLP Syndrome)

HELLP Syndrome

HELLP syndrome is the medical name given to a serious complication of Pre Eclampsia involving a combination of liver and blood disorders. HELLP stands for H (haemolysis - red blood cell damage); EL (elevated liver enzymes - indicating liver damage); and LP (low platelets in the blood leading to a bleeding tendency). HELLP syndrome may be associated with other signs of Pre Eclampsia, such as high blood pressure, protein in the urine and swelling of the hands, feet or face. However, this is not always the case, and this may make its diagnosis more difficult. Women with HELLP syndrome often complain of a pain in the upper abdomen below the ribs, which is indicative of a tender liver. There may also be heartburn, vomiting and headache. The upper abdominal pain of the HELLP syndrome can be very severe, and is not relieved by simple remedies such as antacids, which would be the case if heartburn, for example, was the cause of the pain. HELLP syndrome symptoms can often be confused with other problems such as gallstones (cholelithiasis), inflammation of the gall bladder (cholecystitis) or liver inflammation (hepatitis).

As with the more typical cases of Pre Eclampsia, HELLP syndrome can arise at any stage during the second half of pregnancy.

The diagnosis of HELLP syndrome can be made by blood tests which examine liver enzymes, red blood cells and platelets. As with typical Pre Eclampsia, delivery is required for cure of the HELLP syndrome,irrespective of the stage of the pregnancy and maturity of the baby. Because the HELLP syndrome can be associated with a bleeding tendency secondary to a deficiency of platelets, it may be necessary to administer platelet transfusions. This may be particularly important before undertaking any surgery, such as a Caesarean section.

HELLP Syndrome

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