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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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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How Do You Know You Have HELLP Syndrome?

HELLP Syndrome

The symptoms include fatigue, general malaise, pain in the upper right part of the abdomen, nausea, vomiting, headache, blurry vision, and water retention accompanied by excessive weight gain. Some women also have convulsions. Because most of these symptoms are common in a normal pregnancy or mimic other ailments like the flu, HELLP syndrome is difficult to diagnose. Report any seizures, abdominal pain, or flu-like symptoms to your doctor right away.

If your doctor suspects the syndrome, she will order a complete blood count to look for signs of hemolytic anemia and a platelet count. She will also order liver function tests that detect specific enzymes which signal liver damage, and she may order blood-clotting studies.

A number of other diseases that involve blood vessel and clotting abnormalities can be confused with HELLP. These include: systemic lupus erythematosus (SLE); acute fatty liver of pregnancy (AFL); thrombotic thrombocytopenic purpura (TTP); and other collagen vascular diseases.

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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