HELLP syndrome

HELLP syndrome is a severe form of preeclampsia and stands for Homolysis, Elevated Liver enzymes, and Low Platelet count. It typically occurs during the later stages of pregnancy or postpartum.

. Homolysis: Destruction of red blood cells leading to anaemia and elevated bilirubin levels.
. Elevated Liver Enzymes: Indicating liver damage or dysfunction, often presenting with right upper quadrant pain or epigastric pain.
. Low Platelet Count: Leading to thrombocytopenia, which increases the risk of bleeding and bruising.

Common symptoms include:
. Severe headache
. Nausea and vomiting
. Epigastric or right upper quadrant pain
. Visual disturbances
. Hypertension
. Proteinuria
. Jaundice (in severe cases)

Risk Factors

Several factors can increase the risk of developing HELLP syndrome:

i. Preeclampsia or eclampsia: HELLP syndrome is often seen in women who have preeclampsia or eclampsia.
ii. Previous history of HELLP syndrome: Women who have had HELLP syndrome in a previous pregnancy are at higher risk.
iii. Multiparity: Having had multiple pregnancies.
iv. Maternal age: Women over 35 years old have a higher risk.
v. Obesity: Increased body mass index (BMI) can be a contributing factor.
vi. Underlying medical conditions: Such as diabetes, hypertension, and kidney disease.

Investigations

To diagnose HELLP syndrome, a combination of clinical assessment and laboratory tests is used:
. Complete Blood Count (CBC): To check for haemolysis and low platelet count.
. Liver Function Tests (LFTs): To assess elevated liver enzymes such as AST and ALT.
. Peripheral blood smear: To detect haemolysis.
. Coagulation Profile: To assess the risk of bleeding.
. Serum bilirubin: To evaluate the level of bilirubin which increases with haemolysis.
. Urine analysis: To detect proteinuria.
. Imaging (e.g., ultrasound): May be used to rule out other causes of abdominal pain and assess the liver.

Management

Management of HELLP syndrome focuses on stabilizing the mother, managing symptoms, and delivering the baby if necessary.

. Stabilization: Immediate hospitalization is required. Stabilizing the mother’s blood pressure and managing any complications like seizures (with magnesium sulphate) is crucial.
. Blood Pressure Control: Antihypertensive medications like labetalol or hydralazine are used to manage high blood pressure.
. Platelet Transfusion: In cases of severe thrombocytopenia, platelet transfusions may be necessary.
. Corticosteroids: Administered to help mature the foetal lungs if early delivery is anticipated.
. Delivery: The definitive treatment for HELLP syndrome is the delivery of the baby. The timing of delivery depends on the gestational age of the foetus and the severity of the mother’s condition. If the syndrome develops after 34 weeks of gestation or if the mother’s condition deteriorates, immediate delivery is often indicated.
. Postpartum Care: Close monitoring of the mother post-delivery for any complications, such as bleeding or liver failure.