WHAT IS HELLP SYNDROME?
HELLP syndrome is a clinical liver disorder first described in 1982 that occurs as a result of complications during pregnancy that normally begins at the last three months of pregnancy and shortly after childbirth and is characterized by hemolysis, high liver enzymes, and low platelet count. It is considered a severe type of preeclampsia and involves the destruction of red blood cell
HELLP syndrome has a prevalence rate of about 0.7% occurrence in pregnant women and approximately 15% in women with preeclampsia of severe preeclampsia. However, the mortality rate of the mothers is low at an estimated percentage of 1 both the babies may be given birth prematurely.
HELLP syndrome affects approximately 10 – 20% of preeclampsia women and its complication rate is about 0.5 to 0.9 % of most pregnancies. It is also mostly found amongst caucasian women over 25 years of age.
In 70% of reported cases that occur before childbirth, is observed to manifest itself the 3 last month of pregnancy and only about 20 – 30% occurs and shows symptoms before and after the last 3 months of pregnancy and postpartum cases are observed to occur in 30% of all reported cases of HELLP syndrome.
TYPES OF HELLP SYNDROME
HELLP syndrome can be classified based on the severity of the syndrome depending on the platelet count. They include:
Here, the syndrome is characterized by platelet counts below 50,000/uL. It is considered the most severe with a high occurrence of HELLP syndrome death.
Class II hellp syndrome is characterized by a platelet count of about 50000 – 100,000/uL. It is not as severe as Class I help syndrome.
Here, the blood platelet count is approximately 100000-150000/uL.
HELLP syndrome can also be classified based on its expression and manifestation. It includes:
Partial expression is said to occur when one or two medical criteria are exhibited.
This is characterized by the expression or manifestation of all medical criteria for the manifestation of Hello syndrome.
RISK FACTORS OF HELLP SYNDROME
Risk factors of help syndrome include:
- Partial or Incomplete Expression
HELLP SYNDROME DIAGNOSIS
In other to properly diagnose HELLP syndrome, certain lab tests and imaging will be carried out in other to eliminate other conditions.
Diagnosing HELLP syndrome is quite challenging as the signs and symptoms may vary from person to person and sometimes can be thought to be pregnancy signs especially when symptoms are mild.
When diagnosing, three main criteria are checked, they include:
- Medical history of preeclampsia
- Previously having this syndrome
- mothers older than 35 years
- Abnormal placental development
- Increase in body mass index and metabolic disorders such as antiphospholipid syndrome, etc
- Family history of HELLP syndrome
- Kidney disease
- The incidence of twins
Diagnosing the syndrome can be done through the following ways:
- Hepatic dysfunction, which is the liver dysfunction
- Thrombocytopenia is the earliest sign of coagulation present in all HELLP syndrome cases that occurs due to low platelet count in the blood.
- Microangiopathic hemolytic anemia in people suspected of preeclampsia.
HELLP SYNDROME TREATMENT
One of the effective HELLP treatments of the delivery of the baby will cause the signs and symptoms to reduce drastically due to the absence of the placenta after the child is delivered. This could be either a vaginal birth or cesarean section but the cesarean section is preferred if the mother and child are not stable.
Certain medications can be administered to help with the symptoms. They include corticosteroids some medications are also given to control the seizure such as magnesium sulfate and decrease blood pressure levels.
Blood transfusion can also be administered to treat the anemia.
HELLP SYNDROME COMPLICATIONS
Some complications could result in severe cases of HELLP syndrome which might affect the next pregnancy of the mother, liver complications, anemia, and low platelet count, liver rupture, kidney failure, acute respiratory failure, pulmonary edema,
Excessive bleeding during childbirth, placental abruption due to detachment of the placental from the uterus before the baby is born.
RECOVERY AND MORTALITY RATE
Most cases of recovery from HELLP syndrome take place within few days after delivery. But in severe cases, it might take some time, especially when there are complications of HELLP syndrome. Hence, it requires close monitoring during few weeks after post patrum.
- You will be taken to the lab and your blood samples were taken to check for abnormalities such as helmet cells, bur cells, etc.
- A test to ascertain your fibrin metabolite level and antithrombin will be done
- Your personal medical history will be examined.
- Your family medical history will be checked for anyone with HELLP syndrome.
- You will also some scanning tests such as ultrasound tests, magnetic resonance imaging, etc to check your liver function.
- Urine test to check for abnormal proteins.
HELLP SYNDROME SYMPTOMS
The symptoms of HELLP syndrome manifest fully during the last trimester of pregnancy that is the last three months of pregnancy although in some cases it could before then or after then. The symptoms vary with individuals.
The symptoms of HELLP syndrome include:
- General body discomfort
- Severe epigastric pain or pains at the upper right quadrant of the abdomen (abdominal pains).
- Increase in blood pressure.
- Severe back, shoulder ache.
- Dizzying sight or unclear vision.
- Swellings especially at the hands and feet.
- Excessive weight gain.
- Pains when breathing deep.
- Spontaneous bleeding due to liver capsule rupture in severe cases.
HELLP SYNDROME CAUSES
HELLP syndrome cause has not yet been discovered although it has been observed to be associated with conditions such as preeclampsia or eclampsia.
HELLP syndrome pathophysiology is quite unclear but its mechanism resembles that of an endothelial cell injury and other conditions such as acute kidney injury and thrombocytopenia purpura.
- What is the full meaning of HELLP syndrome?
It stands for the medical criteria that must be fulfilled. If not all at least two, before one is considered to have this condition. These include:
H: Hemolysis of red blood cells
EL: Elevated liver enzymes
LP: Low platelet count.
- How can I prevent HELLP syndrome during pregnancy?
Since the cause is not yet known, prevention of HELLP syndrome is relatively hard but some adjustments can be made to reduce the risk of having HELLP syndrome. This involves regular exercise, healthy diets containing vegetables, whole grains, fruits, and lean proteins
Preeclampsia is characterized by an abnormal increase in blood pressure and protein level in the urine. It is observed to occur in 5 to 8 % of pregnant cases
- Can HELLP syndrome occur without signs of preeclampsia?
HELLP syndrome can occur without alarming signs of preeclampsia, hence making it quite difficult to differentiate from normal pregnancy symptoms and diagnose.
- Is HELLP syndrome life-threatening?
HELLP syndrome is a life-threatening clinical condition and without early detection and treatment could lead to the death of both mother and fetus.