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Pregnancy and Childbirth: The answers

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Home |  Pregnancy overview |  Reproductive Health | Complications | Labor & Birth

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Holding measures once HELLP syndrome has been diagnosed include giving steroids to accelerate fetal lung maturity ready for delivery. Other measures may include blood transfusion, intravenous fluids and anti-hypertensives to control the blood pressure.

 

If HELLP is complicated by DIC (see previous page), Fresh frozen Plasma (FFP) may be required to control this very dangerous development.

 

The bottom line is that delivery of the baby is the only effective cure for HELLP syndrome.

 

HELLP syndrome complications

HELLP Syndrome can be fatal. Mortality is just over 1%. Other complications that could occur include serious respiratory difficulties (for the mother) in the form of pulmonary edema or Adult Respiratory Distress Syndrome (ARDS), DIC (see above), placental abruption and liver and/or kidney failure.

 

Role of corticosteroids in HELLP syndrome

There is some evidence that administering corticosteroids such as Dexamethasone might help stabilise the situation in mild or moderate HELLP syndrome to buy vital time for safe delivery of the baby. The aim of these is to arrest the destruction of the platelets and probably the hemolysis to stop progression into full-blown DIC.

 

The evidence to their effectiveness is not very strong. In any case, these will only be considered where the condition is judged to be mild or moderate and the baby is severely pre-term. There is no place for prevarication when this develops in the third trimester.

 

Cesarean section with HELLP syndrome

Unless it is absolutely necessary, operative delivery needs to be avoided in this condition. With the risk of DIC and uncontrollable hemorrhage, it is not difficult to see why.

 

HELLP syndrome recurrence

HELLP syndrome will recur in up to a quarter of all patients in a subsequent pregnancy. When this happens, it tends to at a later stage of pregnancy and generally will be less severe. However, significantly, the risk of pre-eclampsia in a subsequent pregnancy is much higher, at just under 45%.

 

HELLP syndrome after delivery

HELLP syndrome can occur after delivery. Postnatal HELLP accounts for almost 1 in 12 of all cases. Aggressive management here is aided by the fact that there is no fetal wellbeing to consider.

 

 

Contraception after HELLP syndrome

It is perfectly OK to use the oral contraceptive pill after HELLP syndrome once all the liver function tests are back to normal. This is, as long as there are no other contra-indications to the use of the Pill.