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Pregnancy and Childbirth: The answers

 

HELLP syndrome complicating pregnancy

HELLP is a specific presentation or can occur as a variant of pre-eclampsia. It was first described as a clinical entity in its own right by a Dr Weinstein in the early 1980s. It is not clearly known why HELLP syndrome develops.

 

HELLP syndrome is characterized by three main features which make up its acronym:

Ø Hemolysis: This means the destruction of red blood cells

Ø Elevated Liver enzymes: A blood test will show that the levels of the liver enzymes especially the ‘Transaminases’ will be raised.

Ø Low Platelets: A blood count will show falling platelet count as these are destroyed.

 

HELLP is a very serious pregnancy complication which can be fatal. Once this is diagnosed, the life of the baby is  in peril and so could the mother’s. Expedited delivery is the only effective answer.

HELLP can occur with no obvious preceding pre-eclampsia. In fact proteinuria, a necessary feature of pre-eclampsia may be absent.

Recognising HELLP Syndrome

Symptoms suggestive of developing HELLP syndrome include

· General malaise

· Headache

· Pain in the right upper abdomen (location of the liver)

· Tingling or ‘pins and needles’ sensation in the extremeties (toes and fingers)

· Nausea and/or vomiting

HELLP syndrome could occur in the absence of most or even all of the above symptoms.

Blood tests will quickly show falling platelet count and elevated liver enzymes as well as a falling hemoglobin level. There will be the telltale features of breakdown of blood cells (hemolysis) as a result of activation of the coagulation cascade and of-course progressive anemia.

 

HELLP syndrome could lead to what is medically known as consumptive coagulopathy. Basically, this means there is wide-spread coagulation (clotting) taking place in the micro-vasculature and these tiny clots are continually broken down forming a vicious cycle. This is termed Disseminated Intravascular Coagulation (DIC). DIC can lead to an exhaustion of the stores of cloting factors resulting in the exact opposite complication: Uncontrolled hemorrhage.

 

A test known as D-dimer which detects products of clot breakdown in the blood is sometimes useful in predicting HELLP syndrome complication in patients with pre-eclampsia. It is not a very specific test and hence is not used routinely for this purpose.

 

Management of HELLP syndrome

Being a potentially very serious condition, it is imperative that once the diagnosis is suspected or confirmed, management should be at a center with the expertise and facilities to deal with this as well as neonatal intensive care.

 

When this condition develops very remote from ‘Term’ and severe prematurity is inevitable, the baby’s prospects are dire. Close to half of all babies in HELLP syndrome are lost, the main cause being prematurity.

 

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