HELLP syndrome

The HELLP syndrome is a serious medical condition during pregnancy, which is one of the hypertensive disorders. The letters HELLP stand for the English words of the most important findings:

  • Haemolysis (haemolytic anemia)
  • Elevated Liver enzyme levels ( elevated liver enzymes (GOT, GPT, GLDH, LDH, AP, GGT, bilirubin ) )
  • Low Platelet count ( reduction of platelets ( platelet ) = thrombocytopenia)

The HELLP syndrome occurs in approximately 1-2 of 300 pregnancies, about 4 to 12 % of pregnant women with severe pre-eclampsia, a form of HELLP syndrome.

Symptoms

The HELLP is a more complicated variant of preeclampsia. Symptom is in addition to the symptoms of pre-eclampsia (edema, high blood pressure, protein in the urine) of liver dysfunction with massive, often radiating pain especially in the right upper abdomen (liver capsule voltage). Accompanying non-specific symptoms such as nausea, vomiting or diarrhea may be. Headaches, blurred vision ( therefore possibly confusion with impending eclampsia! ) Can be an indication. You may quickly develop a shock syndrome as a result of DIC, acute renal failure, pulmonary edema, cerebral hemorrhage, or rupture of a subcapsular liver hematoma with intraabdominal bleeding.

Diagnostics

Laboratory:

Crucial for the diagnosis of HELLP syndrome is the " chemical laboratory triad " consisting of hemolysis (lowered haptoglobin ), transaminases ( ASAT, ALAT ) and thrombocytopenia.

  • Haemolysis (Hb, bilirubin, LDH, haptoglobin ), hematocrit
  • Reduction of coagulation factors
  • Increase of GOT, GPT, LDH and bilirubin
  • Platelet waste
  • Creatinine (renal failure), proteinuria

Child:

  • Intrauterine: up to 50 % growth retardation
  • Asphyxia with CTG changes as a result of placental insufficiency
  • Perinatal mortality: 10-40 %

Forecast

Materne 3-5% mortality, fetal perinatal mortality 10-40 %. No correlation with the severity of pre-eclampsia, and in particular the height of the blood pressure.

Course

Hemolysis may progress to massive anemia with their symptoms. The reduction of platelet internal bleeding often can not be ruled out. With increasing duration of the HELLP syndrome, the liver damage is constantly increasing, which may result, under the liver capsule and subsequently even to Leberrupturen to hematomas. Another serious complication is acute renal failure and the sudden removal of the placenta.

Causes

The cause (etiology ) of the HELLP syndrome is not yet clear. Is currently investigated whether by damage to the inner side ( see endothelium) of blood vessels of the placenta where a bleeding is caused. This massive clotting, the platelet count falls dangerously. The deposition of excess fibrin leads to increasing damage to the liver.

Therapy

The dynamics of the HELLP syndrome is very difficult to estimate. Therefore, a cesarean section is performed in most cases. In the literature it has been reported from cases in which the platelet count dropped to values ​​of 20.000/Mikroliter. Therefore, the HELLP patient in need of intensive care monitoring. In the acute situation antihypertensives come for blood pressure control and anticonvulsants used.

A conservative therapy with ASA, immunoglobulins, plasmapheresis are regarded as special cases and are used in very early pregnancies and very slow progression. The reason is the already mentioned unpredictable dynamics. A rupture of the liver can lead to death within a short time of the pregnant woman.

Literature and sources

  • Kay Goerke: Pocket Atlas of Obstetrics, Thieme Verlag, Stuttgart 2006, ISBN 3- 13-131141 -X
  • Haram K, Svendsen E, Abildgaard U: The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth. 2009 February 26; 9:8. PMID 19245695
  • Mihu D, Costin N, Mihu CM, Seicean A, Ciortea R: HELLP syndrome - a multisystemic disorder. J Gastrointestin Liver Dis. 2007 Dec, 16 ( 4) :419 -24. Review. PMID 18193124
  • Padden MO. HELLP syndrome: recognition and perinatal management. Am Fam Physician. Sep 1, 1999, 60 (3) :829-36, 839 Review. PMID 10498110
  • Rath, Werner: The HELLP syndrome - an interdisciplinary challenge. Dtsch Arztebl 1998; 95 (47 ): A- 2997 / B- 2555 / C- 2367
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