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HELLP syndrome is a life-threatening http://www.answers.com/topic/obstetrics complication considered by many to be a variant of http://www.answers.com/topic/pre-eclampsia. Both conditions occur during the latter stages of http://www.answers.com/topic/pregnancy, or sometimes after http://www.answers.com/topic/childbirth. HELLP is an abbreviation of the main findings: * http://www.answers.com/topic/hemolysis
* Elevated http://www.answers.com/topic/liver-function-tests-1 and
* http://www.answers.com/topic/thrombocytopenia-7
Often, a patient who develops HELLP syndrome has already been followed up for http://www.answers.com/topic/pregnancy-induced-hypertension (gestational hypertension), or is suspected to develop http://www.answers.com/topic/pre-eclampsia (high blood pressure and http://www.answers.com/topic/proteinuria). Up to 8% of all cases present after delivery. There is gradual but marked onset of http://www.answers.com/topic/headache (30%), blurred vision, http://www.answers.com/topic/malaise-10 (90%), http://www.answers.com/topic/nausea-14/vomiting (30%), "band pain" around the upper http://www.answers.com/topic/abdomen (65%) and tingling in the extremities. http://www.answers.com/topic/edema may occur but its absence does not exclude HELLP syndrome. http://www.answers.com/topic/hypertension-20 is a diagnostic requirement, but may be mild. Rupture of the liver capsule and a resultant http://www.answers.com/topic/hematoma may occur. If the patient gets a http://www.answers.com/topic/seizure or http://www.answers.com/topic/coma, the condition has progressed into full-blown http://www.answers.com/topic/eclampsia. Patients who present symptoms of HELLP can be misdiagnosed in the early stages, increasing the risk of liver failure and morbidity (Padden, 1999). rarely post caesarean patient may present in shock condition mimicking either pulmonary embolism or reactionary haemorrhage. In a patient with possible HELLP syndrome, a batch of http://www.answers.com/topic/blood-test is performed: a http://www.answers.com/topic/full-blood-count, http://www.answers.com/topic/liver-function-tests-1, http://www.answers.com/topic/renal-function and http://www.answers.com/topic/electrolyte and http://www.answers.com/topic/coagulation studies. Often, http://www.answers.com/topic/fibrin degradation products (FDPs) are determined, which can be elevated. http://www.answers.com/topic/lactate-dehydrogenase is a marker of hemolysis and is elevated (>600 U/liter). http://www.answers.com/topic/proteinuria is present but can be mild. The http://www.answers.com/topic/platelet count has been found to be moderately predictive of severity: under 50 million/L is class I (severe), between 50 and 100 is class II (moderately severe) and >100 is class III (mild). This system is termed the Mississippi classification (Martin et al 1990). The exact cause of HELLP is unknown, but general activation of the coagulation cascade is considered the main underlying problem. Fibrin forms crosslinked networks in the small http://www.answers.com/topic/blood-vessel. This leads to a http://www.answers.com/topic/microangiopathic-hemolytic-anemia: the mesh causes destruction of http://www.answers.com/topic/red-blood-cell as if they were being forced through a strainer. Additionally, http://www.answers.com/topic/platelet are consumed. As the http://www.answers.com/topic/liver appears to be the main site of this process, downstream liver cells suffer http://www.answers.com/topic/ischemia, leading to periportal necrosis. Other organs can be similarly affected. HELLP syndrome leads to a variant form of http://www.answers.com/topic/disseminated-intravascular-coagulation (DIC), leading to paradoxical http://www.answers.com/topic/bleeding, which can make emergency surgery a serious challenge. The only effective treatment is delivery of the baby. Several medications have been investigated for the treatment of HELLP syndrome, but evidence is conflicting as to whether http://www.answers.com/topic/magnesium-sulfate decreases the risk of seizures and progress to eclampsia. The DIC is treated with http://www.answers.com/topic/fresh-frozen-plasma-1 to replenish the coagulation proteins, and the http://www.answers.com/topic/anemia may require http://www.answers.com/topic/blood-transfusion. In mild cases, http://www.answers.com/topic/corticosteroid and http://www.answers.com/topic/antihypertensive (http://www.answers.com/topic/labetalol, http://www.answers.com/topic/hydralazine, http://www.answers.com/topic/nifedipine) may be sufficient. Intravenous fluids are generally required. Its incidence is reported as 0.2-0.6% of all pregnancies. Of women with (pre)eclampsia, 4-12% also develop signs of a "superimposed" HELLP syndrome. Mortality is 7-35% and perinatal mortality of the child may be up to 40%. HELLP usually begins during the third trimester, and usually in Caucasian women over the age of 25. (Padden, 1999.) Rarely, cases have been reported as early as 23 weeks gestation.
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What are some signs and symptoms for the HELLP syndrome?
The "HELLP" syndrome is a series of symptoms that occurs in pregnant women and refers to "hemolysis, elevated liver enzymes and low platelet count". Some signs and symptoms of the HELLP syndrome are hypertension, nausea and heartburn.
What causes elevated liver enzymes during pregnancy?
HELLP syndrome is a condition during pregnancy that includes elevated liver enzymes.
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What does the medical abbreviation HELLP mean?
HELLP stands for hemolysis, elevated liver enzymes, and low platelets. It is a dangerous condition in pregnancy with a high mortality rate.
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HELLP syndrome?
DefinitionHELLP syndrome is a group of symptoms that occur in pregnant women who have:H -- hemolysisEL -- elevated liver enzymesLP -- low platelet countCauses, incidence, and risk factorsHELLP syndrome occurs in approximately 10% of pregnant women with preeclampsiaor eclampsia. HELLP syndrome is associated with more serious cases.Many women have high blood pressure and are diagnosed with preeclampsia before they develop HELLP syndrome. However, in some cases, HELLP symptoms are the first warning of preeclampsia and the condition is misdiagnosed as hepatitis, gallbladder disease, idiopathic thrombocytopenic purpura, or thrombotic thrombocytopenic purpura.SymptomsHeadacheNausea and vomiting that continues to get worseUpper abdominal painVision problemsSigns and testsDuring a physical examination, the doctor may discover upper abdominal tenderness, especially in the right upper side. The liver may be enlarged.Liver function tests (liver enzymes) may be elevated. Red blood cell and platelet counts may be low.TreatmentThe main treatment is to deliver the baby as soon as possible, even if premature, since liver function in the mother gets worse very quickly. Problems with the liver can be harmful to both mother and child.Expectations (prognosis)When the disease is not treated early, up to 25% of women develop serious complications. Without treatment, a small number of women die. The death rate among babies born to mothers with HELLP syndrome varies and depends on birth weight and the development of the baby's organs, especially the lungs. (See also: Prematurity)ComplicationsThe mother's liver may bleed (hemorrhage). Permanent liver damage may occur if delivery is delayed. Such damage can lead to death.Calling your health care providerSee your obstetrician immediately, call the local emergency number (such as 911), or get to the emergency room if the symptoms above occur during pregnancy.Although there is no known way to prevent HELLP syndrome, it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as HELLP syndrome early.ReferencesSibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 33.Martin JN, Rose CH, Briery CM. Understanding and managing HELLP syndrome: The integral role of aggressive glucocorticoids for mother and child. American Journal of Obstetrics and Gynecology. 2006; 195(914-34).
