HELLP SYNDROME

HELLP SYNDROME

occurs in 4% to 12% of

patients who have elevated blood pressure during

pregnancy. It is a serious syndrome because it

results in a maternal mortality rate as high as

24% and an infant mortality rate as high as 35%.

HELLP Syndrome pneomonic

● Hemolysis that leads to anemia,

● Elevated Liver enzymes that lead to

epigastric pain,

● Low platelets that lead to abnormal

bleeding/clotting, and

● Petechiae (tiny spots caused by broken

capillaries under the skin or mucous

membranes; looks like a rash but is not; may

be purple, red, or brown.)

RISKS / PREDISPOSING FACTORS

Reason why some women with elevated

blood pressure also develop the HELLP

syndrome is unknown.

● It occurs in both primigravidas and

multigravidas.

● Associated with antiphospholipid

syndrome or the presence of

antiphospholipid antibodies.

Other risk factors for HELLP syndrome include:

● History of HELLP syndrome in a previous

pregnancy.

● Being older than 35.

● Having given birth at least once before.

● Being white (reported in some studies).

● History of kidney disease, diabetes or high

blood pressure.

Signs & Symptoms

● Proteinuria

● Edema

● Increased blood pressure

● Additional symptoms:

a. Nausea

b. Epigastric pain,

c. General malaise

d. Right upper quadrant tenderness

from liver inflammation

Clinical Manifestations

● Hemolysis of red blood cells (they appear

fragmented on a peripheral blood smear)

● Thrombocytopenia (a platelet count

100,000/mm 3 )

● Elevated liver enzyme levels (alanine

aminotransferase [ALT] and serum aspartate

aminotransferase [AST]).

All are effects of hemorrhage and necrosis of the liver.

PREVENTION

There is no known way to prevent HELLP

syndrome.

COMPLICATIONS

● Subcapsular liver

● Hematoma

● Hyponatremia (lower than normal level of

sodium in the bloodstream)

● Renal failure

● Hypoglycemia from poor liver function.

MOTHERS

● Cerebral hemorrhages

● Aspiration pneumonia

● Hypoxic encephalopathy

● Pulmonary edema

● Eclampsia

● Placental abruption

FETUS

● Growth restriction

● Preterm birth

● Born with low platelet count, anemia, or

other blood disorders

● Respiratory distress

DIAGNOSTIC TESTS

To diagnose HELLP syndrome, the healthcare

provider will do a physical exam and check for:

● Belly pain, especially on the upper right side.

● Leg swelling.

Often, the blood pressure will be high and/or there

will be protein in the urine. The provider will order the

following blood tests:

● Complete blood count (CBC).

● Liver function test.

● Kidney function test.

In severe cases, the healthcare provider may use an

ultrasound or CT scan (computed tomography scan)

to check for an enlarged liver or bleeding in the liver

THERAPEUTIC MANAGEMENT /

TREATMENT

● Transfusion of fresh frozen plasma or

platelets in order to improve the platelet

count.

● If hypoglycemia is present, this is corrected

by an intravenous glucose infusion.

● The infant is born as soon as feasible by

either vaginal or cesarean birth.

Other things the healthcare provider can do to treat

HELLP syndrome until the fetus matures include:

● Medication to lower your blood pressure.

● Magnesium sulfate to prevent seizures.

● Corticosteroids to help the lungs of the fetus

develop.

● Blood tests to monitor your liver function

and platelet count.

NURSING INTERVENTION

Because of the low platelet count, women

with the HELLP syndrome need extremely

close observation for bleeding, in addition to

the observations necessary for

preeclampsia.

● Be alert that maternal hemorrhage may

occur at birth because of poor clotting

ability.

● Epidural anesthesia may not be possible

because of the low platelet count and the

high possibility of bleeding at the epidural

site.

● Laboratory results return to normal after

birth, the same as preeclamptic symptoms,

but the experience of developing the HELLP

syndrome is frightening.

● Women need assurance afterward that

symptoms were pregnancy related and so

will not return.