HELLP Syndrome

“HELLP” Syndrome refers to a grouping of symptoms which represent a severe and potentially life threatening obstetrical emergency, requiring careful obstetrical management.

The acronym “HELLP” refers to: H = Hemolysis; EL = Elevated liver enzymes; and LP = Low platelets.

HELLP Syndrome is recognized as most typically occurring in patients who have the most severe forms of the disease pre-eclampsia, also known as toxemia of pregnancy.

It has been estimates that as many as 20 percent of patients with severe pre-eclampsia or eclampsia also suffer from HELLP Syndrome.

It is believed by many researchers that liver or hepatic damage associated with severe pre-eclampsia is directly associated with the onset of HELLP Syndrome. When the liver is damaged, liver enzymes will be elevated.

In the most severe forms of HELLP Syndrome, liver or hepatic hemorrhage or infarction may occur, leading to the rupture of the liver, and placing the life of both the mother and baby at grave risk. The acute rupture of the liver is typically associated with acute upper abdominal or right upper quadrant pain, nausea and vomiting.

It has been estimated that the maternal death rate associated with liver rupture is as high as 30 percent.

Hemolysis refers to the breakdown of red blood cells, another serious complication associated with HELLP Syndrome.

Low platelets, also known as thrombocytopenia, can result in coagulation disorders, which alone can lead to potentially severe or life threatening complications.

Patients at risk for the development of HELLP Syndrome require meticulous obstetrical monitoring and treatment. The management of patients at risk for HELLP Syndrome typically includes frequent blood pressure assessments, close control of hypertension and serial blood and urine laboratory evaluations to assess major organ function, including liver enzyme studies, blood glucose and coagulation studies.

In addition to closely monitoring and treating a patient at risk for HELLP Syndrome, safe and careful obstetricians will typically initiate a regimen of fetal surveillance.

Such fetal surveillance may consist of ultrasonography, serial nonstress testing and biophysical profile testing.

The babies of patients who are at risk for the development of HELLP Syndrome are also at risk for preterm delivery and fetal growth restriction, also known as “IUGR”.

Because the babies of patients who are at risk for HELLP Syndrome are also at risk for uteroplacental insufficiency, the additional stress of uterine contraction associated with labor may result in fetal hypoxia, potentially leading to permanent neurologic injury or even death.

Because of the extreme risks to both mother and baby associated with HELLP Syndrome, many safe and careful obstetricians will deliver their patients well prior to term.

In many cases, safe and careful obstetricians will refer their patients who are at risk for developing HELLP Syndrome to maternal-fetal specialists, doctors who are specifically trained in managing the pregnancies of patients at risk for HELLP Syndrome.

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