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HELLP Syndrome

The HELLP syndrome is a form of pregnancy poisoning that poses a high risk of serious complications in the mother.

HELLP Syndrome

What is HELLP Syndrome?

HELLP syndrome is a complication that can occur during pregnancy or shortly after birth. It is a condition characterized by the destruction of red blood cells (hemolysis, H), the amount of liver enzymes in the blood increases (elevated liver enzymes, EL) and the number of platelets decreases (low platelets, LP). The term syndrome refers to the fact that there can be a variety of symptoms and signs. The HELLP syndrome is classified as either an atypical form of preeclampsia or as a complication of severe pregnancy poisoning. The diagnosis is based on laboratory findings. The syndrome was first described in 1982.

This form of pregnancy poisoning poses a high risk of serious complications in the mother.

It is stated that 10-20% of pregnant women with severe pregnancy poisoning develop HELLP syndrome, but the incidence is probably higher because the diagnosis is not made. For more information about pregnancy and maternity fashion, please see BESTAAH.COM maternity sweatpants. The HELLP syndrome occurs before birth in 70% of cases, in most before the 37th week of pregnancy and in 11% of these during the 2nd trimester. In 30% of patients, the syndrome develops during the first 48 hours after birth. As the HELLP syndrome debuts after birth, there is no evidence of pregnancy poisoning before birth at 20%. There is a subgroup (5-10%) where the syndrome debuts more than 72 hours after birth, or where there is no evidence of improvement in the disease 72 hours after birth.

Cause

The underlying cause is unknown. Probably both hereditary (genetic) and immunological factors are involved. Early in the course of the disease, there appear to be disorders of the blood's delivery system (coagulation system) and damage to the inside of the blood vessels (endothelial damage). Liver damage results in increased secretion of liver enzymes into the blood.

Patients with severe pregnancy poisoning are at greater risk of a number of serious complications in the mother.

Diagnosis

The starting point is usually the presence of pregnancy poisoning (high blood pressure, a lot of fluid in the body, protein in the urine). HELLP syndrome usually leads to abdominal pain (90%), nausea and vomiting (about 50%) and changes in blood tests (liver enzymes and platelets). The abdominal pain is usually located in the upper right side of the stomach. In 15-20% of cases, the condition is without stomach pain, high blood pressure and protein in the urine. Symptoms can be confused with viral disease and biliary tract disease.

The diagnosis is made on the basis of typical laboratory findings.

Treatment

The condition requires hospitalization and close monitoring. The blood pressure, the degree of high blood pressure, liver damage and proteinuria are the basis for assessing when the patient can leave the hospital.

The goal of treatment is to prevent injuries, and death of mother and child. Treatment of patients with HELLP syndrome is difficult. The risk of failure in many organs and the woman's death must be emphasized in relation to the child's risk of premature delivery. The only known cure is childbirth with removal of the entire placenta. In most cases, there will be improvement in the woman's condition and laboratory values ​​within the first 48 hours after birth. It is common for the birth to be by caesarean section if the condition complicates severe pregnancy poisoning during the 32nd-34th week of pregnancy.

Sometimes, cortisone therapy is attempted, but there is considerable uncertainty about the benefits of such treatment.

In women with a history of HELLP syndrome, it may be necessary to provide prophylactic treatment with acetylsalicylic acid in combination with blood thinners (low molecular weight heparin) in the next pregnancy.

Forecast

The process is unpredictable. The condition can progress rapidly with a decrease in the number of platelets and increased liver damage, or remain stable with a slight decrease in the number of platelets in the blood. A HELLP syndrome associated with childbirth is most pronounced during the first 24 hours. The condition goes back in most people during the first 48 hours after birth.

Maternal mortality is set at 3–5%. The risk is greatest for those with the most extreme symptoms. There is an increased risk of complications such as premature discharge of the placenta and severe pregnancy poisoning. An important reason for poor prognosis is that the diagnosis is often made late in the process.

Child mortality is estimated at 6–37%. It is due to premature discharge of the placenta, lack of oxygen to the fetus and premature birth.

In a new pregnancy, the risk of HELLP syndrome is stated to be 3-4%. At an early start in pregnancy, before the 32nd week of pregnancy, there is a recurring risk of 42% in the next pregnancy.

Follow-up

Women who have previously had HELLP syndrome can in most cases use birth control pills. A woman who has had HELLP syndrome may need to be assessed for a deficiency in the blood supply system (coagulation defect).

 

 

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