HELLP Syndrome is a problem that occurs in pregnancy and is responsible for a considerable number of both maternal and perinatal deaths. This syndrome, which is considered by many experts to be a variant of pre eclampsia, affects one or two women in every 1000 pregnancies.
HELLP syndrome usually affects women who are between the 28th and 36th week of pregnancy. This syndrome occurs due to a trophoblastic invasion that puts the fetal tissue in contact with the mother's immune system, causing a immune rejection.
The disease has three classic laboratory signs: hemolysis, increased levels of liver enzymes and a low platelet count (plateletopenia). This triad gave the disease its name: H- hemolysis, EL- elevated liver and LP- low plateler count.
The symptoms of HELLP syndrome vary greatly from patient to patient, but are usually seen. abdominal pain, epigastric pain (most frequent symptom), nausea, vomiting, headache, fatigue and malaise. These symptoms, not being very specific, are often confused with the symptoms of pre-eclampsia.
To make the diagnosis, some laboratory tests are performed. In order for the disease to be confirmed, the exams must show:
- Hemolytic anemia, seen through a blood smear;
- Platelet value equal to or less than 100,000 cells/µl;
- LDH equal to or greater than 600UI/l or total bilirubin equal to or greater than 1.2mg/dL;
- Serum concentration of AST (aspartate aminotransferase) equal to or greater than 70 IU/l.
Once the diagnosis is made, it is essential to carry out tests to know the conditions in which the baby is found and to stabilize the mother's condition. It is important to initially maintain blood pressure with the use of medications. In case of bleeding, very low platelet count values or the need for cesarean section, it is recommended that a platelet transfusion be performed.
The normal procedure in case of HELLP Syndrome is termination of pregnancy with the delivery. However, this will mainly depend on the gestational age. In women 34 weeks and older, delivery is indicated. In women with lower gestational age, it is recommended to use steroids for fetal lung maturation and wait at least 48 hours. It is worth noting that the type of delivery to be performed should be analyzed with the doctor, who will check the conditions of the mother and baby. This topic is still a matter of debate among physicians.
Early diagnosis is essential for the establishment of an efficient treatment, avoiding possible complications. Among the most common complications of HELLP syndrome, we highlight the disseminated intravascular coagulation, placental abruption, acute renal failure, hepatic subcapsular hematoma, pulmonary and cerebral edema, and multiple organ failure. Liver rupture is one of the most important problems as it is linked to many deaths of mothers and babies.
Therefore, it is essential that all pregnant women perform a judicious prenatal care, as only so it is possible to check the problems of pregnancy early and establish a procedure right.
By Ma. Vanessa dos Santos
Source: Brazil School - https://brasilescola.uol.com.br/biologia/sindrome-hellp.htm