HELLP Syndrome as a separate entity : HELLP Syndrome as a separate entity Dr. Mohammed Abdalla
EGYPT, Domiat G. Hospital HELLP Syndrome : HELLP Syndrome may it be a separate entity? yes Slide 4: In some cases , HELLP symptoms are the first warning of preeclampsia and the condition is misdiagnosed as hepatitis, idiopathic thrombocytopenic purpura, gallbladder disease, or thrombotic thrombocytopenic purpura. Slide 18: Platelet count appears to be the most reliable indicator of the presence of HELLP syndrome Classification : Classification full HELLP syndrome partial HELLP syndrome based on the number of abnormalities Audibert F, Friedman SA, Frangieh AY, Sibai BM. Am J Obstet Gynecol 1996; 175:460-4. considered for delivery within 48 hours candidates for more conservative management Classification : Classification on the basis of platelet count class I, less than 50,000 per mm3 class II, 50,000 to less than 100,000 per mm3 class III, 100,000 to 150,000 per mm3 Slide 22: Management Corticosteroids Magnesium sulphate Hypotensive drugs Blood products Delivery Slide 24: hypertension is controlled at less than 160/110 mm hg,
Oliguria responds to fluid management .
Elevated liver function values are not associated with right upper quadrant or epigastric pain.
Class II –III .(platelet count).>50000 Eligibility to conservative management Slide 25: Corticosteroids Slide 26: The Cochrane Library holds two protocols which when complete may summarize evidence to date on the use of corticosteroids for HELLP syndrome . and interventionist versus expectant management of severe pre-eclampsia before term. Slide 27: The antenatal administration of dexamethasone (Decadron) in a high dosage of 10 mg intravenously every 12 hours has been shown to markedly improve the laboratory abnormalities associated with HELLP syndrome.
Steroids given antenatally do not prevent the typical worsening of laboratory abnormalities after delivery. However, laboratory abnormalities resolve more quickly in patients who continue to receive steroids postpartum. Magann EF, Bass D, Chauhan SP, Sullivan DL, Martin RW, Martin JN Jr. Am J Obstet Gynecol 1994;171:1148-53. Slide 29: Intravenously administered dexamethasone appears to be more effective than intramuscularly adminstered betamethasone for the antepartum treatment of mothers with HELLP syndrome.
(Am J Obstet Gynecol 2001;184:1332-9.). Slide 30: Administration of glucocorticoids increases the use of regional anesthesia in women with antepartum HELLP syndrome who have thrombocytopenia.
(Am J Obstet Gynecol 2002;186:475-9.). Slide 31: Patients treated with dexamethasone exhibit longer time to delivery; This facilitates maternal transfer to a tertiary care center and postnatal maturity of fetal lungs (Am J Obstet Gynecol 2002;186:475-9.). Slide 32: Magnesium sulphate Slide 34: antihypertensive agent Slide 37: blood product Slide 40: Anesthesia Considerations Slide 42: Complications Complications : Complications The mortality rate for women with HELLP syndrome is approximately 1.1 %
From 1 to 25 % of affected women develop serious complications such as DIC, placental abruption, adult respiratory distress syndrome, hepatorenal failure, pulmonary edema, subcapsular hematoma and hepatic rupture.
A significant percentage of patients receive blood products. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993;169:1000-6. Complications : Infant morbidity and mortality rates range from 10 to 60 %, depending on the severity of maternal disease.
Infants affected by HELLP syndrome are more likely to experience intrauterine growth retardation and respiratory distress syndrome. Dotsch J, Hohmann M, Kuhl PG. Neonatal morbidity and mortality associated with maternal haemolysis, elevated liver enzymes and low platelets syndrome. Eur J Pediatr 1997;156:389-91. Complications Complications : Complications take home : take home Once the diagnosis of HELLP syndrome has been established, the best markers to follow are the
maternal lactate dehydrogenase level and
the maternal platelet count take home : The incidence of hemorrhagic complications is higher when platelet counts are < 40,000 per mm3 take home Slide 51: Thank you