HELP syndrome is a rare pathology in women who are on later pregnancy. It is almost always discovered about a month before the start. labor activity. In some women, signs of this syndrome appeared after childbirth. George Pritchard was the first to describe this pathology. It must be said that this rare syndrome occurs in only seven percent of women, but 75% of cases are fatal.
The name HELLP is an abbreviation English words. Each letter is deciphered as follows:
- H – destruction of red blood cells.
- EL – increase in liver enzyme levels.
- LP - a decrease in the level of red blood cells, which serve for blood clotting.
IN medical practice, namely in obstetrics, HELP syndrome is understood as some deviations in female body, which do not allow a woman to become pregnant or bear a healthy baby without pathologies.
Etiology
To date, the exact causes of this syndrome have not yet been clarified. However, scientists continue to put forward various theories of its origin. Today there are already more than thirty theories, but not one can point to the fact that affects the appearance of pathology. Experts have noticed one pattern - such a deviation appears against the background of something that appeared late.
A pregnant woman suffers from swelling, which begins in the arms and legs, then moves to the face, then to the whole body. The level of protein in the urine increases, and blood pressure also increases. This condition is extremely unfavorable for the fetus, because aggressive antibodies to it are formed in the mother’s body. They negatively affect red blood cells and platelets, destroying them. In addition, the integrity of blood vessels and liver tissue is compromised.
As mentioned earlier, HELP syndrome occurs for currently unknown reasons.
However, you can pay attention to some factors that increase the risk of pathology:
- diseases immune system;
- heredity, when there is a lack of enzymes in the liver, that is congenital pathology;
- changes in the number and purpose of lymphocytes;
- education in blood vessels liver;
- long-term use medications without doctor's supervision.
When observing pathology, we can identify certain factors that are called provoking:
- numerous births in the past;
- the age of the woman in labor is more than twenty-five years;
- pregnancy with multiple fetuses.
The hereditary factor has not been established.
Classification
Based on exactly what signs HELP syndrome exhibits, some experts have created the following classification:
- obvious symptoms of intravascular thickening;
- suspect signs;
- hidden.
The classification of J. N. Martin has a similar principle: here the syndrome with same name HELP is divided into two classes.
Symptoms
The first signs that appear are nonspecific, so it is impossible to diagnose the disease based on them.
A pregnant woman experiences symptoms such as:
- nausea;
- often vomiting;
- dizziness;
- pain in the side;
- causeless anxiety;
- fast fatiguability;
- painful sensations at the top of the abdomen;
- color change skin to yellow;
- the appearance of shortness of breath even with light exertion;
- visual impairment, brain activity, fainting.
The first manifestations are observed against the background of large edema.
During the rapid development of the disease or in the case when medical care was provided too late, it develops, appears, the process of urination is disrupted, convulsions occur, and body temperature rises. In some situations, a woman may fall into a coma. The doctor can put accurate diagnosis HELP syndrome only based on laboratory test results.
There is also a pathology that appears after the birth resolution. The risk of its development increases when a woman had severe late toxicosis during pregnancy. Besides, C-section or difficult childbirth can also be provocateurs. If a woman in labor has previously experienced the symptoms described above, then she should be taken under close supervision. This should do medical staff maternity hospital.
Diagnostics
If a doctor suspects a pregnant woman has such a disease, he must write her a referral for laboratory tests, such as:
- urine analysis - it can be used to find out the level and presence of protein, in addition, the functioning of the kidney is diagnosed;
- taking blood for analysis to find out the level of hemoglobin, platelets and red blood cells, and the bilirubin indicator is also important;
- ultrasonography conditions of the placenta, peritoneum, liver and kidneys;
- CT scan so as not to make a false diagnosis that has similar symptoms;
- cardiotocography - determines the viability of the fetus and evaluates its heartbeat.
In addition to these studies, a visual examination of the patient and anamnesis is performed. The presence of signs such as yellow skin, bruises from injections will help to more accurately establish the diagnosis.
Doctors often resort to the help of their colleagues working in other areas, for example, a resuscitator, gastroenterologist, or hepatologist.
When diagnosing this pathology, it is necessary to exclude the following diseases:
- exacerbation;
- different shapes(A, B, C);
- cocaine addiction;
- red and others.
Based on the diagnostic results, treatment tactics are determined.
Treatment
When a pregnant woman is diagnosed with HELP pathology, this is already an indication for urgent hospitalization. The main method of therapy is termination of pregnancy, because it is precisely because of this that this pathology arises.
However, there is a chance to save the child, because this condition in pregnant women manifests itself in the later stages, so the woman is induced for labor. In a situation where the uterus is ready and the gestation period is more than thirty-five weeks, a caesarean section is prescribed.
If the pregnancy is shorter, then the woman is prescribed glucocorticosteroids: they will help the fetal lungs open. But if there are signs such as heavy bleeding, high blood pressure, or bleeding in the brain, then an urgent caesarean section is necessary, and it does not matter how far along the pregnancy the woman is. The therapy provided stabilizes the woman’s condition and helps restore the baby’s health after surgery.
If the therapy method is correct, then the mother’s health will improve within a couple of days after the operation.
After this, the doctor must:
- stabilize the patient's condition;
- treat with antibiotics to prevent infectious diseases;
- prescribe medications to normalize the functioning of the kidneys and liver, as well as to prevent the formation of blood clots;
- stabilize blood pressure.
Before to the expectant mother will undergo a cesarean section, she may be prescribed a procedure such as plasmapheresis - plasma is removed from the blood, but only a clearly designated volume is used.
This is done with a special sterile, and disposable, device that separates the plasma. This is a harmless procedure that does not cause any discomfort to the woman. The duration takes approximately two hours. After this, a blood transfusion is necessary.
Also, in the process of preparing for the operation and immediately after it, the woman is prescribed medicines to lower blood pressure, liver failure, as well as renal.
This will only help complex therapy, which will include drugs such as:
- hormonal medications;
- means for stabilizing the functioning of the liver;
- medications that artificially reduce immunity.
After the operation, blood transfusion continues. The doctor also prescribes the use of lipoic and folic acid, vitamin C. If therapy is started on time and the operation is successful, then the prognosis is quite favorable. After delivery, all signs of pathology begin to disappear, however, relapse of the disease is high in all subsequent pregnancies.
Possible complications
The occurrence of complications from this pathology is quite common. Unfortunately, deaths cannot be ruled out. This applies not only to the mother, but also to the fetus.
The disease is dangerous due to the formation of blood clots and heavy bleeding any location. At severe course, hemorrhages may occur in the brain, and this is a malfunction of the central nervous system.
Disturbances in the kidneys and liver are also scary, because the consequences are such that the body is poisoned. Some cases of pathology end in coma, and it is not easy to get a woman out of this state.
It should be noted that pathologies may also occur in the fetus, because with this syndrome occurs.
This disease causes a woman following signs:
- pain in the upper abdomen;
- a sharp decline blood pressure;
- dyspnea;
- severe weakness.
The fetus experiences oxygen starvation, which leads to deviations in development, height and weight. In addition, the mother’s emerging ailments lead to diseases of the baby’s nervous system. Such children suffer, lag behind physically and mental development, moreover, they are .
When one-third of the placenta is separated, the fetus dies.
Prevention
Even if the health of the expectant mother before pregnancy is excellent, there is still a risk of pathology.
Therefore, a woman must follow the following rules of prevention:
- consciously plan pregnancy, avoid unwanted conception;
- carrying out therapeutic actions when identifying any diseases;
- exercise more, maintain a clear daily routine;
- after establishing the fact of pregnancy, visit the doctor according to the schedule;
- regular health monitoring, that is, testing;
- timely treatment of late toxicosis;
- healthy eating;
- drinking the required amount of fluid per day;
- give up heavy physical work, avoid ;
- compliance with the work/rest schedule;
- Be sure to notify your doctor about taking medications for chronic diseases.
Self-medication is unacceptable.
HELLP syndrome- rare and dangerous pathology in obstetrics. The first letters of the abbreviated name of the syndrome indicate the following:
H - Hemolysis (hemolysis);
EL - elevated liver enzymes (increased activity of liver enzymes);
LP - low platelet count (thrombocytopenia).
This syndrome was first described in 1954 by J.A. Pritchard, and R.S. Goodlin et al. (1978) associated the manifestation of this syndrome with preeclampsia. In 1982, L. Weinstein for the first time combined the triad of symptoms with a special pathology - HELLP syndrome.
EPIDEMIOLOGY
In severe cases of gestosis, HELLP syndrome, in which high maternal (up to 75%) and perinatal (79 cases per 1000 children) mortality is noted, is diagnosed in 4-12% of cases.
CLASSIFICATION
Based on laboratory signs, some authors have created a classification of HELLP syndrome.
- P.A Van Dam et al. Patients are divided according to laboratory parameters into 3 groups: with obvious, suspected and hidden signs of intravascular coagulation.
- The classification of J.N. is based on a similar principle. Martin, in which patients with HELLP syndrome are divided into two classes.
- First class - the platelet count in the blood is less than 50 x 10 9 / l.
- Second class - the concentration of platelets in the blood is 50-100 x 10 9 / l.
ETIOLOGY
Until now the real reason The development of HELLP syndrome could not be identified, but some aspects of the development of this pathology were clarified.
Celebrate possible reasons development of HELLP syndrome.
- Immunosuppression (depression of T-lymphocytes and B-lymphocytes).
- Autoimmune aggression (antiplatelet, antiendothelial antibodies).
- Decrease in the prostacyclin/thromboxane ratio (decreased production of prostacyclin-stimulating factor).
- Changes in the hemostasis system (liver vascular thrombosis).
- Genetic defects of liver enzymes.
- Use of medications (tetracycline, chloramphenicol). The following risk factors for the development of HELLP syndrome are identified.
- Bright skin.
- The pregnant woman is over 25 years old.
- Multiparous women.
- Multiple pregnancy.
- The presence of severe somatic pathology.
PATHOGENESIS
The pathogenesis of HELLP syndrome is currently not fully understood.
The main stages of the development of HELLP syndrome in severe forms of gestosis are considered to be autoimmune damage to the endothelium, hypovolemia with blood thickening and the formation of microthrombi with subsequent fibrinolysis. When the endothelium is damaged, it increases platelet aggregation which, in turn, promotes involvement in pathological process fibrin, collagen fibers, complement system, IgG and IgM. Autoimmune complexes are found in the sinusoids of the liver and in the endocardium. In this regard, it is advisable to use glucocorticoids and immunosuppressants for HELLP syndrome. The destruction of platelets leads to the release of thromboxanes and imbalance in the thromboxane-prostacyclin system, generalized arteriolospasm with worsening hypertension, cerebral edema and seizures. A vicious circle develops, which is currently only possible to break through emergency delivery.
Preeclampsia is considered a syndrome of multiple organ failure, and HELLP syndrome is its extreme degree, which is a consequence of maladaptation of the mother's body when trying to provide normal life fetus
Macroscopically, with HELLP syndrome, an increase in the size of the liver, thickening of its consistency, and subcapsular hemorrhages are noted. The color of the liver becomes light brown. At microscopic examination detect periportal hemorrhages, deposits of fibrin, IgM, IgG in the sinusoids of the liver, multilobular necrosis of hepatocytes.
CLINICAL PICTURE
HELLP syndrome usually occurs in the third trimester of pregnancy, most often at 35 weeks or more. The disease is characterized by a rapid increase in symptoms. Initial manifestations are nonspecific: nausea and vomiting (in 86% of cases), pain in the epigastric region and, especially, in the right hypochondrium (in 86% of cases), severe swelling (in 67% of cases), headache, fatigue, malaise, motor restlessness, hyperreflexia.
Characteristic signs of the disease are jaundice, vomiting blood, hemorrhages at injection sites, increasing liver failure, convulsions and severe coma.
Most common Clinical signs HELLP syndrome
Signs |
HELLP syndrome |
| Pain in the epigastric region and/or right hypochondrium | +++ |
| Headache | ++ |
| Jaundice | +++ |
| Arterial hypertension | +++/- |
| Proteinuria (more than 5 g/day) | +++/- |
| Peripheral edema | ++/- |
| Vomit | +++ |
| Nausea | +++ |
| Brain or visual disturbances | ++/- |
| Oliguria (less than 400 ml/day) | ++ |
| Acute tubular necrosis | ++ |
| Cortical necrosis | ++ |
| Hematuria | ++ |
| Panhypopituitarism | ++ |
| Pulmonary edema or cyanosis | +/- |
| Weakness, fatigue | +/- |
| Stomach bleeding | +/- |
| Bleeding at injection sites | + |
| Increasing liver failure | + |
| Hepatic coma | +/- |
| Convulsions | +/- |
| Fever | ++/- |
| Itchy skin | +/- |
| Weight loss | + |
| Note: +++, ++, +/- - severity of manifestations. | |
DIAGNOSTICS
Laboratory research
Quite often, laboratory changes occur much earlier than clinical manifestations.
- One of the main laboratory symptoms HELLP syndrome is caused by hemolysis, which is manifested by the presence of wrinkled and deformed red blood cells and polychromasia in the blood smear. The destruction of red blood cells leads to the release of phospholipids and to intravascular coagulation, i.e. chronic disseminated intravascular coagulation syndrome, which can cause fatal obstetric hemorrhages.
- If HELLP syndrome is suspected, it is necessary to immediately carry out laboratory research, including determination of the activity of ALT, AST, lactate dehydrogenase, concentration of bilirubin, haptoglobin, uric acid, platelet count in the blood and assessment of the state of the blood coagulation system.
The fundamental criteria for diagnosing HELLP syndrome are laboratory parameters
Laboratory indicators |
Changes in HELLP syndrome |
| Content of leukocytes in blood | Within normal limits |
| Activity of aminotransferases in the blood (ALT, AST) | Increased to 500 units (normal is up to 35 units) |
| Alkaline phosphatase activity in the blood | Marked increase (3 times or more) |
| Bilirubin concentration in blood | 20 µmol/l or more |
| ESR | Reduced |
| The number of lymphocytes in the blood | Normal or slight decrease |
| Blood protein concentration | Reduced |
| Blood platelet count | Thrombocytopenia (less than 100 x 10 9 /l) |
| The nature of red blood cells in the blood | Altered red blood cells with Barr cells, polychromasia |
| Number of red blood cells in the blood | Hemolytic anemia |
| Prothrombin time | Increased |
| Blood glucose concentration | Reduced |
| Clotting factors | Consumption coagulopathy: decrease in the content of factors for the synthesis of which vitamin K is required in the liver, decrease in the concentration of antithrombin III in the blood |
| Concentration of nitrogenous substances in the blood (creatinine, urea) | Promoted |
| Haptoglobin content in blood | Reduced |
Instrumental studies
- For early detection of subcapsular hematoma of the liver, ultrasound of the upper abdomen is indicated. Ultrasound of the liver in pregnant women with severe gestosis complicated by HELLP syndrome also reveals multiple hypoechoic areas, which are regarded as signs of periportal necrosis and hemorrhage (hemorrhagic liver infarction).
- For differential diagnosis CT and MRI are used for HELLP syndrome.
Differential diagnosis
Despite the difficulties in diagnosing HELLP syndrome, there are a number of signs characteristic of this nosology: thrombocytopenia and impaired liver function. The severity of these disorders reaches a maximum 24-48 hours after birth, while with severe gestosis, on the contrary, regression of these indicators is observed during the first day of the postpartum period.
Signs of HELLP syndrome may also be present in other pathological conditions in addition to gestosis. Differential diagnosis required this state with hemolysis of red blood cells, increased activity of liver enzymes in the blood and thrombocytopenia that developed in the following diseases:
- Cocaine addiction.
- Systemic lupus erythematosus.
- Thrombocytopenic purpura.
- Hemolytic uremic syndrome.
- Acute fatty hepatosis of pregnant women.
- Viral hepatitis A, B, C, E.
- CMV and infectious mononucleosis.
The clinical picture of liver damage during pregnancy is often blurred, and doctors sometimes consider the symptoms described above as a manifestation of another pathology.
Indications for consultation with other specialists
Consultations with a resuscitator, hepatologist, and hematologist are indicated.
An example of a diagnosis formulation
Pregnancy 36 weeks, cephalic presentation. Preeclampsia in severe form. HELLP syndrome.
TREATMENT
Treatment Goals: Restoration of disturbed homeostasis.
Indications for hospitalization
HELLP syndrome, as a manifestation of severe gestosis, in all cases serves as an indication for hospitalization.
Not drug treatment
Emergency delivery is carried out against the background of infusion-transfusion therapy under anesthesia.
Drug treatment
Along with infusion-transfusion therapy, protease inhibitors (aprotinin), hepatoprotectors (vitamin C, folic acid), lipoic acid 0.025 g 3-4 times a day, fresh frozen plasma at a dose of at least 20 ml/kg body weight per day, transfusion of platelet concentrate (at least 2 doses when the platelet count is less than 50 x 10 9 /l), glucocorticoids (prednisolone at a dose of less than 500 mg/day intravenously). In the postoperative period, under the control of clinical and laboratory parameters, the administration of fresh frozen plasma is continued at a dose of 12-15 ml/kg body weight in order to replenish the content of plasma coagulation factors, and it is also recommended to carry out plasmapheresis in combination with a replacement transfusion of fresh frozen plasma, the elimination of hypovolemia, antihypertensive and immunosuppressive therapy. Mayen et al. (1994) believe that the administration of glucocorticoids helps improve maternal outcomes in women with preeclampsia and HELLP syndrome.
Timing and methods of delivery
For HELLP syndrome, emergency delivery by cesarean section is indicated against the background of correction of metabolic disorders, replacement and hepatoprotective therapy, and prevention of complications.
Possible complications in pregnant women with severe gestosis complicated by HELLP syndrome
During caesarean section, the most gentle methods of protecting mother and fetus from obstetric aggression should be used. Opting for epidural or spinal anesthesia, we must not forget about high risk extradural and subdural bleeding with thrombocytopenia. A platelet content of less than 100 x 10 9 /l is considered a critical value for regional anesthesia for severe gestosis with HELLP syndrome. Subdural hematomas can also occur during regional anesthesia in pregnant women with severe gestosis who have been taking acetylsalicylic acid for a long time.
At delivery Special attention pay attention to the condition of children. It has been established that thrombocytopenia occurs in newborns in 36% of cases, which leads to the development of hemorrhages and damage to the nervous system. 5.6% of children are born in a state of asphyxia, and the majority of newborns are diagnosed with respiratory distress syndrome. In 39% of cases, FGR is noted, in 21% of cases - leukopenia, in 33% of cases - neutropenia, in 12.5% of cases - intracranial hemorrhage, in 6.2% of cases - intestinal necrosis.
Evaluation of treatment effectiveness
Success intensive care HELLP syndrome largely depends on timely diagnosis, both before childbirth and in the postpartum period. Despite the extreme severity of the course of HELLP syndrome, its occurrence should not serve as an excuse for the lethal outcome of severe gestosis, but rather indicates untimely diagnosis and late or inadequate intensive therapy.
Prevention
Timely diagnosis and adequate treatment gestosis.
Information for the patient
HELLP syndrome is a severe complication of gestosis that requires professional treatment in a hospital. In most cases, a week after delivery, the manifestations of the disease disappear.
Forecast
With a favorable course in the postpartum period, rapid regression of all symptoms is observed. At the end of pregnancy, after 3-7 days, laboratory blood parameters normalize, with the exception of cases of severe thrombocytopenia (below 50 x 10 9 / l), when, with the use of appropriate corrective therapy, the platelet content returns to normal on the 11th day, and LDH activity - in 8-10 days. The risk of relapses during subsequent pregnancies is small and amounts to 4%, but women should be included in the group increased risk on the development of this pathology.
- Obstetrics: A Handbook of the University of California / Ed. K. Niswander, l Evans. - M.: Praktika, 1999. - P. 132-134.
- Wallenberg H.S.S. New achievements in the management of early preeclampsia and HELLP syndrome / H.S.S. Wallenberg // Obstetrics and gynecology. - 1998. - No. 5. - P. 29-32.
- Intensive care in obstetrics and gynecology / V.I. Kulakov and others - M.: Medical information Agency, 1998. - pp. 44-61.
- Achieving better treatment results for mothers with postpartum HELLP syndrome using dexamethasone therapy / Martin J. et al. // AG-info. - 2000. - No. 1. - P. 20-21.
- Makatsaria A.D., Bitsadze V.O. Thrombophilias and antithrombotic therapy in obstetric practice/ A.D. Makatsaria, V.O. Bitsadze. - M.: Triada-X, 2003. - 904 p.
- Nikolaeva E.I., Bobkova M.V. HELLP syndrome or acute fatty hepatosis of pregnant women / E.I. Nikolaeva, M.V. Bobkova // Medical assistance. - Medicine, 1994. - No. 2. - P. 23-25.
- Sidorova I.S. Gestosis / I.S. Sidorova. - M., 1997. - P. 130-136.
- Surov A.V. HELLP syndrome in obstetrics / A.V. Surov // Obstetrics and gynecology. -1997. - No. 6. - P. 7-9.
- Savelyeva G.M., Shalina R.I., Belyakova G.I. HELLP syndrome: etiology, pathogenesis, diagnosis, treatment / G.M. Savelyeva, R.I. Shalina, G.I. Belyakova // Bulletin Russian Association obstetricians-gynecologists. - 1997. - No. 2. - P. 33-37.
- Khadasevich L.S., Khareva O.V., Abramov A.A. Preeclampsia in pregnant women complicated by HELLP syndrome / L.S. Hadasevich, O.V. Khareva, A.A. Abramov // Pathology Archive. -1999. - T. 61, No. 6. - P. 41-43.
HELLP syndrome:
H– hemolysis
EL – increase in blood enzyme levels
LP – low platelet count.
The frequency of HELLP syndrome is 2-15%, characterized by high maternal mortality (up to 75%).
The basis of HELLP syndrome is abnormal placentation.
Classification: based on platelet count.
class 1 – less than 50x10 9 /l platelets
class 2 - 50x10 9 /l – 100x10 9 /l platelets
class 3 - 100x10 9 /l - 150x10 9 /l platelets.
Clinic.
headache, heaviness in the head;
weakness or fatigue;
muscle pain in the neck and shoulders;
visual impairment;
pain in the abdomen, in the right hypochondrium;
hemorrhages at injection sites;
vomiting blood-stained contents;
jaundice, liver failure;
convulsions;
Develops in the third trimester from 33 weeks, most often at 35 weeks.
In 30% it manifests itself in the postpartum period.
Initial nonspecific manifestations:
then join:
Often there is tissue rupture with bleeding into the abdominal cavity.
HELLP syndrome can manifest itself:
clinical picture of total premature abruption of a normally located placenta, accompanied by massive coagulopathic bleeding and the formation of hepatic-renal failure;
DIC syndrome;
pulmonary edema;
acute renal failure.
Diagnostics.
Laboratory methods:
clinical blood test;
blood chemistry: total protein, urea, glucose, creatinine, electrolytes, cholesterol, direct and indirect bilirubin, ALT, AST, alkaline phosphatase, triglycerides;
hemostasiogram: APTT, platelet count and aggregation, PDF, fibrinogen, AT-III;
determination of lupus anticoagulant;
determination of antibodies to hCG;
clinical urine analysis;
Nechiporenko's test;
Zimnitsky's test;
Reberg's test;
analysis of 24-hour urine for protein;
diuresis measurement;
urine culture;
Physical examination:
blood pressure measurement;
24-hour blood pressure monitoring;
pulse determination;
Instrumental methods:
Ultrasound of the liver, kidneys;
Ultrasound and Doppler measurements of the fetus, maternal and fetal hemodynamics;
fundus examination;
Laboratory signs HELLP – syndrome :
Increased levels of transaminases in the blood - AST more than 200 U/l, ALT more than 70 U/l, LDH more than 600 U/l;
Thrombocytopenia (less than 100x10 9 /l);
Decrease in AT level below 70%;
Increased bilirubin levels;
Prolongation of prothrombin time and APTT;
Decrease in fibrinogen levels;
Decreased glucose levels;
All signs of HELLP syndrome are not always observed. In the absence of hemolysis, the symptom complex is designated as ELLP syndrome.
Treatment.
in case of HELLP-syndrome, termination of pregnancy is indicated first of all as soon as possible;
termination of pregnancy is the only way to prevent the progression of the pathological process;
stabilization of the functions of affected organs and systems.
Treatment regimen for pregnant women HELLP – syndrome :
Fresh frozen plasma IV 20 ml/kg/day in the preoperative period and intraoperatively. In the postoperative period 12-15 ml/kg/day
Intensive preoperative preparation, which should last no more than 4 hours;
Hydroxyethylated starch 6% or 10% w/v 500 ml
Crystalloids (complex salt solutions)
Fresh frozen plasma IV 20 ml/kg/day
Platelet-rich plasma (with platelet levels less than 40-10 9 /l)
Thrombotic concentrate (at least 2 doses at a platelet level of 50-10 9 /l)
Crystalloids (complex salt solutions)
Hydroxyethylated starch 6% or 10% w/v 500 ml.
Plasmapheresis
Prednisolone IV 300 mg
Urgent surgical delivery:
At the beginning of the infusion, the rate of administration of solutions is 2-3 times higher than diuresis. Subsequently, during or at the end of the administration of solutions, the amount of urine per hour should exceed the volume of injected fluid by 1.5 - 2 times.
Fibrinolysis inhibitors
Tranexamic acid IV 750 mg 1 time/day
Prednisolone IV 300 mg/day
Hepatoprotectors
Essential phospholipids IV 5 ml
Ascorbic acid 5% IV solution 5 ml
infusion therapy
Postoperative period
Hydroxyethylated starch 6% or 10% w/v 12-15 ml/kg/day
Fresh frozen plasma 12-15 ml/kg/day.
The volume of ITT is determined by the values:
hematocrit not lower than 24 g/l and not higher than 35 g/l;
diuresis 50-100 ml/hour;
CVP at least 6-8 cm water column
AT-III not less than 70%
total protein not less than 60 g/l
blood pressure indicators.
Replacement therapy and hepatoprotectors
Dextrose 10% solution IV volume and duration of administration is determined individually
Ascorbic acid up to 10g/day
Essential phospholipids iv 5 ml 3 times a day
Antihypertensive therapy – when systolic blood pressure increases above 140 mmHg.
Prednisolone, including preoperative and intraoperative doses, ranges from 500-1000 mg/day.
Antibacterial therapy.
Antibacterial therapy begins from the moment of surgical delivery.
Antibiotics with bactericidal activity and a wide spectrum of action:
III - IV generation cephalosporins; combined ureidopenia cillins.
Name/cilastatin IV 750 mg 2 times a day or
Ofloxacin 200 mg 2 times a day or
Cefotaxime 2 g 1-2 times/day or
Ceftriaxone 1 g 1-2 times/day.
Plasmapheresis, ultrafiltration, hemosorption.
Forecast.
With timely diagnosis and pathogenetic therapy, mortality can be reduced to 25%.
Hellp syndrome is a rare but serious complication that affects pregnant women. This is a variant of preeclampsia. HELLP syndrome means the following signs and symptoms:
- H – hemolysis (decomposition of red blood cells);
- EL - Elevated liver enzyme;
- LP-Low platelet count.
The condition affects about 0.5-0.9% of pregnant women. Occurs later in pregnancy or maybe even after childbirth.
The exact cause of the syndrome is unknown. It is considered a symptom of an underlying disorder and not in itself. It is a complication of preeclampsia, a disorder in pregnant women with high blood pressure and the presence of protein in the urine (proteinuria).
Other risk factors include:
- obesity;
- Poor nutrition;
- Diabetes;
- Age of pregnant women (over 35 years);
- Multiple pregnancy;
- History of preeclampsia.
Signs and symptoms
It is accompanied by a series of symptoms:
- Fatigue and malaise;
- Fluid retention;
- Increase in excess weight;
- Nausea and vomiting worsen over time;
- Paresthesia (tingling sensation in the limbs);
- Visual disturbances;
- swelling, especially in the legs;
- Nose bleed;
- Cramps.
Diagnostics
Symptoms associated with Hellp syndrome often mimic other diseases or complications. A physical examination followed by confirmation from blood and urine tests is carried out to diagnose it.
- During a physical examination, the doctor will look for an enlarged liver or excess swelling, especially in the legs.
Blood tests
- CBC ( full analysis blood) contains information about red blood cells, leukocytes, platelet count. Hemolysis, the breakdown of red blood cells, is characteristic feature help syndrome An abnormal peripheral smear with a low platelet count indicates a problem.
- LDH (lactate dehydrogenase) is an enzyme that helps body tissues produce energy. LDH is present in almost all tissues of the body. LDH levels increase if there is damage.
- An LFT (liver function test) is a series of blood tests done to detect the presence of liver disease. Liver enzymes are high due to liver damage, excessive breakdown of red blood cells.
To learn more Chronic fatigue: treatment options
Other studies
- A urine test determines the presence of excess protein along with increased level uric acid.
- Blood pressure, if high, means Help syndrome.
- An MRI or CT scan is recommended to check for internal bleeding, especially in the liver.
- Fetal monitoring tests include sonograms, stress-free tests, and fetal movement assessments to check the baby's health.
Treatment
Having a child is the final treatment. This will prevent further complications. Most women stop experiencing symptoms 4-5 days after giving birth. Delivery should be considered after completion of 34 weeks of pregnancy.
- Corticosteroids are prescribed to help the baby and mother. If birth can be delayed, corticosteroids should be given to promote fetal maturation.
- During pregnancy, women with low platelet counts may need blood. Consequently, blood transfusion occurs. Transfusion of red blood cells, platelets, and fresh frozen plasma is required.
- It is necessary to take medications to control blood pressure. Antihypertensive drugs such as labetalol, nifedipine are prescribed.
- Magnesium sulfate is prescribed to prevent episodes of seizures.
Forecast
Early diagnosis is key to reducing morbidity and mortality. If the condition is treated early, most women make a full recovery.
If Hellp syndrome remains undiagnosed, about 25% of women develop serious complications such as blood clots, placental abruption, renal failure, liver damage.
The condition cannot be completely prevented. However, if a woman is diagnosed with preeclampsia, precautions can be taken to reduce the risk of Hellp syndrome.
- Support healthy image life, which includes regular exercise, weight control appropriate to your height
- Observe balanced diet consisting of fresh vegetables, fruits, protein.
Which doctor should I contact?
If you find any signs associated with Hellp syndrome, contact your obstetrician or gynecologist.
Is it always associated with preeclampsia?
No. Although Help syndrome is a complication of preeclampsia, only about 10-20% of preeclampsia cases develop it.
What happens when placental abruption occurs?
The placenta is the structure responsible for nutrition developing child. In placental abruption, the placental lining separates from the inner lining of the uterus before birth.
To learn more Fragile X syndrome, Martin Bell
How is preeclampsia treated?
In most cases, preeclampsia resolves after delivery. Corticosteroids are used in severe preeclampsia to improve liver and platelet function. Magnesium sulfate is best choice for treatment.
How does it affect children?
Hellp syndrome may affect a baby's survival after birth because women have premature birth. For example, if a child is born weighing more than 1000 g, the survival rate and health of the child is the same as normal newborn.
However, if the weight is less than 1000g, then the child will need to be monitored in hospital. Additional tests will be required to ensure its safety.
Is there a risk of it appearing in the future?
There is a 20% chance of developing Help syndrome in future pregnancies.
When does it occur?
It can occur any time after the second trimester to six months after birth. Mostly occurs in the third trimester, or 24-48 hours after birth.
Pregnancy is a happy time for every woman. However, this joyful period may be overshadowed by the development of HELLP syndrome. Such a pathology requires urgent medical care. How to recognize a dangerous condition and avoid negative consequences?
What is HELLP syndrome?
Doctors designate the pathology as dangerous and severe complication gestosis - late toxicosis in the last months of pregnancy. In obstetrics, the syndrome was named after the basic symptoms that make up clinical picture diseases:
- H - hemolysis (decomposition of erythrocytes - red blood cells that deliver oxygen to all tissues of the body);
- EL - increased levels of liver enzymes, which may indicate a disease of this organ;
- LP - thrombocytopenia - decreased platelet formation and, as a result, poor blood clotting.
In addition, the syndrome causes multiple damage to the organs and body systems of a pregnant woman, thereby aggravating the course of pregnancy.
Although the pathology is quite dangerous, fortunately, it is rare. The disease is detected in 0.9% of pregnant women, and more often HELLP syndrome is diagnosed in those women who suffer from severe gestosis (from 4–12%).
The diagnosis of “HELLP syndrome” is made in 70% of cases in the third trimester of pregnancy (after 35 weeks) and in the first two weeks after birth.
Causes and risk factors
It is still not known exactly what causes the pathology. Obstetricians identify several probable reasons:
- taking tetracycline antibiotics;
- thrombosis - the formation of blood clots in arterial or venous vessels;
- destruction by the body of red blood cells (cells that are responsible for the delivery of oxygen) and platelets (bodies that influence blood clotting);
- hereditary liver diseases;
- severe form of gestosis (complications in the second half of pregnancy).
Studies have shown that the risk group includes women who suffered from HELLP syndrome in previous pregnancies. The probability that the situation will repeat itself is about 25%.
In addition, the development of pathology is influenced by:
- too pale skin;
- age of the expectant mother after 25 years;
- multiple pregnancy;
- severe autoimmune diseases.
Often the syndrome occurs in women whose pregnancy was difficult from the first days of conception. This indicates early toxicosis, increased arterial pressure, threat of relapse, placental insufficiency and other undesirable conditions.
Clinical picture
For HELLP syndrome, the initial symptoms are nonspecific. A pregnant woman appears:
- headache;
- vomit;
- pain under the right rib;
- fast fatiguability;
- severe swelling (in 67%);
- motor restlessness.
After some time, the following symptoms appear:
- yellowness of the skin;
- nausea and vomiting;
- convulsions;
- hematomas (bruising) at injection sites;
- visual disturbances;
- anemia;
- heart rhythm failure;
- increasing renal and liver failure.
At severe form the disease causes disruption of the brain centers, cerebral edema, deep violation organ function, which can lead to coma. If several signs appear, you should urgently seek medical help.
Diagnostics
The following methods are used to diagnose pathology:
- Ultrasound of the upper abdomen;
- biochemical and clinical tests blood;
- MRI and CT.
A doctor can diagnose “HELLP syndrome” if research reveals:
- insufficient platelet count - less than 100 x 10 9 /l;
- reduced amount of protein and lymphocytes;
- increased level of bilirubin (bile pigment) - from 20 µmol or more;
- deformation and low performance erythrocytes (red blood cells);
- increased concentration of urea and creatinine in the blood.
Timely detection dangerous condition increases the effectiveness of therapy and increases the chances of recovery.
HELLP syndrome should be distinguished from the following diseases:
- viral hepatitis;
- liver failures;
- liver pathologies;
- gastritis.
In severe cases of gestosis, as well as to clarify the diagnosis, the doctor may prescribe additional studies:
- Ultrasound of the liver and kidneys;
- Fetal ultrasound;
- Doppler ultrasound is a method for studying blood flow in the vessels of the placenta, uterus and child;
- cardiotocography - assessment of fetal heart rate.
HELLP syndrome is a severe pathological complication of gestosis, which requires professional treatment and observation in the hospital.
Obstetric tactics
If HELLP syndrome is confirmed, obstetricians follow a clear plan, which includes:
- Possible stabilization of the pregnant woman's condition.
- Prevention of complications for the expectant mother and fetus.
- Normalization of blood pressure.
- Delivery.
Doctors say that the only and correct method of treatment is a caesarean section or emergency birth(depending on the duration of pregnancy and the severity of the symptoms of the pathology).
Most obstetricians say that pregnancy should be terminated within 24 hours of diagnosis (regardless of the date).
All other therapeutic and organizational therapy is preparation for childbirth.
Drug therapy
Additionally, drug treatment is provided, which includes:
- plasmaphoresis - a procedure for cleaning plasma from aggressive substances;
- administration of fresh frozen plasma;
- transfusion of platelet concentrate.
The following are administered intravenously:
- protease inhibitors - substances that prevent protein breakdown;
- hepaprotectors - to improve the condition of the liver;
- glucocorticoids - hormones to stabilize the adrenal glands.
IN postoperative period assigned:
- fresh frozen plasma to normalize blood clotting;
- glucocorticoids;
- immunosuppressive and antihypertensive (to lower blood pressure) therapy.
Treatment prognosis
At early detection pathology and timely provision of medical care, the prognosis is quite favorable. On days 3–7 after delivery, all blood parameters usually return to normal, with the exception of thrombocytopenia (special therapy is required).
The time spent in the hospital depends on the health of the mother and child, as well as the presence of complications.
Possible complications
The consequences of HELLP syndrome for mother and child are quite serious. That is why much attention is paid to solving this problem.
Possible complications in a pregnant woman - table
Possible complications in newborns - table
Prevention
To prevent the disease, expectant mothers are advised to:
- regularly take tests and visit a doctor;
- to refuse from bad habits;
- lead a healthy lifestyle;
- register with the antenatal clinic in a timely manner;
- normalize physical activity;
- avoid stressful situations.
Gestosis in women during pregnancy - video
HELLP syndrome is a dangerous pathology that occurs in the second half of pregnancy and can lead to severe consequences. Only timely medical assistance and compliance with all recommendations will help the expectant mother avoid serious complications and give birth to a healthy baby.
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