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HELLP syndrome is an English acronym named on the basis of laboratory deviations characteristic for the disease (red cells breaking, increased liver enzyme and low platelet number) by Weinstein in the United States in 1982. It occurs in less than 1 % of deliveries. Classic manifestation of HELLP syndrome is characteristic for multigravidas over 25 years, whose previous pregnancies showed normal course

There are still disputes of the origin, clinical course and treatment of the disease. However being aware of it is very important for every doctor who deals with expectant women, because when it develops both maternal and embryonic mortality and the rate of incidence are significantly raised. The topic has become actual because clinical pattern has been developing more and more frequently in the past two decades and it is one of the determining factors of mother’s mortality in the developed countries, as it had been in our country in the previous years. There can be several causes of more frequent development of the syndrome, one is the older age of primagradivas and the second is that the doctors dealing with expectant women are thinking of the possibility of development of this disease and consequently it is diagnosed more often.

The cause of this clinical pattern is still unknown; there are several theories about the role of the possible inducing factors. Basically two forms can be distinguished. There is a type of early manifestation when the disease presents already in 2nd trimester of pregnancy. Disease of the placenta feeding the fetus is in the background, the process begins already in the first three month of pregnancy with the development of a pathological placenta, but the symptoms emerge only after 20th week of pregnancy both in the mother (in addition to the characteristic symptoms also high blood pressure and protein urea) and the fetus (intrauterine atrophy, less amniotic fluid). This form leads to premature birth; pregnancy must be ended often before 30th week because of the severe symptoms.

The other type occurs suddenly and later between 32-34th weeks with severe subjective symptoms. In majority of the cases HELLP syndrome is accompanied with severe or middle high blood pressure, however it can also occur with normal or mildly higher blood pressure as well. The symptoms can develop in case of conservative treatment of gravidas with gestational intoxication, or in the post-delivery period.

The patients complain of stomach pain or pain under the right quadrant, which can first raise the suspicion of gall stones or gastric ulcer. However the actual reason of the pain is in the liver and it is caused by tense Glissos’s capsule. Nausea, vomiting and other symptoms characteristic for virus infection present in half of the cases and most patients also report of discomfort for several days. When the above symptoms occur laboratory tests – enabling for prompt diagnosis - are required for each pregnant for early diagnosis. The international investigations have shown that uncertain symptoms and variable presentation of the disease may delay setting up of the correct diagnosis by days, which would involve serious consequences both to the mother and the fetus.

The treatment of the diseases is ending of pregnancy itself; possible in an institute where experience is available regarding curing of the disease and premature infant care is also at hand. Maternal mortality can be rather high, either 20 %. In case of non-appropriate patient’s care there are frequent complications for the mother. These can include coagulation disorder, placental abruption, renal disorders or stroke. The most severe complication of HELLP syndrome is liver rupture occurring in about 1 %; when maternal mortality can reach 50 % and fetal mortality can be even up to 60-70 %.

Irrespective of the fact that HELLP syndrome is considered as an independent disease or only as a severe complication of pregnancy, the main point is that it always presents itself before terminus or more rarely after deliver and it involves unfavourable maternal and fetal output.

If you have these complaints please do not hesitate to contact our specialists!

Dr. Petronella Hupuczi

Dr. Petronella Hupuczi
Head of the anesthesiology service.

 

Phone number: +36(06)1-213-4222

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