A variant of preeclampsia.the etiology of HELLP and preeclampsia isnot clear (disease of theories). Endothelial cells activation due to a releaseof placental factors and initiation of inflammatory and coagulation cascades.This is characterized by elevated lipid peroxides and oxidative stress.
Thecomplement system is a key mediator of systemic inflammation and is excessivelyactivated in preeclampsia and HELLP syndrome. Complement activation inducesdysregulation of angiogenic factors, mutation of complement system may explainetiology as some patient show mutation as aHUS. HELLP occur mostly at secondand third trimesters as TTP but HUS occur more common postnatal.Elevated liverenzymes and hyperreflexia are common in HELLP whereas neurologicalabnormalities are most common in TTP.Platelet count more than 50000 × 109 /liter in HELLP and more decrease in TTP.HELLP is associated with increasedmaternal and neonatal complications.
Maternal complication includes DIC whichis the common complication as there are vascular endothelium activation andmicrothrombi formation, renal failure, abruption placenta, liver rupture andpulmonary edema. Neonatalcomplications include thrombocytopenia, IUGR, respiratory distress. Treatmentmonitor patient vital signs and immediate control of blood pressure andseizure. The patients with suspected HELLP syndrome should receiveparenteral magnesium sulfate as prophylaxis for seizure.3,23 The magnesium sulfate loading dose of 6 g intravenous over 20 min followed by a continuous infusionof 2 grams/hr until 24-h postpartum.3 for recurrent seizures occur, an additional bolus of 2 gmagnesium sulfate can be given over 3–5 min. . Hypertension is managedas preeclampsia.
NICE recommendsantihypertensive therapy for severe preeclampsia and HELLP syndrome if theblood pressure is ?160/110 mmHg. NICE recommends that the first line therapy for moderate hypertensionshould be labetalol. Alternative antihypertensive aremethyldopa and nifedipine. For treatment of acute severehypertension in pregnancy intravenous hydralazine, and labetalol areequally efficient. Corticosteroids can be given for antepartum and postpartummanagement in patients with HELLP. Steroids decrease the degree ofintravascular endothelial injury.
Dexamethasone is used for enhancing fetal lungmaturity. The only cure forpreeclampsia and HELLP isdelivery. Timing, and method of delivery largelydepend on clinical expert. Cesarean section should be consideredin the patients with HELLP syndrome <32–34 weeks of gestation where longinduction with cervical ripening agents is expected. In advanced cases with HELLP syndrome, Plasmapheresis with freshfrozen plasma could be used.