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 The
majority of pregnancies continue for nine months without serious
problems and result in the birth of a healthy child. Occasionally,
however, serious complications can be seen during pregnancy, which
require urgent medical care. One of these serious conditions is
the HELLP syndrome.
What
is HELLP syndrome?
The
HELLP syndrome is a severe type of preeclampsia, commonly referred
to as toxemia of pregnancy. Preeclampsia is an abnormal increase
in blood pressure accompanied by abnormal swelling in the feet and/or
hands. Kidney abnormalities that allow abnormal levels of protein
to spill into the urine also occur. This is one of the reasons that
blood pressure is measured and urine samples are taken at every
prenatal visit. Preeclampsia is primarily of concern because it
poses a health risk to both the mother and the unborn child. It
is not known why toxemia develops in some pregnant women and not
others and the mechanism by which it occurs is poorly understood.
What
are the symptoms?
The
symptoms of toxemia are important for pregnant women to recognize
and report to their physician immediately. Toxemia almost always
occurs after the fifth month of pregnancy. The presence of any of
the following symptoms should be reported to your doctor immediately:
- Abnormal
swelling in the hands and feet (some swelling in the feet and ankles
is normal during pregnancy, but hand swelling or large amounts of
ankle and foot swelling are suspicious)
- Upper abdominal pain
- Yellowing of the eyes or skin (known as jaundice)
- Blurry vision
- Confusion
- Persistent headaches
- Seizures
HELLP
is an acronym that stands for Hemolysis, Elevated
Liver enzymes and Low Platelets. It occurs within
the context of severe preeclampsia and is an indication for urgent
treatment.
- Hemolysis
is a term that means that the red blood cells, the oxygen carrying
cells of the blood, are being destroyed inside the blood vessels
by inflammation. This results in anemia, or low red blood cell counts,
and decreased oxygen-carrying ability of the blood.
- Elevated liver enzymes refer to the presence of enzymes that can
be detected by blood tests when the liver is inflamed.
- Platelets are cells in the blood that are important for clotting.
When the level of platelets is low, also thought to be due to inflammation
inside the blood vessels in this case, abnormal and prolonged bleeding
can occur.
What
is the treatment?
Whereas
mild toxemia or preeclampsia can usually be managed with careful
observation, the presence of the HELLP syndrome implies the need
for urgent treatment and stabilization of the mother. Interestingly,
delivery of the child is the only way to truly cure toxemia. However,
delivery of the child can only be attempted if the mother is stable,
which is often not initially the case when the HELLP syndrome is
present.
Women
with the HELLP syndrome are admitted to the hospital and given intravenous
fluids and medications. Medication to control the blood pressure
is often required. Sometimes preeclampsia can cause seizures, in
which case it is called eclampsia (preeclampsia is eclampsia without
seizures). This also requires medication to control. Transfusions
of blood or platelets may also be required.
Once
the mother is stable, the child must be delivered. If the mother
is near term, a vaginal delivery is often preferred. Medications
are usually given to stimulate the uterus to contract and hasten
the onset of labor. If the mother is not yet at term, the uterus
usually won't respond to the labor-inducing medications and a caesarian
section (C-section) is required.
It
is important to realize that watching and waiting is not generally
appropriate in the setting of severe preeclampsia or the HELLP syndrome.
Waiting for the child to deliver naturally could result in the death
of the mother, the child or both!
After
delivery, resuscitation and observation of the mother and child
continues for at least 48 to 72 hours. If the mother and baby are
healthy 72 hours after the delivery of the child, the toxemia is
considered to have resolved. Occasionally, preeclampsia or eclampsia
can occur for the first time or worsen in the first 48 hours after
delivery. By 72 hours after delivery, however, symptoms should resolve.
While
toxemia is absent in the overwhelming majority of pregnancies, it
is one of the most common causes of maternal death associated with
pregnancy and childbirth. Pregnant women should report the development
of any unusual symptoms to their doctor immediately and maintain
regularly scheduled prenatal visits. Most of the time, maternal
complaints will turn out to be normal pregnancy-associated changes,
but this is one of the times in life where it's better to be wrong
than be quiet.
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