A life-threatening occurrence that complicates pregnancies is called a HELLP syndrome. The acronym HELLP is variation of PIH named for the common symptoms that occur such as:
H – Hemolysis
E – Elevated
L – Liver Enzymes
P – Platelet
- The syndrome occurs in 4 to 12 % of women with pregnancy induced hypertension or PIH.
- Approximately it occurs 1 in every 130 births.
- It is a serious condition because it results in maternal mortality rate as high as 24 % and an infant mortality as high as 35 %.
HELLP syndrome is believed to occur as a result:
Hemolysis occurs due to the fragmentation and distortion of the erythrocytes during passage through small damaged blood vessels. The answer to the question as to why some women with severe preeclampsia also develop HELLP syndrome is unknown. It occurs both in primigravid and multigravid women.
Elevated Liver Enzyme
When hepatic blood flow is obstructed by fibrin deposits, liver enzymes increase.
Vascular damage from vasospasm causes low platelet levels.
Signs and Symptoms
- Pain – pain in the upper right quadrant, the lower right chest or the midepigastric area
- Nausea and vomiting
- General malaise
- Right upper quadrant tenderness because of liver distention and inflammation
- Severe edema
Laboratory Studies reveal the following:
- Hemolysis of red blood cells – RBCs appear fragmented on a peripheral blood smear
- Thrombocytopenia – a platelet count below 100,000/mm3
- Elevated liver enzyme levels such as alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST)
- Assist the client to a setting with intensive care facilities available.
- Administer magnesium sulfate per doctor’s order to control seizures.
- To control the blood pressure, give Hydralazine as ordered.
- Avoid traumatizing the liver by abdominal palpation. A sudden increase in the intraabdominal pressure, including seizure, could lead to the rupture of a subcapsular hematoma that could result to internal bleeding and hypovolemic shock. Events such as this could result to hepatic rupture leading to maternal and fetal mortality.
- Manage prescribed fluid replacement accurately to avoid worsening the woman’s reduced intravascular tone. Excessive fluid administration could lead to pulmonary edema or ascites.
- If the gestation is at 34 weeks, cervical ripening with labor induction is usually done. Delivery may be delayed if the gestation is less than 34 weeks and the woman’s condition is stable to give steroids for stimulating fetal lung maturation.
- Transfuse fresh-frozen plasma or platelets as ordered to improve the platelet count.
- Use care when transporting the woman.
- Give psychosocial support.