A antepartum and postpartum management in patients with

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A variant of preeclampsia.the etiology of HELLP and preeclampsia is
not clear (disease of theories). Endothelial cells activation due to a release
of placental factors and initiation of inflammatory and coagulation cascades.
This is characterized by elevated lipid peroxides and oxidative stress. The
complement system is a key mediator of systemic inflammation and is excessively
activated in preeclampsia and HELLP syndrome. Complement activation induces
dysregulation of angiogenic factors, mutation of complement system may explain
etiology as some patient show mutation as aHUS. HELLP occur mostly at second
and third trimesters as TTP but HUS occur more common postnatal.Elevated liver
enzymes and hyperreflexia are common in HELLP whereas neurological
abnormalities are most common in TTP.Platelet count more than 50000 × 109 /
liter in HELLP and more decrease in TTP.HELLP is associated with increased
maternal and neonatal complications. Maternal complication includes DIC which
is the common complication as there are vascular endothelium activation and
microthrombi formation, renal failure, abruption placenta, liver rupture and
pulmonary edema. Neonatal
complications include thrombocytopenia, IUGR, respiratory distress. Treatment
monitor patient vital signs and immediate control of blood pressure and
seizure. The patients with  suspected HELLP syndrome should receive
parenteral magnesium sulfate as prophylaxis for seizure.3,23 The magnesium sulfate  loading dose of 6 g intravenous  over 20 min followed by a continuous infusion
of 2 grams/hr  until 24-h postpartum.3 for recurrent seizures occur, an additional bolus of 2 g
magnesium sulfate can be given over 3–5 min. . Hypertension is managed
as preeclampsia. NICE recommends
antihypertensive therapy for severe preeclampsia and HELLP syndrome if the
blood pressure is ?160/110 mmHg. NICE recommends that the first line therapy for moderate hypertension
should be labetalol. Alternative antihypertensive are
methyldopa and nifedipine. For treatment of acute severe
hypertension in pregnancy intravenous hydralazine, and labetalol are
equally efficient. Corticosteroids can be given for antepartum and postpartum
management in patients with HELLP. Steroids decrease the degree of
intravascular endothelial injury.Dexamethasone is used for enhancing fetal lung
maturity. The only cure for
preeclampsia and HELLP is
delivery. Timing, and method of delivery largely
depend on clinical expert. Cesarean section should be considered
in the patients with HELLP syndrome <32–34 weeks of gestation where long induction with cervical ripening agents is expected. In advanced cases with HELLP syndrome, Plasmapheresis with fresh frozen plasma could be used.

Categories: Management


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