Hellp Syndrome
Basics
Description
Description
- HELLP syndrome:
- Hemolysis
- Elevated Liver Enzymes
- Low Platelets
- No universally accepted definition of HELLP
- Continuum with severe preeclampsia as most patients will be hypertensive
- Liver involvement is hallmark:
- Other organs may be involved (e.g., brain, kidneys, lungs)
- Most maternal deaths occur with severe preeclampsia
- Increased mortality rate is associated with hepatic hemorrhage or CNS or vascular insult to the cardiopulmonary or renal systems
- Incidence: 0.2% of all pregnancies
- 12–18% have normal BP
- Occurs in 20% of pregnancies with severe preeclampsia or eclampsia
- At diagnosis:
- 52% preterm
- 18% term
- 32% postpartum
Risk Factors
Risk Factors
Frequently white, multiparous, older
Pediatric Considerations
Infant mortality is greater in women with HELLP
Etiology
Etiology
- Unclear, but linked to the etiology of preeclampsia which has 4 proposed etiologies:
- Abnormal trophoblastic invasion of uterine vessels
- Immune reaction to maternal, paternal, and fetal tissues
- Maternal response to cardiovascular or inflammatory changes of pregnancy
- Genetic factors
- Proposed mechanism of HELLP:
- Fetal–placental debris is released into maternal circulation, causing systemic inflammatory response
- Vascular constriction causes resistance to blood flow and HTN
- Vasospasm probably damages vessels directly
- Endothelial cell is damaged and interendothelial cell leaks are the result
- Small-vessel leaks:
- Platelets and fibrinogen get deposited in the subendothelium
- Fibrin deposition develops in severe cases
- Vascular changes and local tissue hypoxia lead to hemorrhage, necrosis, and end-organ damage
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Citation
Schaider, Jeffrey J., et al., editors. "Hellp Syndrome." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome.
Hellp Syndrome. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome. Accessed December 12, 2024.
Hellp Syndrome. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome
Hellp Syndrome [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 12]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307300/all/Hellp_Syndrome.
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