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Mother needs HELLP -  HELLP syndrome:

Dr Sampurna Roy MD 

 

It is estimated that 2 to 14% of patients with toxemia of pregnancy develop the HELLP syndrome.

It is a multisystemic disease and considered a severe variant of hypertensive disorder in pregnancy, that causes maternal and perinatal mortality and morbidity.

HELLP syndrome is acronym for:

H = Haemolysis

EL =Elevated liver enzymes and a

LP = Low platelet count.

A B

(A) Normal platelet count in peripheral blood smear (B) Low platelet count in peripheral blood smear

It occurs predominantly in multiparous women over 25 years old.

These patients typically present at early third trimester with epigastric or right upper quadrant pain, nausea and vomiting.

Some cases occur a few hours to six hours days post partum.

Maternal complications include cerebral hemorrhage, retinal detachment, placental abruption, disseminated intravascular coagulation, acute renal failure and hepatic rupture, with a maternal mortality rate of 3%. Recurrence of the syndrome is rare.

            

Renal Failure                        Cerebral hemorrhage          Retinal detachment               Placental abruption

There is controversy and confusion as to whether HELLP is a variation of toxemia of pregnancy or whether it represents a mild form of disseminated intravascular coagulation.

Masson Trichrome Stain: Liver in Toxemia of Pregnancy showing mild portal tract chronic inflammatory infiltrate and area of periportal necrosis with intrasinusoidal fibrin deposition.

The liver biopsy shows features of non-specific reactive hepatitis with a mild portal tract chronic inflammatory cell infiltrate.

Periportal or focal parenchymal necrosis with a fibrin exudate has been reported similar to that noted in eclampsia.

Intrahepatic haemorrhage and subcapsular haematomas with rupture may also occur.

Decrease in maternal morbidity and mortality associated with hypertensive disorders of pregnancy is in proper diagnosis and effective management of HELLP syndrome.

 

Further reading:

HELLP syndrome - a multisystemic disorder.

[HELLP syndrome--severe complication during pregnancy].

HELLP Syndrome Complicated by Subcapsular Hematoma of Liver: A Case Report and Review of the Literature.

Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review.

HELLP syndrome].

HELLP syndrome and placental inflammatory pathology.

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Dr  Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

 


 

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