HELLP SYNDROME

ADRIAN SETIAWAN.M.D.

HELLP SYNDROME

PREGNANCY

10-14% CASE

HYPERTENSION AND PROTEINURIA

PREECLAMPSIA

HELLP SYNDROME

HELLP SYNDROME
FIRST DISCRIBED BY WEINSTEIN 1982: ACRONYM OF : H : HEMOLYSIS

EL
LP INCIDENCE :

:
:

ELEVATED LIVER ENZYM

LOW PLATETLED COUNT

2%-12% AMONG PATIENTS WITH PREECLAMPSIA. 30% OCCURS IN POSTPARTUM

CRITERIA DIAGNOSTIC
LABORATORY FINDING:
HEMOLYSIS ABNORMAL PERIPHERAL SMEAR : SCHISTOCYTES AND BURR CELLS TOTAL BILIRUBIN LEVEL > 1,2 mg/Dl LACTATE DEHYDROGENASE LEVEL > 600 /L

ELEVATED LIVER FUCTION SGOT LEVEL 70 / L (LDH) LACTATE DEHYDROGENASE LEVEL > 600 /L LOW PLATELET COUNT PLATELET COUNT < 100.000/m3
THE LABORATORY DIAGNOSTIC CRITERIA USED AT THE UNIVERSITY OF TENNESSEE DIVISION OF MATERNAL FETAL MEDECINE, MEMPHIS TN. WITLIN AND SIBAI (1999)

CLASSIFICATION BASED ON PLATELET COUNT (MISSISIPPI):

CLASS I : PLATELET 50.000/m3

WITH : LDH 600 U/L SGOT 40 U/L CLASS II : PLATELET 50.000/m3 - < 100.000/m3 WITH : LDH 600 U/L SGOT 40 U/L
CLASS II : PLATELET 50.000/m3 - < 150.000/m3 WITH : LDH 600 U/L SGOT 40 U/L

MANAGEMENT OF HELLP SYNDROME

MATERNAL STABILISATION IS THE MAYOR PRIORITY

BEGIN WITH A STANDART MANAGEMENT OF SEVERE PREECLAMPSIA

HELLP SYNDROME IS NOT AN INDICATION FOR CS

MEDICAL MANAGEMENT
SAME AS SEVERE PREECLAMPSIA WHEN THROMBOCYTE COUNT IS < 50.000 mm3, 10 UNITS OF THROMBOCYTE OR FRESH WHOLE BLOOD MUST BE GIVEN WHEN PATIENT IS COMATOUS, SHE MUST BE TAKEN TO THE ICU WHEN THROMBOCYTE COUNTS IS < 50.000/mm3 FIBRINOGEN LEVEL, PROTHROMBINE TIME, PARTIAL THROMBOPLASTIN TIME, D-DIMMER MUST BE CHECKED TO FIND DIC

OBSTETRIC MANAGEMENT
WHEN MOTHERS IS STABLE TERMINATE THE PREGNANCY OR CONSERVATIVE MANAGEMENT. CONSERVATIVE MANAGEMENT CAN BE DONE WHEN :

THE BLOOD PRESSURE < 160/110 m g

THE OLIGURIA RESPONSE TO FLUID REPLACEMENT

THERE IS NO EPIGASTRIC PAIN

THE GESTATIONAL AGE IS < 34 WEEKS

COMPLICATION
THE COMPLICATIONS THAT CAN OCCUR IN HELLP SYNDROME ARE : NEUROLOGIC

DISORDER, PULMONARY EDEMA, ABRUPTIO

PLACENTA, DIC AND IUGR