HELLP SYNDROME

ADRIAN SETIAWAN.M.D.
HELLP SYNDROME

PREGNANCY

HYPERTENSION AND
PROTEINURIA
10-14% CASE

PREECLAMPSIA

HELLP SYNDROME
HELLP SYNDROME
 FIRST DISCRIBED BY WEINSTEIN 1982:
 ACRONYM OF : H : HEMOLYSIS
EL : ELEVATED LIVER ENZYM
LP : LOW PLATETLED COUNT

 INCIDENCE : 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