23/08/2021
HELLP SYNDROME
CAROLINE HARDEE, MSN, RN
1
1
OBJECTIVES
• DESCRIBE THE PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS
OF HELLP SYNDROME
• DISCUSS TREATMENTS AVAILABLE FOR A PATIENT WITH HELLP
SYNDROME
• DISCUSS THE MOST COMMON DIAGNOSTIC AND LABORATORY TESTS
USED FOR HELLP SYNDROME
2
2
HELLP SYNDROME: WHAT IS IT?
• HEMOLYSIS ELEVATED LIVER ENZYMES, LOW PLATELETS
• LIFE-THREATENING PREGNANCY COMPLICATION USUALLY
CONSIDERED TO BE A VARIANT OF PREECLAMPSIA.
• DIFFICULT TO DIAGNOSE; ESPECIALLY WHEN HIGH BLOOD
PRESSURE AND PROTEIN IN THE URINE AREN'T PRESENT.
• ITS SYMPTOMS ARE SOMETIMES MISTAKEN FOR GASTRITIS, FLU,
ACUTE HEPATITIS, GALL BLADDER DISEASE, OR OTHER CONDITIONS.
• THE MORTALITY RATE OF HELLP AS HIGH AS 25%.
3
• CRITICAL FOR EXPECTING MOTHERS TO RECEIVE EARLY DIAGNOSIS
AND TREATMENT.
3
1
, 23/08/2021
RISK FACTORS
• UNCLEAR ON WHAT EXACTLY CAUSES HELLP SYNDROME.
• COMMON IN WOMEN WHO HAVE PREECLAMPSIA OR PREGNANCY
INDUCED HYPERTENSION; THERE ARE STILL A NUMBER OF WOMEN
WHO GET IT WITHOUT PREVIOUSLY SHOWING SIGNS OF
PREECLAMPSIA.
• PREVIOUS PREGNANCY WITH HELLP SYNDROME (19-27% CHANCE OF
RECURRENCE IN EACH PREGNANCY)
• WOMEN OVER THE AGE OF 25
• CAUCASIAN
• MULTIPAROUS (GIVEN BIRTH TWO OR MORE TIMES)
4
4
SIGNS AND SYMPTOMS
• PHYSICAL SYMPTOMS SIMILAR TO PREECLAMPSIA.
• HEADACHE
• NAUSEA/VOMITING/INDIGESTION WITH PAIN AFTER EATING
• ABDOMINAL OR CHEST TENDERNESS AND UPPER RIGHT UPPER SIDE
PAIN (FROM LIVER DISTENTION)
• SHOULDER PAIN OR PAIN WHEN BREATHING DEEPLY
• BLEEDING
• CHANGES IN VISION
• SWELLING
• SIGNS TO LOOK FOR INCLUDE:
• HIGH BLOOD PRESSURE
• PROTEIN IN THE URINE
• THE MOST COMMON REASONS FOR MOTHERS TO BECOME CRITICALLY ILL 5
OR DIE ARE LIVER RUPTURE OR STROKE
5
HELLP SYNDROME CLASSIFICATION
• THE SEVERITY OF HELLP SYNDROME IS MEASURED ACCORDING TO
THE BLOOD PLATELET COUNT OF THE MOTHER
• IT IS DIVIDED INTO THREE CATEGORIES, ACCORDING TO A SYSTEM
CALLED "THE MISSISSIPPI CLASSIFICATION."
• CLASS I (SEVERE THROMBOCYTOPENIA): PLATELETS UNDER
50,000/MM3
• CLASS II (MODERATE THROMBOCYTOPENIA): PLATELETS BETWEEN
50,000 AND 100,000/MM3
• CLASS III (AST > 40 IU/L, MILD THROMBOCYTOPENIA): PLATELETS
BETWEEN 100,000 AND 150,000/MM3
6
6
2
HELLP SYNDROME
CAROLINE HARDEE, MSN, RN
1
1
OBJECTIVES
• DESCRIBE THE PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS
OF HELLP SYNDROME
• DISCUSS TREATMENTS AVAILABLE FOR A PATIENT WITH HELLP
SYNDROME
• DISCUSS THE MOST COMMON DIAGNOSTIC AND LABORATORY TESTS
USED FOR HELLP SYNDROME
2
2
HELLP SYNDROME: WHAT IS IT?
• HEMOLYSIS ELEVATED LIVER ENZYMES, LOW PLATELETS
• LIFE-THREATENING PREGNANCY COMPLICATION USUALLY
CONSIDERED TO BE A VARIANT OF PREECLAMPSIA.
• DIFFICULT TO DIAGNOSE; ESPECIALLY WHEN HIGH BLOOD
PRESSURE AND PROTEIN IN THE URINE AREN'T PRESENT.
• ITS SYMPTOMS ARE SOMETIMES MISTAKEN FOR GASTRITIS, FLU,
ACUTE HEPATITIS, GALL BLADDER DISEASE, OR OTHER CONDITIONS.
• THE MORTALITY RATE OF HELLP AS HIGH AS 25%.
3
• CRITICAL FOR EXPECTING MOTHERS TO RECEIVE EARLY DIAGNOSIS
AND TREATMENT.
3
1
, 23/08/2021
RISK FACTORS
• UNCLEAR ON WHAT EXACTLY CAUSES HELLP SYNDROME.
• COMMON IN WOMEN WHO HAVE PREECLAMPSIA OR PREGNANCY
INDUCED HYPERTENSION; THERE ARE STILL A NUMBER OF WOMEN
WHO GET IT WITHOUT PREVIOUSLY SHOWING SIGNS OF
PREECLAMPSIA.
• PREVIOUS PREGNANCY WITH HELLP SYNDROME (19-27% CHANCE OF
RECURRENCE IN EACH PREGNANCY)
• WOMEN OVER THE AGE OF 25
• CAUCASIAN
• MULTIPAROUS (GIVEN BIRTH TWO OR MORE TIMES)
4
4
SIGNS AND SYMPTOMS
• PHYSICAL SYMPTOMS SIMILAR TO PREECLAMPSIA.
• HEADACHE
• NAUSEA/VOMITING/INDIGESTION WITH PAIN AFTER EATING
• ABDOMINAL OR CHEST TENDERNESS AND UPPER RIGHT UPPER SIDE
PAIN (FROM LIVER DISTENTION)
• SHOULDER PAIN OR PAIN WHEN BREATHING DEEPLY
• BLEEDING
• CHANGES IN VISION
• SWELLING
• SIGNS TO LOOK FOR INCLUDE:
• HIGH BLOOD PRESSURE
• PROTEIN IN THE URINE
• THE MOST COMMON REASONS FOR MOTHERS TO BECOME CRITICALLY ILL 5
OR DIE ARE LIVER RUPTURE OR STROKE
5
HELLP SYNDROME CLASSIFICATION
• THE SEVERITY OF HELLP SYNDROME IS MEASURED ACCORDING TO
THE BLOOD PLATELET COUNT OF THE MOTHER
• IT IS DIVIDED INTO THREE CATEGORIES, ACCORDING TO A SYSTEM
CALLED "THE MISSISSIPPI CLASSIFICATION."
• CLASS I (SEVERE THROMBOCYTOPENIA): PLATELETS UNDER
50,000/MM3
• CLASS II (MODERATE THROMBOCYTOPENIA): PLATELETS BETWEEN
50,000 AND 100,000/MM3
• CLASS III (AST > 40 IU/L, MILD THROMBOCYTOPENIA): PLATELETS
BETWEEN 100,000 AND 150,000/MM3
6
6
2
