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Hellp Syndrome PowerPoint Presentation

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Description : Weinstein regarded signs and symptoms to constitute an entity separate from severe preeclampsia and in 1982 named the condition HELLP

Tags : Syndrome,symptoms,HELLP Syndrome,epigastric pain

Published on : Feb 13, 2023 | Views : 3009 | Downloads : 10

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Slide 1-

HELLP Syndrome
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Objectives Intro of disease Symptoms Sign Diagnosis Classification Differential diagnosis Management Summary
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HELLP Syndrome Weinstein regarded signs and symptoms to constitute an entity separate from severe preeclampsia and in 1982 named the condition HELLP H = Haemolysis EL = Elevated Liver enzymes LP = Low Platelets currently regarded as a variant of severe preeclampsia or a complication . HELLP syndrome usually develops within the first 48 hours in women who have had proteinuria and hypertension prior to delivery
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Cont.... The HELLP syndrome occurs in about 0.5 to 0.9% of all pregnancies and in 10 to 20% of cases with severe preeclampsia 70% of the cases develops before delivery with a peak frequency between the 27th and 37th gestational weeks 10% occur before the 27th week 20% beyond the 37th gestational week hypertension and proteinuria absent in 10–20% of the cases
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Causes of maternal death in developed countries WHO data on maternal mortality
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Symptoms right upper abdominal quadrant epigastric pain nausea and vomiting 30–60% of women have headache 20% visual symptoms partial HELLP syndrome fewer symptoms less complications
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Reported frequency of signs and symptoms of HELLP syndrome
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H(hemolysis) high LDH concentration unconjugated bilirubin low or undetectable haptoglobin concentration is a more specific indicator. Low haptoglobin concentration (< 1 g/L – < 0.4 g/L) Haemolysis, one of the major characteristics of the disorder, is due to a microangiopathic haemolytic anaemia
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Elevated Liver enzymes(EL) Elevation of liver enzymes may reflect the haemolytic process as well as liver involvement. Haemolysis contributes to the elevated levels of LDH enhanced asparate aminotransferase (AST) and alanine aminotransferase (ALAT) levels are mostly due to liver injury
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Low platelet(LP) Thrombocytopenia < 150·109/L) caused by gestational thrombocytopenia (GT) (59%) immune thrombocytopenic purpura (ITP) (11%) preeclampsia (10%) HELLP syndrome (12%). PLTs < 100·109/L are relatively rare in preeclampsia and gestational thrombocytopenia, frequent in ITP and obligatory in the HELLP syndrome (according to the Sibai definition)
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Diagnosis Many different criteria Biochemical markers Clinical Preeclampsia ELLP
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Tennessee Classification System Platelets ≤ 100·109/L AST ≥ 70 IU/L LDH ≥ 600 IU/L Sibai has proposed strict criteria for "true" or "complete" HELLP syndrome Intravascular haemolysis is diagnosed by abnormal peripheral blood smear, increased serum bilirubin (≥ 20.5 μmol/L or ≥ 1.2 mg/100 mL) and elevated LDH levels (> 600 units/L (U/L)
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Mississippi classificationClass 1 Platelets ≤ 50·109/L AST ≥ 70 IU/LAST LDH ≥ 600 IU/L Platelets ≤ 100·109/L≥ 50·109/L AST or ALT ≥ 70 IU/L LDH ≥ 600 IU/L Class 2 Class 3 Platelets ≤ 150·109/L≥ 100·109/L AST or ALT ≥ 40 IU/L LDH ≥ 600 IU/L
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Differential diagnosis viral hepatitis cholangitis and other acute disease ITP acute fatty liver of pregnancy (AFLP) haemolytic uremic syndrome (HUS) thrombotic thrombocytopenic purpura (TTP) systemic lupus erythematosus (SLE)
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Complications reported
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Management > 34 weeks' gestation or later Nonreassuring tests of fetal status Presence of severe maternal disease: multiorgan dysfunction, DIC, liver infarction or hemorrhage, renal failure, or abruptio placenta Immediate delivery 27 to 34 weeks of gestation Delivery within 48 hours evaluation stabilization steroid treatment for fetal lung maturity before 24 weeks' gestation, termination of pregnancy should be strongly considered
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HELLP syndrome
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Method of Delivery Vaginal Cesarean section
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Intensive Care - The use of Dexamethasone  ANTEPARTUM: (0,15mg/kg)10mg IV bid - when Platelets <100.000/mm 3 - if Platelets 100.000-50.000/mm 3 AND Eclampsia, Severe Hypertension, Epigastric Pain  POSTPARTUM: 10mg IV bid for 2 dosis, then 5mg bid for 2 additional doses: - when steroids were used in antepartum - suspend when there is clinical and laboratory improvement (platelets >100.000mm 3, decreased LDH, diuresis >100 ml/h)
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Steroid use no clear evidence of any effect of corticosteroids on substantive clinical outcomes. insufficient evidence for the routine use The use of corticosteroids only to increase rate of recovery in platelet count if considered clinically worthwhile.
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Anesthesia Choice According to ACOG regional anesthesia is preferred for women with preeclapmsia and eclampsia General anesthesia carries more risk than regional Platelet counts >100,000/ul are acceptable to most anesthesiologists Platelet counts in 50,000-100,000 range are potential candidates according to ACOG Risk of spinal or epidural hematoma Paralysis
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Conclusion HELLP syndrome is unique to pregnancy HELLP syndrome develops in approximately 1 of 1000 pregnancies overall and 10 to 20 percent of pregnancies with severe preeclampsia/eclampsia Delivery and supportive management is cure Multidisciplinary approach Tertiary center outcome for mothers with HELLP syndrome is generally good, but serious complications can occur Recommendations are against giving dexamethasone for treatment
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Case
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