Diagnostics
In order to diagnose HELLP syndrome, first of all the blood must be examined. This reveals a lowered haptoglobin level. Haptoglobin is a transport protein that removes free blood pigment (haemoglobin).
Since hemolysis (dissolution of red blood cells) occurs in HELLP syndrome, haptoglobin is reduced. Hemoglobin is also reduced. In contrast, the liver values (GOT, GPT, LDH and D-dimers) in the blood are increased.
The coagulation factors are lowered. The thrombocyte count in the blood is significantly reduced to <100,000 per microliter. As a sign of kidney damage, creatinine is elevated, and the urine contains increased protein.
A CTG (cardiotocography) is written to determine whether the child is already at risk. CTG changes can indicate a reduced oxygen supply to the child as a result of a placental dysfunction. In combination with the clinical symptoms of the woman, HELLP syndrome can be detected very reliably in this way. Pathological circulatory conditions in the uterine artery are considered to be early signs of pre-eclampsia (which may develop into HELLP syndrome). These can be detected by Doppler sonography (ultrasound examination).
Therapy
Since HELLP syndrome can lead to a life-threatening condition within a very short period of time, an emergency C-section is usually performed and the child is thus born. Since the course of the disease is very difficult to assess, this is the treatment method of choice. The pregnant woman must be monitored intensively and can receive medication to reduce high blood pressure and to prevent seizures. In rare cases where the HELLP syndrome occurs early in pregnancy and progresses very slowly, an attempt can be made to treat the pregnant woman with acetylsalicylic acid (ASA), immunoglobulins and plasmapheresis (all conservative therapy methods).However, the indication for these restrained measures is extremely rare. Premature Caesarean section therefore remains the standard therapy and must always be performed under risk-benefit consideration.
Prognosis
If the HELLP syndrome is detected early and treated quickly by a caesarean section, the prognosis is good. Nevertheless, the overall maternal mortality rate is about 3-5%, and the infant mortality rate is as high as 10-40%. Early consultation with a physician for the above-mentioned symptoms is therefore essential for maintaining the health of mother and child.
Permanent damage is generally not to be expected after a survived HELLP syndrome. In some cases, short-term memory disorders may occur. Depending on how early in the pregnancy HELLP syndrome occurs, the child may have a significantly reduced birth weight.