HELLP syndrome is a serious complication in the course of pregnancy. It can have life-threatening consequences for both mother and baby.
What is HELLP syndrome?
HELLP syndrome is one of the hypertensive disorders and occurs during pregnancy. The term HELLP syndrome is made up of the English terms for the three main symptoms: These are H for Hemolysis, EL for Elevated Liver Enzymes, and LP for Low Platelets. This refers to an insufficient number of platelets (thrombocytes). HELLP syndrome is a severe form of preeclampsia. This condition, also known as pregnancy poisoning or gestosis, occurs exclusively during pregnancy. This pregnancy complication is characterized by blood clotting disorders, liver dysfunction and high blood pressure. In addition, elevated protein levels show up in the urine.
Causes
The triggering causes of HELLP syndrome are still unclear. The only confirmed finding is a connection with processes in the placenta. A signal is emitted from there that causes an increase in blood pressure in the affected woman. In some cases, this can affect the kidneys. In addition, certain diseases appear to play an important role in the development of HELLP syndrome. These are primarily hepatitis, immune system disorders, and chronic hypertension. In addition, a tendency to blood clots and genetic factors may have a negative effect. According to another hypothesis, a hormonal imbalance is responsible for the HELLP syndrome. Prostaglandin E and thromboxane A play a role in this. These hormones, which belong to the prostaglandins, are tissue hormones that are produced in principle in all body cells. While prostaglandin E dilates blood vessels and has an inhibitory effect on blood clotting, thromboxane A causes blood vessels to constrict and promotes blood clotting. If there is a disturbance in the ratio of the two hormones to each other, this results in negative changes in blood clotting.
Symptoms, complaints, and signs
Even in a short period of a few hours, symptoms may appear in HELLP syndrome. The first indications of the disease are swelling of the face and limbs, severe pain in the right upper abdomen that is especially severe when touched, visual disturbances, nausea, vomiting, and a general feeling of illness that increases rapidly. In addition, protein is increasingly excreted in the urine. Furthermore, the blood pressure of pregnant women increases to values above 190/110 mmHg. However, some symptoms are often mild or do not occur at all. Problematically, swelling, nausea, and vomiting are common in pregnancy, so they do not provide concrete information. However, in the worst cases, the symptoms of HELLP syndrome can have life-threatening effects on both mother and child. HELLP syndrome usually develops in the last trimester of pregnancy. Most often, it shows up during the 34th week of pregnancy (SSW).
Diagnosis and course
If HELLP syndrome is suspected, a diagnosis must be made as soon as possible. For this reason, the immediate admission of the affected pregnant woman to a hospital takes place. There, the attending physician first establishes the patient’s medical history. Existing pre-existing conditions such as diabetes mellitus, chronic high blood pressure, kidney disease and previous family history are important. The presence of HELLP syndrome can only be confirmed by laboratory tests. In the course of diagnostics, blood coagulation parameters and liver values are determined. In addition, various examinations are performed to monitor the course of the disease, such as sonography (ultrasound examination) of the uterus. The course of the disease HELLP syndrome is considered to be alarming. If hemolysis progresses, there is a risk of massive anemia. Likewise, internal bleeding is within the realm of possibility. The longer HELLP syndrome persists, the greater the risk of liver cell damage. Particularly dangerous complications include detachment of the placenta and acute renal failure.
Complications
HELLP syndrome can cause serious complications and discomfort for the child and for the mother during pregnancy. In the worst case, both the mother and the child die. First and foremost, the mother feels generally ill, with severe swelling of the face. There are also visual disturbances and vomiting with nausea. These complaints extremely reduce the patient’s quality of life. There is extreme pain in the upper abdomen, especially when touched. In many cases, HELLP syndrome is diagnosed late because the complaints and symptoms are not clear for this disease. However, without treatment, the syndrome can have a very negative impact on the child’s health. Internal bleeding and kidney failure may continue to occur. In this case, the affected person is dependent on dialysis. As a rule, no treatment of the HELLP syndrome is possible. For this reason, the birth must be performed earlier, which in most cases leads to discomfort and complications. It is not possible to make a general prediction about the success of the birth. The child may not be born fully healthy.
When should you go to the doctor?
Because HELLP syndrome can, in the worst case, lead to both the death of the mother and the death of the child, medical treatment and examination should always be sought. As a rule, a doctor should be consulted if the pregnant woman’s face swells severely or if there is severe pain in the upper part of the abdomen. Furthermore, visual disturbances or nausea with vomiting may also indicate HELLP syndrome and should be examined by a medical professional. Since these complaints can also occur during pregnancy without HELLP syndrome, an examination is still recommended if they occur. High blood pressure may also indicate this complaint. First and foremost, the pregnant woman should consult a gynecologist. He or she will be able to diagnose the HELLP syndrome. However, in acute emergencies or if the symptoms are very severe, the hospital should be visited or the emergency doctor should be called. Early diagnosis and treatment can save the life of the child and the mother.
Treatment and therapy
Treatment for HELLP syndrome depends on when the condition appears. If it manifests after the 34th week of pregnancy, the birth of the child must be induced. If, on the other hand, the syndrome appears before the 32nd week of pregnancy, doctors delay the birth process as long as possible. This is urgently necessary for the maturation of the child’s lungs. Medication is used to stabilize the mother’s blood clotting and blood pressure. It is important to lower the blood pressure in a controlled manner to prevent damage to the placenta. For this reason, a CTG check is always performed, during which a special labor recorder checks the mother’s contractions on the one hand and the baby’s heart activity on the other. However, delayed delivery is only feasible when the blood coagulation values, blood pressure and liver values have returned to normal. The later the delivery can be induced, the higher the child’s chances of survival. To support lung maturation, the child also receives cortisone or cortisone-like preparations. To enable rapid intervention in an emergency, mother and child are monitored around the clock. If the HELLP syndrome is only mild, it is sometimes possible to wait without inducing delivery. However, strict monitoring of the mother’s blood pressure and blood counts is important.
Outlook and prognosis
HELLP syndrome is a serious complication during pregnancy and can lead to serious sequelae. Close medical monitoring of both mother and child is required to intervene quickly in the event of an emergency. Initially, the pregnant woman may develop severe anemia with all its symptoms. This often means that internal bleeding cannot be ruled out, as the platelet count drops massively. At best, these bleedings turn out to be so minimal that they are not noticed, but bleedings with symptoms may also occur. The longer the HELLP syndrome persists, the more the damage to the pregnant woman’s liver cells progresses. This results in the formation of more or less large hematomas under the liver capsule, which are usually easily visible on ultrasound.In an emergency, this leads to liver rupture, which requires immediate surgery and can be life-threatening. HELLP syndrome can also lead to severe damage to the kidneys, including acute kidney failure. All this affects the unborn child at most by the necessary medication and surgical interventions in the mother. It becomes dangerous for the baby if the placenta detaches prematurely as a result of HELLP syndrome. This can happen not only during birth, but also unexpectedly earlier in the course of pregnancy.
Prevention
In order to detect HELLP syndrome in time and treat it appropriately, prenatal care should be consistently performed. This is done by regularly measuring blood pressure, checking urine output, and examining kidney and liver functions.
Follow-up care
In most cases, the measures and options for follow-up care in HELLP syndrome are severely limited. In this case, the affected person first depends on a rapid diagnosis with subsequent treatment to prevent further complications. In the worst case, this can lead to the death of the child or the mother, so that the early detection of the disease is in the foreground in HELLP syndrome. The possibilities of aftercare are usually almost non-existent, since the further course depends strongly on the birth of the child. Regular examinations of the child and the mother are necessary to monitor the situation properly. After birth, the child is usually dependent on taking medication. In this case, the parents must pay attention to the correct dosage and also to the regular intake. Likewise, regular check-ups by a doctor are still necessary after the birth. Parents depend on the support of family and friends to prevent psychological upsets or depression. In this context, loving care and support have a positive effect on the course of the disease. Whether HELLP syndrome will result in a decreased life expectancy for the child or mother cannot be generally predicted.
Here’s what you can do yourself
HELLP syndrome is always a medical emergency that requires prompt medical attention. If poisoning is suspected, a hospital must be visited immediately, as there is a concrete danger to the life of both the mother and the child. Independent treatment away from conventional medicine is strongly discouraged. Otherwise, there is a risk of an unnecessary aggravation of the situation, which can lead to irreversible damage to health. In the majority of cases, the life of mother and child can only be saved by delivering the baby by cesarean section. However, this does not yet lead to an interruption of the HELLP syndrome. Often, the peak occurs only after the induction of labor. This makes the importance of comprehensive aftercare all the greater. In addition to the physical care of mother and child, mental care should also be considered. This is because the psychological after-effects often continue to be felt by the woman concerned even years later. Psychotherapeutic support helps to process the traumatic experience, avoid long-term impairments and cope with everyday life.
