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HELLP syndrome

HELLP syndrome (Haemolysis, Elevated Liver Enzymes, Low Platelet Count) is a rather rare, nonetheless a very serious complication of pregnancy. It often occurs in the setting of preeclampsia but can occur independently, too. One third of cases manifests in the immediate postpartum period. This condition cannot be predicted, the final diagnosis can only be determined based on the laboratory test results, medical signs and patient-reported symptoms. This interactive case takes you on a tour from the recognition of the first signs of HELLP syndrome, its diagnosis and therapy to its possible complications and their consequences.

Author: Assoc. Prof. Petr Štourač, MD, PhD, Pavla Miřátská, Petr Zámečník

Institution: Faculty of Medicine at Masaryk University in Brno

Medical discipline: Emergency Medicine

Keywords: HELLP syndrome | complications of pregnancy | postpartum complications

Educational evel: Undergraduate level | Graduate

HELLP syndrome (Haemolysis, Elevated Liver Enzymes, Low Platelet Count) is a rather rare, nonetheless a very serious complication of pregnancy. It often occurs in the setting of preeclampsia but can occur independently, too. One third of cases manifests in the immediate postpartum period. This condition cannot be predicted, the final diagnosis can only be determined based on the laboratory test results, medical signs and patient-reported symptoms. This interactive case takes you on a tour from the recognition of the first signs of HELLP syndrome, its diagnosis and therapy to its possible complications and their consequences.


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Review

HELLP syndrome is a very serious, possibly critical condition occurring during pregnancy and as such it must not be underestimated. This interactive case of HELLP syndrome is coherent, all the right and wrong choices are well explained and put in logical order. The priority of obtaining thorough patient’s medical history is emphasised since nowadays it is often overshadowed by the accessibility of many modern tests and imaging techniques and therefore sometimes neglected. Pointing out the necessity to recognise the gravity of the situation when making the decision to admit the patient to the ICU is also very important. When making the differential diagnosis, it is perceived as essential to mention several other conditions with similar signs and symptoms which must be considered and to explain and clarify the differences between these and HELLP syndrome. When a wrong course of action is taken regarding the therapy, it is well explained what kind of medication should not be administered during pregnancy and why. I find it very interesting having the option of ending the pregnancy with either caesarean section or vaginal childbirth. Both paths further lead to different kinds of troubles and complications. In conclusion, I must acknowledge the emphasis being put on taking a modern approach when inducing and maintaining general anaesthesia and managing the complications. I also appreciate informing the new mother of how this condition may affect another pregnancy. The interactive case of HELLP syndrome will surely contribute to the ability of managing this serious condition and thanks to the explanation of possible missteps it will provide deeper insight into this complication of pregnancy.

publikováno: 25.5.2017 | last modified on: 17.5.2018