✓ Hellp syndrome in pregnancy: what it is, how it manifests itself, how to intervene

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Hellp syndrome, what is it

It is a syndrome associated with preeclampsia, which therefore can affect pregnant women. The term Hellp is an acronym consisting of the initials of the words (English) that indicate the main clinical manifestations, at the biochemical level, of the disease:

hemolysis (destruction of red blood cells);
elevated levels of liver enzymes;
low levels of platelets.

Fortunately, this is a rather rare condition that affects him 0,2-0,6% of pregnancies (10% of pregnancies with preeclampsia).

"The acronym was invented in the early XNUMXs by a doctor who had identified some forms of preeclampsia characterized by a particular (but not unique) liver pain" explains the gynecologist. , medical director of the Buzzi Children's Hospital in our city, an expert in the pathology of pregnancy.

When it manifests itself

By definition the Hellp syndrome concerns the second or, more frequently, the third trimester of pregnancy: "It occurs after 24 weeks"He specifies." If similar symptoms are found before 24 weeks it is actually other conditions, with kidney or liver involvement. "However, it can also occur in the 48 hours after delivery.

Read also: Last month of pregnancy, 8 things to know

How it manifests itself, what are the symptoms

"The syndrome usually arises suddenly and there are three ways in which its presence can be detected" explains the gynecologist.

Ipertensione, which is one of the two typical manifestations of preeclampsia (the other is the presence of protein in the urine, proteinuria);
Blood tests showing low levels of platelets and high levels of liver enzymes;
Very severe epigastric pain, in the upper part of the stomach: "It is like a stab, and it is due to the stretching of a membrane that surrounds the liver, which suddenly stretches."

In fact, the clear association with preeclampsia and its main manifestation, hypertension, is present in the majority of cases (85%), but not in all. 15% of Hellp syndromes do not present with hypertension, which can complicate and delay diagnosis.

"It should therefore be specified that Hellp syndromes are not all the same"He specifies." There are various forms, of different severity. "

Hellp syndrome: the risks for mom and baby

The onset of Hellp syndrome can have serious consequences for the baby and mother. "At the fetal level, there is a risk of placental abruption, fetal distress, growth restriction and prematurity," she says. "On the maternal side, on the other hand, there is the risk of suffering from pulmonary edema, renal insufficiency, major haemorrhages, disseminated intravascular coagulation, respiratory disorders".

The syndrome is associated with a risk of maternal mortality of 1% and perinatal mortality of 7-20%.

Causes and risk factors

"Unfortunately, we still don't know exactly what the causes of this syndrome are" explains the gynecologist. "It is possible that they are involved placental enzymes emitted as a result of some damage during the implantation phase, but we don't know much more about it ".

We do know, however, that there is a risk of recurrence - estimated at around 2-19% - in those who have already had the syndrome in a previous pregnancy and who are more at risk of developing it than women with thrombophilia and autoimmune diseases. "On the other hand, it is rarely associated with metabolic disorders such as diabetes."

Unfortunately, women at risk cannot do much to prevent the onset of a new manifestation of the syndrome: " more frequent checks and we will try not to go beyond the term of pregnancy "she says. Underlining that the latest guidelines (British and American) on the subject also recommend - always for women at risk - to take aspirinetta from early pregnancy: 150 milligrams per day, to be taken in the evening.

Read also: Aspirinetta in pregnancy: what it is for, when to take it, when to stop

How is it done?

“The first thing to do - he says - is stabilize the condition of the woman, administering magnesium sulphate to prevent complications and possible hypertensive in case of high blood pressure. Then you evaluate it fetal state, with cardiotocography, evaluation of the amniotic fluid, doppler of the fetal vessels, and finally it is decided whether to give birth or not. In general, the birth must take place as soon as possible, despite the risks associated with a possible prematurity ".

Read also: Premature babies, the possible risks to life

They may be necessary plasma transfusions, while the use of corticosteroids is still controversial, which should favor the resumption of platelet production. However, their real effectiveness has not yet been definitively demonstrated.

Regarding childbirth, Hellp syndrome is not an absolute indication for the Caesarean section, but in many cases, childbirth happens just like that. The anesthesia of choice is usually general (epidural is not recommended if platelets are too low for the risk of bleeding or bruising). "The vaginal delivery it is possible if the labor has already started and the forecast is that of rather short times ".

Other sources for this article: Guidelines for the management of hypertension in pregnancy; Hypertensive Disorders in Pregnancy (Higher Health Institute Material)

The testimony: Hellp syndrome and childbirth at 27 weeks
My baby was born at 27 weeks. I had Hellp's syndrome during pregnancy, a severe worsening of gestosis and I was in intensive care for a week with a breathing mask. I also had heart failure. The girl had to stay in Tin for 97 days. Today we have many scars left: these will forever remind us of the strength we had to overcome everything.

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