HELLP syndrome
introduction
HELLP syndrome is a condition that can occur during pregnancy.
It affects about one to two in 300 pregnancies.
Women who already suffer from gestosis of pregnancy (preemclampsia or also commonly referred to as pregnancy poisoning) during pregnancy develop HELLP syndrome in up to 12% of cases.
It is therefore also considered a particularly severe form of preeclampsia. HELLP is an abbreviation for the various symptoms that characterize the disease. H stands for Haemolysis (hemolysis = dissolution of the blood), E and L for Elevated Liver Enzyme Levels (increased liver values) and L and P for Low Platelet Count (low number of blood platelets / thrombocytes).
Since the HELLP syndrome is a high blood pressure disease and it can be very dangerous during pregnancy, the HELLP syndrome is a serious illness that requires hospitalization. If left untreated, HELLP syndrome can be life-threatening for both mother and child.
root cause
The exact cause of the HELLP syndrome has not yet been clarified. It is believed that there is damage to blood vessels in the Plaster cake (Placenta), causing a massive drop in Platelets under an excessive Blood clotting is generated. This could be due to an altered development of the placenta in the Early pregnancy be conditional. As a result, the placenta is poorly supplied with blood and reacts by releasing various messenger substances that become one in the maternal organism Inflammatory response and the generalized Blood clotting to lead.
Symptoms
The symptoms of HELLP syndrome are diverse. On the one hand, there are the classic symptoms of Preemclampsia: high blood pressure and increased Protein in the urine. In addition, there is usually severe pain in the right upper abdomen caused by a Enlargement of the liver are conditional. The pain can also extend into the move radiate. Also nausea, Vomit and diarrhea can occur. For this reason, the HELLP syndrome often starts with a Gastrointestinal infection mistaken. On the other hand, other symptoms can also occur, such as Visual disturbances (Eye flicker, double vision, sensitivity to light), a headache or itching of the skin. If the HELLP syndrome is left untreated, it can worsen enormously and become one Shock symptoms to lead. This can then lead to kidney failure, Pulmonary edema (Fluid build-up in the lungs) Cerebral hemorrhage by rupture of a blood vessel or a Liver tear accompanied. Most of the time, HELLP syndrome occurs in the last trimester of pregnancy.
Diagnosis
In order to diagnose HELLP syndrome, one must first of all Blood examined become. This shows a degraded Haptoglobin level. Haptoglobin is a transport protein that contains free blood pigment (hemoglobin) transported away. Since hemolysis (dissolution of the red blood cells) occurs in the HELLP syndrome, haptoglobin is low. Also hemoglobin is humiliated. The opposite are those Liver values (GOT, GPT, LDH and D dimers) in the blood increased. The Clotting factors are humiliated. The Platelet count in the blood is significantly reduced with <100,000 per microliter. As a sign of Kidney damage is this Creatinine increased, there is more in the urine protein. To determine if the child is already at risk, a CTG (Cardiotocography) written. CTG changes can result in a Oxygen deficiency of the child as a result of a disruption of the placental function. In combination with the clinical symptoms of women, the HELLP syndrome can be diagnosed very reliably in this way.
As an early sign of one pre-eclampsia (from which a HELLP syndrome may develop), pathological blood flow conditions in the uterine artery apply. By a Doppler sonography (Ultrasound examination) these can be discovered.
therapy
Since the HELLP syndrome can lead to a life-threatening condition within a very short time, it is usually a Emergency caesarean section carried out and thus brought the child into the world. Since the course of the disease is very difficult to assess, this is the therapy method of choice. The pregnant woman needs intensive medical monitoring and can take medication to lower the High blood pressure and against Seizures receive. In rare cases in which the HELLP syndrome occurs early in the pregnancy and only proceeds very slowly, an attempt can be made to convince the pregnant woman Acetylsalicylic acid (ASS), Immunoglobulins and Plasmapheresis (all conservative therapy methods) to treat. However, the indication for these cautious measures is extremely rare. The premature caesarean section remains the standard therapy and must always be carried out with a risk-benefit assessment.
forecast
If the HELLP syndrome is recognized early and accordingly quickly by a Caesarean section treated, the prognosis is good. Nevertheless, the maternal mortality rate is around 3-5% overall, and the infant mortality rate is as high as 10-40%. The early consultation of a doctor in the event of the above symptoms is therefore essential for maintaining the health of both mother and child. As a rule, permanent damage is not to be expected after a HELLP syndrome has been overcome. In some cases, the Short term memory come. Depending on how early in the pregnancy the HELLP syndrome occurs, the child may have a significantly reduced Birth weight exhibit.
prophylaxis
Some risk factors have already been identified for the HELLP syndrome, which unfortunately cannot necessarily be influenced by the woman. These include, for example, a Diabetes (Diabetes mellitus), chronic Kidney disease, high blood pressure, Multiple pregnancies and a family history. Also at overweight HELLP syndrome is more common in pregnant women and pregnant women over the age of 40. If a woman has had an increased pregnancy rate in a previous pregnancy Blood pressure special care is required. Unfortunately, there is therefore no direct prophylaxis to safely avoid HELLP syndrome. A healthy lifestyle before and during pregnancy and the avoidance of Obesity can, however, have a protective effect to a certain extent and is generally positive for the health of mother and child.
