HELLP syndrome
Updates to Article Attributes
HELLP syndrome is a pregnancy related condition and isan abbreviation for:
- haemolysis
- elevated liver enzymes and
- low platelets
It is considered a severe and life threatening form of pre-eclampsia.
Epidemiology
The estimated incidence is at ~ 0~0.17-0.85 of live births 9. The condition often occurs in the 3rd trimeter of pregnancy (and occasionally post partum). It tends to present in young primagravid women.
Clinical presentation
Presentation can be variable and can include malaise , epigastric / right/right upper-quadrant pain, and nausea / vomiting/vomiting. Some may have non-specific viral-syndrome-like symptoms. Hypertension and proteinuria (classic symptoms of pre eclampsia) may be absent or slight 7.
Pathology
On liver histology, there is may a combination of deposited fibrin, haemorrhage and hepatocellular necrosis surrounding portal areas 6.
Radiographic features
CT abdomen
The place of CT is mainly to assess for complications.
When considering a CT scan the radiologist needs to discuss with the obstetrician regarding radiation risk to fetus from radiation versus clinical suspicion of a complications in order to make a rational judgement. The CT scan may show hepatic complications such as rupture, sub capsular haematoma or hepatic infarction.
Complications
-
disseminated intravascular coagulation: reported to occur in
~ 20~20-40% of patients 5 - hepatic infarction
- hepatic haematoma
- hepatic rupture
- placental abruption
Treatment and prognosis
Management is often supportive. Patients with hepatic rupture +/- intraperitoneal bleeding require immediate surgery or selective hepatic arterial embolisation.
EtymologyHistory and etymology
The condition was originally described Pritchard et al in 1954 3 with the acronym later coined by L Weinstein in 1982 4.
-<p><strong>HELLP syndrome</strong> is a pregnancy related condition and is an abbreviation for</p><ul>-<li>-<strong>h</strong>aemolysis</li>-<li>-<strong>e</strong>levated <strong>l</strong>iver enzymes and </li>-<li>-<strong>l</strong>ow <strong>p</strong>latelets</li>-</ul><p>It is considered a severe and life threatening form of <a href="/articles/pre-eclampsia" title="pre-eclampsia">pre-eclampsia</a>.</p><h4>Epidemiology</h4><p>The estimated incidence is at ~ 0.17-0.85 of live births <sup>9</sup>. The condition often occurs in the 3<sup>rd</sup> trimeter of pregnancy (and occasionally post partum). It tends to present in young primagravid women. </p><h4>Clinical presentation</h4><p>Presentation can be variable and can include malaise , epigastric / right upper-quadrant pain, and nausea / vomiting. Some may have non-specific viral-syndrome-like symptoms. Hypertension and proteinuria (classic symptoms of pre eclampsia) may be absent or slight <sup>7</sup>. </p><h4>Pathology</h4><p>On liver histology, there is may a combination of deposited fibrin, haemorrhage and hepatocellular necrosis surrounding portal areas <sup>6</sup>. </p><h4>Radiographic features</h4><h5>CT abdomen</h5><p>The place of CT is mainly to assess for complications.</p><p>When considering a CT scan the radiologist needs to discuss with the obstetrician regarding radiation risk to fetus from radiation versus clinical suspicion of a complications in order to make a rational judgement. The CT scan may show hepatic complications such as rupture, sub capsular haematoma or hepatic infarction. </p><h4>Complications</h4><ul>-<li>-<a href="/articles/disseminated-intravascular-coagulation" title="disseminated intravascular coagulation">disseminated intravascular coagulation</a> : reported to occur in ~ 20-40 % of patients <sup>5</sup>-</li>-<li><a href="/articles/hepatic-infarction-1" title="hepatic infarction">hepatic infarction</a></li>-<li><a href="/articles/hepatic-haematoma" title="hepatic haematoma">hepatic haematoma</a></li>-<li><a href="/articles/hepatic-rupture" title="hepatic rupture">hepatic rupture</a></li>-<li><a href="/articles/placental-abruption" title="Placental abruption">placental abruption</a></li>-</ul><h4>Treatment and prognosis</h4><p>Management is often supportive. Patients with hepatic rupture + / - intraperitoneal bleeding require immediate surgery or selective <a href="/articles/hepatic-arterial-embolisation" title="hepatic arterial embolisation">hepatic arterial embolisation</a>. </p><h4>Etymology</h4><p>The condition was originally described <strong>Pritchard </strong>et al in 1954 <sup>3</sup> with the acronym later coined by <strong>L Weinstein</strong> in 1982 <sup>4</sup>.</p>- +<p><strong>HELLP syndrome</strong> is a pregnancy related condition and is an abbreviation for:</p><ul>
- +<li>
- +<strong>h</strong>aemolysis</li>
- +<li>
- +<strong>e</strong>levated <strong>l</strong>iver enzymes and </li>
- +<li>
- +<strong>l</strong>ow <strong>p</strong>latelets</li>
- +</ul><p>It is considered a severe and life threatening form of <a href="/articles/pre-eclampsia">pre-eclampsia</a>.</p><h4>Epidemiology</h4><p>The estimated incidence is at ~0.17-0.85 of live births <sup>9</sup>. The condition often occurs in the 3<sup>rd</sup> trimeter of pregnancy (and occasionally post partum). It tends to present in young primagravid women. </p><h4>Clinical presentation</h4><p>Presentation can be variable and can include malaise , epigastric/right upper-quadrant pain, and nausea/vomiting. Some may have non-specific viral-syndrome-like symptoms. Hypertension and proteinuria (classic symptoms of pre eclampsia) may be absent or slight <sup>7</sup>. </p><h4>Pathology</h4><p>On liver histology, there is may a combination of deposited fibrin, haemorrhage and hepatocellular necrosis surrounding portal areas <sup>6</sup>. </p><h4>Radiographic features</h4><h5>CT abdomen</h5><p>The place of CT is mainly to assess for complications.</p><p>When considering a CT scan the radiologist needs to discuss with the obstetrician regarding radiation risk to fetus from radiation versus clinical suspicion of a complications in order to make a rational judgement. The CT scan may show hepatic complications such as rupture, sub capsular haematoma or hepatic infarction.</p><h4>Complications</h4><ul>
- +<li>
- +<a href="/articles/disseminated-intravascular-coagulation">disseminated intravascular coagulation</a>: reported to occur in ~20-40% of patients <sup>5</sup>
- +</li>
- +<li><a href="/articles/hepatic-infarction-1">hepatic infarction</a></li>
- +<li><a href="/articles/hepatic-haematoma">hepatic haematoma</a></li>
- +<li><a href="/articles/hepatic-rupture">hepatic rupture</a></li>
- +<li><a href="/articles/placental-abruption">placental abruption</a></li>
- +</ul><h4>Treatment and prognosis</h4><p>Management is often supportive. Patients with hepatic rupture +/- intraperitoneal bleeding require immediate surgery or selective <a href="/articles/hepatic-arterial-embolisation">hepatic arterial embolisation</a>. </p><h4>History and etymology</h4><p>The condition was originally described <strong>Pritchard </strong>et al in 1954 <sup>3</sup> with the acronym later coined by <strong>L Weinstein</strong> in 1982 <sup>4</sup>.</p>
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