HELLP syndrome - Therapeutic dilemma

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HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a severe and life-threatening form of preeclampsia. The classical symptoms, despite the typical laboratory evaluation, are epigastric or right upper quadrant pain, nausea and vomiting; the classical signs of preeclampsia may be absent in 20% of women. As no reliable clinical and laboratory indicators exist, as well as no precisely defined cut-off values in predicting the course and prognosis, the outcome of HELLP syndrome is unpredictable. The high maternal morbidity and mortality are mainly due to the development of disseminated intravascular coagulation (DIC); the frequency of DIC has been shown to increase significantly with the time interval between diagnosis and delivery. The management of HELLP syndrome has been controversial, with some authors recommending a conservative approach to induce fetal maturity in pregnancies below the 32(nd) (34(th)) week of gestation, whereas the majority recommend immediate delivery by Cesarean section in patients with an unfavorable cervix irrespective of the gestational age. It is generally agreed that early diagnosis by laboratory screening methods is mandatory and that patients with the HELLP syndrome should be transferred to a perinatal center. A literature review since 1990 clearly demonstrates that aggressive management is associated with a significant reduction in maternal and perinatal mortality. Conservative management is only justified in cases of fetal immaturity under of following conditions: a) no evidence of progression of the disease, b) no suspected or manifest DIC, c) fetal well-being, and d) intensive monitoring of the patient in cooperation with experienced anesthesiologists and neonatologists.

Original languageEnglish
Pages (from-to)32-36
Number of pages5
JournalArchives of Gastroenterohepatology
Issue number1
Publication statusPublished - Jan 1 1998

ASJC Scopus subject areas

  • Gastroenterology

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