HELLP SYNDROME

• What does HELLP syndrome mean?

  Hemolysis, Elevated Liver Enzymes, Low Platelet
• HELLP syndrome


  severe form of eclampsia characterized by hemolysis of red blood cells, elevated liver enzymes and low platelet
• HELLP syndrome


  involved the hepatic dysfunction which kidneys and liver are affected
• HELLP syndrome

  variation of gestational hypertension that occurs to patients with hypertension
• What will you monitor when the mother has HELLP syndrome?

  Serum glutamic oxaloacetic transaminase (SGOT or AST), Serum glutamate pyruvate transaminase (SGPT or ALT)
• HELLP SYNDROME PATHOPHYSIOLOGY

  • Hemolysis: breaking down of red blood cells
  • Elevated/increased liver enzymes: that will lead to increased bilirubin level
  • Due to blood flow being obstructed by fibrin deposits, it will also lead to increased bilirubin levels. Patient's skin becomes yellowish in color (jaundice)
  • Low platelets: caused by vascular damage resulting from vasospasm. Bleeding starts - gums, orifice bleeding (mouth, anus, vagina, ears)
• Risk factors, mothers with:

  • Chronic renal failure
  • Chronic hypertension
  • History of preeclampsia
  • Age >35 and <18
  • Maternal infection
  • Obese mothers
  • Multiparity
  • History of or with gestational diabetes mellitus
  • Rh incompatibility
• Rh incompatibility- mother's blood is Rh negative and her fetus is Rh positive. Antibodies of the mother will enter the blood stream of the fetus-damage red blood cells
• First signs and symptoms

  • Fatigue - duo to developing hemolytic anemia
  • Blurred vision
  • Sudden weight gain
  • Edema - 1st trimester
  • Increased blood pressure
• Other signs and symptoms

  • Abnormal bleeding/clotting issue
  • Petechia - skin rashes
  • Increased proteinuria - associated with pregnancy-induced hypertension
  • Tenderness felt at the right upper quadrant of the abdomen which signifies = liver inflammation due to elevated liver enzymes that results to liver damage
• Other signs and symptoms (2)

  • Anemia - hemolysis of rbc
  • Seizures increased CNS irritability
  • Hyperbilirubinemia - jaundice
  • Disseminated intravascular coagulation
  • Nausea and vomiting due to vascular congestion of liver or pancreas
  • Ruptured liver - due to obstructed blood flow
• Nursing management / treatment

  • Blood transfusion of platelet and plasma
  • Monitor and control of blood pressure
  • Deliver the fetus as soon as possible
  • Monitor maternal and fetal well-being
  • Administer corticosteroids = to aid the lung maturity of the fetus in case of premature labor and delivery
  • Bedrest and restricted strenuous activities
  • Magnesium sulfate, calcium gluconate, oxygen and tongue depressor must be at bed side
  • Prepare mother for cesarean section
• Fetal risk

  • Premature
  • Small for gestational age
  • Hypermagnesemia due to large doses of magnesium sulfate
• Diagnostic test to check for liver function

  • Aspartate aminotransferase (AST)
  • Alanine aminotransferase (ALT)

  Both are important to monitor liver enzymes and functioning

  Elevation of liver enzymes = increased AST and ALT during blood examination