Treatment Options

 

"HELP! I have HELLP! What now?"

Say your doctor has assessed you, run tests, and has now determined that you do have HELLP syndrome. So how do you proceed? What can you expect?

Depending on many factors, the doctor will decide to treat you preemptively, cautiously in the hospital, or determine that you need to be delivered for the safety of you and the baby.

The most common major options for treatment are as follows:

* If you are more than 34 weeks pregnant, current recommendations are to deliver you immediately for the health of both you and your baby. The risk of continuing pregnancy with treatment does is more than  possible benefit that you will resolve your HELLP and recover after delivery, and that your baby will be healthier outside the womb.

*For women between 27 and 34 weeks of pregnancy, the focus will be stabilization of the mothers clinical condition and starting steroid therapy, as well as treatments with magnesium sulfate, platelet infusion, blood pressure medications, and tests for baby such as biophysical profiles, ultrasounds, and non-stress tests to monitor fetal wellbeing. Then reevaluating within 48 hours for the need to deliver to resolve symptoms.

*Before 27 weeks gestation, focus will be on conservatively managing mothers condition with the above treatments, but treatment will vary based on condition and provider preference and policies.

While immediate delivery usually consists of a c-section for moms who are less than 34 weeks, if a mom is further along and both mom and baby will tolerate, a trial of labor for vaginal delivery may be attempted before rushing to surgery.

The other thing to keep in mind is that while delivery of the infant is the cure, symptoms can increase for the first 24-48 hours, before beginning to resolve at 3-4 days post partum. Rarely the condition can continue into the first week or two.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654858/

http://americanpregnancy.org/pregnancy-complications/hellp-syndrome/

http://www.aafp.org/afp/1999/0901/p829.html

treatment diagram: http://www.aafp.org/afp/1999/0901/p829.html

Signs & Symptoms

"What sort of symptoms should I be watching for?"

Some of the major signs and symptoms that you should be alert to at home, are:

* Headaches (severe or worstening)

* Nausea or vomiting that is getting worse

* Upper right abdominal pain or tenderness

* Fatigue or "not feeling well" that is more than usual with pregnancy

* Edema (swelling of the feet, ankles, hands, face)


These are the most common signs. More critical signs may include:

* Bleeding
* Visual changes
* Chest tightening or radiating shoulder pain

Your doctor may assess and tell you that you have:

* High blood pressure
* Protein in your urine
* Abnormal lab values

All of these symptoms can mean that you are developing HELLP syndrome. Some of these by themselves can be normal in pregnancy, but need to be evaluated by a professional. Some women with HELLP syndrome may only show some symptoms and not others, while others may show all symptoms. Only a doctor can diagnose you, but these are just some of the things you would want to watch out for and report to your health care provider for the safety of you and your baby!

Many times HELLP syndrome begins with mild symptoms of pregnancy induced hypertension, or preeclampsia, some show no signs at all until things have developed! It is important to catch things early for early treatment to prevent complications. The most common reasons a mother becomes severely ill (or possible death) are from stroke, hemorrhage, or liver rupture. All of these outcomes can be prevented by early diagnosis and treatment. If you feel like you are exhibiting symptoms, please contact your provider for an assessment!



http://americanpregnancy.org/pregnancy-complications/hellp-syndrome/

http://www.preeclampsia.org/health-information/hellp-syndrome

blood pressure picture: https://www.healthtap.com/topics/does-history-of-therapeutic-abortion-cause-hellp-syndrome

pregnancy picture:http://www.crecerfeliz.es/content/search?SearchText=%22sindrome+couvade%22

symptoms picture:http://www.whatthehellp.com/free-stuff.html

Diagnosis

          "How will I know if I have HELLP?"

There are several different symptoms that can give you a clue is something is wrong, but best to see a doctor for a true diagnosis so they can put together the whole picture! On top of a clinical exam and discussion of symptoms, the doctor may run blood tests to check liver function and look at platelet levels. Urine screen may be done as well to check for proteinuria. HELLP is usually prominent in the 3rd trimester, but can rarely sometimes show up earlier. Sometimes it can happen that the symptoms show up after delivery even!

But here are some of the associated diagnostic tests that can help with the diagnosis of HELLP!


Hemolysis -Red blood bells

• Abnormal peripheral smear
• Lacatate dehydrogenase >600 U/L
• Bilirubin > 1.2 mg/dl

Elevated liver Enzyme levels

• Serum aspartate amniotransferase >70 U/L
• Lacatate dehydrogenase >600 U/L
• Low Platelets <100,000/mm3

http://americanpregnancy.org/pregnancy-complications/hellp-syndrome/

How HELLP Syndrome is Classified

The severity of HELLP syndrome is measured according to the blood platelet count of the mother and divided into three categories, according to a system called "the Mississippi classification."

• Class I (severe thrombocytopenia): platelets under 50,000/mm3
• Class II (moderate thrombocytopenia): platelets between 50,000 and 100,000/mm3
• Class III (AST > 40 IU/L, mild thrombocytopenia): platelets between 100,000 and 150,000/mm3
• http://www.preeclampsia.org/health-information/hellp-syndrome

HELLP syndrome picture: http://www.tipsgettingpregnant.com/?hop=paleodietr

text box: http://www.jpma.org.pk/full_article_text.php?article_id=3584