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

Etiology/Pathophysiology

"How the heck does this even happen in the body"?

Well, doctors are still unsure about what exactly causes HELLP syndrome or what happens in the body to trigger symptoms.

One theory is that the same mechanisms that cause preeclampsia or pregnancy induced hypertension are at play. However, the added complications of elevated liver enzymes and decreased platelets are unknown. One theory, is that the cause of preeclampsia is from defective placental remodeling and inadequate placental perfusion. This then causes different factors that cause placental disfunction, resulting in hypertension, proteinuria, increased platelet activation and aggregation. Activating the coagulation cascade causes platelets to adhere onto damaged endothelium, and hemolysis from the sheared erythrocytes as they travel through platelet-fibrin deposit riddled capillaries. This causes damage to multiple organs, and can cause hepatic (liver) necrosis that leads to the liver dysfunction of HELLP.

Another theory, is that it stems from maternal immune rejection, from contact with a genetically distinct fetus, which would alter the maternal-fetal immune balance, then causing endothelial dysfunction, platelet activation and aggregation, and hypertension. 

Since HELLP is a syndrome with multiple possible abnormalities, there is also classification of HELLP syndrome by how many abnormalities are present. There could be multiple processes going on in the mother playing into effect different abnormalities as part of the bigger problem.

Partial HELLP presents with 1-2 abnormalities, and flu HELLP has all 3. Women with full HELLP are at risk for more severe complications including disseminated intravascular coagulopathy (DIC) and should be candidates for immediate treatment, including delivery within 48 hours.

Sources:

http://emedicine.medscape.com/article/1394126-overview#a4

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

hellp diagram: http://www.clinsci.org/content/122/2/43

help baby picture: http://www.muitomaisquemae.com.br/2015/01/sindrome-de-hellp.html