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HELLP syndrome is a life-threatening obstetric complication usually considered to be a variant of pre-eclampsia. Both conditions occur during the later stages of pregnancy, or sometimes after childbirth.
HELLP is an abbreviation of the main findings:[1]
Often, a patient who develops HELLP syndrome has already been followed up for pregnancy-induced hypertension (gestational hypertension), or is suspected to develop pre-eclampsia (high blood pressure and proteinuria). Up to 8% of all cases present after delivery.
There is gradual but marked onset of headaches (30%), blurred vision, malaise (90%), nausea/vomiting (30%), “band pain” around the upper abdomen (65%) and paresthesia (tingling in the extremities). Edema may occur but its absence does not exclude HELLP syndrome. Arterial hypertension is a diagnostic requirement, but may be mild. Rupture of the liver capsule and a resultant hematoma may occur. If the patient gets a seizure or coma, the condition has progressed into full-blown eclampsia.
Disseminated intravascular coagulation is also seen in about 20% of all women with HELLP syndrome,[2] and in 84% when HELLP is complicated by acute renal failure.[3]
Patients who present symptoms of HELLP can be misdiagnosed in the early stages, increasing the risk of liver failure and morbidity.[4] Rarely, post caesarean patient may present in shock condition mimicking either pulmonary embolism or reactionary haemorrhage.
In a patient with possible HELLP syndrome, a batch of blood tests is performed: a full blood count, liver enzymes, renal function and electrolytes and coagulation studies. Often, fibrin degradation products (FDPs) are determined, which can be elevated. Lactate dehydrogenase is a marker of hemolysis and is elevated (>600 U/liter). Proteinuria is present but can be mild.
A positive D-dimer test in the presence of preeclampsia has recently been reported to be predictive of patients who will develop HELLP syndrome.[5] D-dimer is a more sensitive indicator of subclinical coagulopathy and may be positive before coagulation studies are abnormal.[citation needed]
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