Runny nose

Hellp syndrome: concept, clinical forms, possible complications, therapeutic and obstetric tactics. Ozhgb

HELLP syndrome:

H– hemolysis

EL – increase in blood enzyme levels

LP – low platelet count.

The frequency of HELLP syndrome is 2-15%, characterized by high maternal mortality (up to 75%).

The basis of HELLP syndrome is abnormal placentation.

Classification: based on platelet count.

class 1 – less than 50x10 9 /l platelets

class 2 - 50x10 9 /l – 100x10 9 /l platelets

class 3 - 100x10 9 /l - 150x10 9 /l platelets.

Clinic.

Develops in the third trimester from 33 weeks, most often at 35 weeks.

In 30% it manifests itself in the postpartum period.

Initial nonspecific manifestations:

headache, heaviness in the head;
weakness or fatigue;
muscle pain in the neck and shoulders;
visual impairment;
pain in the abdomen, in the right hypochondrium;

then join:

hemorrhages at injection sites;
vomiting blood-stained contents;
jaundice, liver failure;
convulsions;

Often there is tissue rupture with bleeding into the abdominal cavity.

HELLP syndrome can manifest itself:

clinical picture of total premature abruption of a normally located placenta, accompanied by massive coagulopathic bleeding and the formation of hepatic-renal failure;

DIC syndrome;

pulmonary edema;

acute renal failure.

Diagnostics.

Laboratory methods:

clinical blood test;

biochemical blood test: total protein, urea, glucose, creatinine, electrolytes, cholesterol, direct and indirect bilirubin, ALT, AST, alkaline phosphatase, triglycerides;

hemostasiogram: APTT, platelet count and aggregation, PDF, fibrinogen, AT-III;

determination of lupus anticoagulant;

determination of antibodies to hCG;

clinical urine analysis;

Nechiporenko's test;

Zimnitsky's test;

Reberg's test;

analysis of 24-hour urine for protein;

diuresis measurement;

urine culture;

Physical examination:

blood pressure measurement;

24-hour blood pressure monitoring;

pulse determination;

Instrumental methods:

Ultrasound of the liver, kidneys;

Ultrasound and Doppler measurements of the fetus, maternal and fetal hemodynamics;

fundus examination;

Laboratory signs HELLP – syndrome :

Increased levels of transaminases in the blood - AST more than 200 U/l, ALT more than 70 U/l, LDH more than 600 U/l;

Thrombocytopenia (less than 100x10 9 /l);

Decrease in AT level below 70%;

Increased bilirubin levels;

Prolongation of prothrombin time and APTT;

Decrease in fibrinogen levels;

Decreased glucose levels;

All signs of HELLP syndrome are not always observed. In the absence of hemolysis, the symptom complex is designated as ELLP syndrome.

Treatment.

in case of HELLP-syndrome, termination of pregnancy is indicated first of all as soon as possible;

termination of pregnancy is the only way to prevent the progression of the pathological process;

stabilization of the functions of affected organs and systems.

Treatment regimen for pregnant women HELLP – syndrome :

Intensive preoperative preparation, which should last no more than 4 hours;

Fresh frozen plasma IV 20 ml/kg/day in the preoperative period and intraoperatively. In the postoperative period 12-15 ml/kg/day

Hydroxyethylated starch 6% or 10% w/v 500 ml

Crystalloids (complex salt solutions)

Plasmapheresis

Prednisolone IV 300 mg

Urgent surgical delivery:

Fresh frozen plasma IV 20 ml/kg/day
Platelet-rich plasma (with platelet levels less than 40-10 9 /l)
Thrombotic concentrate (at least 2 doses at a platelet level of 50-10 9 /l)
Crystalloids (complex salt solutions)
Hydroxyethylated starch 6% or 10% w/v 500 ml.

At the beginning of the infusion, the rate of administration of solutions is 2-3 times higher than diuresis. Subsequently, during or at the end of the administration of solutions, the amount of urine per hour should exceed the volume of injected fluid by 1.5 - 2 times.

Fibrinolysis inhibitors

Tranexamic acid IV 750 mg 1 time/day

Prednisolone IV 300 mg/day

Hepatoprotectors

Essential phospholipids IV 5 ml

Ascorbic acid 5% IV solution 5 ml

Postoperative period

infusion therapy

Hydroxyethylated starch 6% or 10% w/v 12-15 ml/kg/day

Fresh frozen plasma 12-15 ml/kg/day.

The volume of ITT is determined by the values:

hematocrit not lower than 24 g/l and not higher than 35 g/l;

diuresis 50-100 ml/hour;

CVP at least 6-8 cm water column

AT-III not less than 70%

total protein not less than 60 g/l

blood pressure indicators.

Replacement therapy and hepatoprotectors

Dextrose 10% solution IV volume and duration of administration is determined individually

Ascorbic acid up to 10g/day

Essential phospholipids iv 5 ml 3 times a day

Antihypertensive therapy – when systolic blood pressure increases above 140 mmHg.

Prednisolone, including preoperative and intraoperative doses, ranges from 500-1000 mg/day.

Antibacterial therapy.

Antibacterial therapy begins from the moment of surgical delivery.

Antibiotics with bactericidal activity and a wide spectrum of action:

III - IV generation cephalosporins; combined ureidopenia cillins.

Name/cilastatin IV 750 mg 2 times a day or

Ofloxacin 200 mg 2 times a day or

Cefotaxime 2 g 1-2 times/day or

Ceftriaxone 1 g 1-2 times/day.

Plasmapheresis, ultrafiltration, hemosorption.

Forecast.

With timely diagnosis and pathogenetic therapy, mortality can be reduced to 25%.

Hellp syndrome is a rare but serious complication that affects pregnant women. This is a variant of preeclampsia. HELLP syndrome means the following signs and symptoms:

H – hemolysis (decomposition of red blood cells);
EL - Elevated liver enzyme;
LP-Low platelet count.

The condition affects about 0.5-0.9% of pregnant women. Occurs later in pregnancy or maybe even after childbirth.

The exact cause of the syndrome is unknown. It is considered a symptom of an underlying disorder and not in itself. It is a complication of preeclampsia, a disorder in pregnant women with high blood pressure and protein in the urine (proteinuria).

Other risk factors include:

obesity;
Poor nutrition;
Diabetes;
Age of pregnant women (over 35 years);
Multiple pregnancy;
History of preeclampsia.

Signs and symptoms

It is accompanied by a series of symptoms:

Fatigue and malaise;
Fluid retention;
Increase in excess weight;
Nausea and vomiting worsen over time;
Paresthesia (tingling sensation in the limbs);
Visual disturbances;
swelling, especially in the legs;
Nose bleed;
Cramps.

Diagnostics

Symptoms associated with Hellp syndrome often mimic other diseases or complications. A physical examination followed by confirmation from blood and urine tests is carried out to diagnose it.

During a physical examination, the doctor will look for an enlarged liver or excess swelling, especially in the legs.

Blood tests

CBC (complete blood count) contains information about red blood cells, white blood cells, platelet count. Hemolysis, the breakdown of red blood cells, is a characteristic feature of help syndrome. An abnormal peripheral smear with a low platelet count indicates a problem.
LDH (lactate dehydrogenase) is an enzyme that helps body tissues produce energy. LDH is present in almost all tissues of the body. LDH levels increase if there is damage.
An LFT (liver function test) is a series of blood tests done to detect the presence of liver disease. Liver enzymes are high due to liver damage, excessive breakdown of red blood cells.

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Other studies

A urine test detects the presence of excess protein along with elevated uric acid levels.
Blood pressure, if high, means Help syndrome.
An MRI or CT scan is recommended to check for internal bleeding, especially in the liver.
Fetal monitoring tests include sonograms, stress-free tests, and fetal movement assessments to check the baby's health.

Treatment

Having a child is the final treatment. This will prevent further complications. Most women stop experiencing symptoms 4-5 days after giving birth. Delivery should be considered after completion of 34 weeks of pregnancy.

Corticosteroids are prescribed to help the baby and mother. If birth can be delayed, corticosteroids should be given to promote fetal maturation.
During pregnancy, women with low platelet counts may need blood. Consequently, blood transfusion occurs. Transfusion of red blood cells, platelets, and fresh frozen plasma is required.
It is necessary to take medications to control blood pressure. Antihypertensive drugs such as labetalol, nifedipine are prescribed.
Magnesium sulfate is prescribed to prevent episodes of seizures.

Forecast

Early diagnosis is the key to reducing morbidity and mortality. If the condition is treated early, most women make a full recovery.

If Hellp syndrome remains undiagnosed, about 25% of women develop serious complications such as blood clots, placental abruption, kidney failure, and liver damage.

The condition cannot be completely prevented. However, if a woman is diagnosed with preeclampsia, precautions can be taken to reduce the risk of Hellp syndrome.

Maintain a healthy lifestyle that includes regular exercise and weight control that is appropriate for your height
Follow a balanced diet consisting of fresh vegetables, fruits, and protein.

Which doctor should I contact?

If you find any signs associated with Hellp syndrome, contact your obstetrician or gynecologist.

Is it always associated with preeclampsia?

No. Although Help syndrome is a complication of preeclampsia, only about 10-20% of preeclampsia cases develop it.

What happens when placental abruption occurs?

The placenta is the structure responsible for feeding the developing baby. In placental abruption, the placental lining separates from the inner lining of the uterus before birth.

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How is preeclampsia treated?

In most cases, preeclampsia resolves after delivery. Corticosteroids are used in severe preeclampsia to improve liver and platelet function. Magnesium sulfate is the best choice for treatment.

How does it affect children?

Hellp syndrome can affect a baby's survival after birth, as women experience preterm birth. For example, if a baby is born weighing more than 1000 g, the survival rate and health of the baby is the same as that of a normal newborn.

However, if the weight is less than 1000g, then the child will need to be monitored in hospital. Additional tests will be required to ensure its safety.

Is there a risk of it appearing in the future?

There is a 20% chance of developing Help syndrome in future pregnancies.

When does it occur?

It can occur any time after the second trimester to six months after birth. Mostly occurs in the third trimester, or 24-48 hours after birth.

During pregnancy, a woman's body experiences enormous stress. All systems ensure the health of not only the mother, but also the baby. The development of pathologies during this period of a person’s life occurs in its most severe form. This is due to the limited “safety margin” of the body, as well as the peculiarities of metabolism during gestation. One of the critical conditions in obstetrics is HELP syndrome. Its consonance with the English word “help” is not accidental. Identification of signs of this disorder is most often recorded in the last trimester or in the first week after birth and requires intensive care and hospitalization of the patient. Several serious violations occur at once, which often threaten not only the health of the child, but also the life of the mother.

HELLP syndrome during pregnancy is a rare pathology that manifests itself with serious hemodynamic disturbances and failure of normal liver function. The mortality rate of women in the absence of medical care reaches 100%. If a patient is diagnosed with such a disease, urgent delivery is required, otherwise both mother and child may die. If the syndrome has formed at a late stage of gestosis, they resort to drug stimulation. At earlier stages, a caesarean section is required. Otherwise the consequences are fatal.

Reasons for the development of the disease in pregnant women

HELLP syndrome in obstetrics has not been fully studied. The exact pathogenesis of its occurrence is unknown. Reasons that can trigger the development of complications include:

Autoimmune processes that lead to the destruction of the body's own cells. There is a decrease in the number of platelets and red blood cells, which is accompanied by serious hemodynamic disorders.
Congenital abnormalities of the functioning of the liver, consisting of failures in the production of enzymes.
Thrombosis of blood vessels of the hepatobiliary system.
Antiphospholipid syndrome is classified as a separate nosological entity, although in essence it is an autoimmune process. Excessive destruction of the lipid structures of the cell membranes of the body occurs by antibodies.

The development of HELP syndrome is common due to lack of attention to pregnancy complications, for example, preeclampsia. If a woman is not registered with a gynecologist and does not control her own health and the condition of the baby, such a disorder can progress. A direct connection between the disease and a serious increase in blood pressure has not been established. Moreover, the development of HELLP syndrome is often recorded simultaneously with eclampsia.

Risk factors

Some features of a woman’s body also predispose to the occurrence of pathology, such as:

First-time mothers rarely face this problem. But recurrence of gestosis can be complicated by HELP syndrome.
Multiple pregnancies more often lead to the formation of such disorders than the development of only one child in the uterus.
The patient has a history of severe chronic lesions of the cardiovascular system, liver and kidneys.
Age over 25 years is a risk factor for gestosis in relation to the further development of hemodynamic disorders.
HELP syndrome is more often recorded in women with fair skin than in dark-skinned patients.

Main symptoms

The clinical picture of the disease is associated with the main pathological processes occurring in the body. Decoding the abbreviation HELLP implies the formation of the following problems:

H - hemolysis. Hemolysis is the process of breakdown of red blood cells directly in the bloodstream.
EL – elevated liver enzymes. An increase in the level of liver enzymes accompanies serious dysfunction of the organ. An increase in enzyme concentration indicates the death of hepatocytes.
LP – low platelet levels. A decrease in the level of platelets - cells that stop bleeding. Such a problem can be either a consequence of the formation of pathological clots and destruction of structures in blood vessels, or it can occur due to insufficient production of platelets by the red bone marrow.

A similar cascade of reactions is accompanied by the following symptoms:

Nausea and vomiting normally occur with toxicosis in early pregnancy. However, with HELP syndrome, they can recur in the last trimester.
Migraine and dizziness are common symptoms that are often the first signal of the development of preeclampsia and other dangerous hemodynamic disorders.
At later stages, icteric staining of the mucous membranes appears. This is due to the active release of the pigment bilirubin, which is found in red blood cells and liver cells, into the blood.
The appearance of hematomas and petechiae at the site of minor injuries, such as abrasions or injections. Such a clinical sign indicates disturbances in the coagulation system.
The most severe symptom of HELP syndrome is the development of seizures. It is associated with a violation of oxygen transport to brain cells, since there is a decrease in the level of red blood cells that perform this function.

Diagnostics

After the symptoms of the disease appear, doctors have very little time left to save the woman and child. Significant deterioration and death may occur as early as 12 hours after the onset of clinical signs. The diagnosis is made on the basis of anamnesis and hematological tests, which reveal changes characteristic of the problem.

HELP syndrome in pregnant women requires visual diagnosis. Ultrasound allows you to assess the presence of organic damage to the liver and thrombosis of its vessels. Ultrasound examination of the fetus is also recommended.

The difficulty in confirming the occurrence of the disease comes down to the fact that diagnosis is often based on different criteria. Although there are special recommendations both for confirming HELLP syndrome and for its treatment, in many sources the authors refer to various pathological changes. Some argue that the diagnosis is made solely on the basis of characteristic abnormalities in the biochemical blood test, which include increased levels of liver enzymes and bilirubin. Others are inclined to believe that to confirm HELLP syndrome, a combination of pronounced severe preeclampsia with hematological parameters characteristic of this disorder is required. However, in a number of studies describing the problem, there was no indication of suspicion or confirmation of the presence of hemolysis in women with this disease. That is, in some patients, when the disorder develops, the breakdown of red blood cells in the bloodstream is completely absent.

Diagnosis of HELP syndrome requires an integrated approach, although one should focus not only on the clinical manifestations of the disease and the patient’s medical history, but also on the presence of characteristic abnormalities in laboratory tests.

Treatment methods

The problem in gynecology is considered an emergency, so special attention is paid to it in the educational process of doctors. Doctors either stimulate natural labor by administering appropriate medications, or resort to surgery to remove the fetus from the uterus.

Obstetric tactics depend on the time of development of gestosis:

If the period exceeds 34 weeks, then prostaglandins and epidural anesthesia are used, since the natural process is preferred. There is no point in waiting: a woman’s condition can worsen at any moment. In severe cases, the patient is placed in the intensive care unit.
When HELP syndrome is detected between 27 and 34 weeks, the mother’s condition is stabilized, as well as the fetus is prepared for a cesarean section. Indications for postponing surgery are eclampsia, the formation of disseminated intravascular coagulation, and bleeding.
If the pathology develops before 27 weeks, after the use of glucocorticoids, surgery is performed to adapt the baby’s underdeveloped lungs.

HELP syndrome can also occur after childbirth. In such cases, treatment is simplified by the fact that only the mother needs to be saved.

Complications

In the absence of medical care or non-compliance with doctors' recommendations, dysfunction of the mother's liver, kidneys and lungs occurs. The child suffers from developmental delays, respiratory distress syndrome and asphyxia. In 20% of cases, the fetus dies even with timely assistance if there are significant changes in the hemodynamics of the female body.

Recovery process after surgery

After delivery, monitoring of the patient's condition is required, since HELLP syndrome may develop later. Symptomatic treatment is carried out, hormonal drugs are used to normalize blood counts. The timing of a woman’s discharge from the hospital depends on her well-being and the health of the baby.

Prevention and prognosis

Despite the insignificant frequency of detection of HELP syndrome in pregnant women, much attention is paid to it. Preventing the formation of the disease comes down to following the rules of a healthy lifestyle and timely consultation with a doctor. The prognosis depends on the duration of gestosis, as well as on the presence of chronic diseases in the woman.

The term HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) - hemolysis, increased activity of liver enzymes (enzymes) and thrombocytopenia - is associated with an extremely severe form of preeclampsia and eclampsia. Back in 1893, G. Schmorl described the characteristic clinical picture of this syndrome, and the term HELLP (taking into account pathogenesis) was proposed by L. Weinstein (1985).

M.V. Mayorov, antenatal clinic of city clinic No. 5, Kharkov

Domestic literature contains very little information about HELLP syndrome, most often limited to brief mentions. This topic was considered in more detail by the luminaries of Russian anesthesiology and resuscitation A.P. Zilber and E.M. Shifman, as well as the chief obstetrician-gynecologist of the Ministry of Health of Ukraine V.V. Kaminsky.

Sad as it may be, inexorable statistics indicate the annual death of approximately 585 thousand women in the world, in one way or another related to pregnancy and childbirth. The main causes of maternal mortality in our country are: obstetric sepsis, bleeding, gestosis, as well as extragenital diseases. In severe forms of gestosis, HELLP syndrome accounts for 4 to 12% of cases and is characterized by high maternal mortality (according to various authors, from 24 to 75% of cases).

A consequence of the lack of knowledge about the clinical and laboratory manifestations of the described symptom complex in recent years is the overdiagnosis of HELLP syndrome. The clinical course of severe forms of preeclampsia can be very diverse. That is why the diagnosis of severe gestosis with HELLP syndrome is often erroneous. In reality, the described pathology may hide hepatitis, fatty hepatosis of pregnancy, hereditary thrombocytopenic purpura, etc. Often, “under the guise” of HELLP syndrome, obstetric sepsis or other pathology remains unrecognized.

Consequently, the detection of a triad in pregnant women - hemolysis, hepatic hyperenzymemia and thrombocytopenia - should not yet mean the immediate establishment of an unconditional diagnosis of “HELLP syndrome”. Only a careful and thoughtful clinical and physiological interpretation of these symptoms in each specific case allows us to differentiate it as a form of preeclampsia, which in advanced cases is a variant of severe multiple organ failure.

Differential diagnosis of HELLP syndrome, according to V.V. Kaminsky et al. , should be carried out with the following diseases:

uncontrollable vomiting of pregnant women (in the first trimester);
intrahepatic cholestasis (in the first trimester of pregnancy);
cholelithiasis (at any stage of pregnancy);
Dabin-Johnson syndrome (in the 2nd or 3rd trimester);
acute fatty liver degeneration of pregnant women;
viral hepatitis;
drug-induced hepatitis;
chronic liver disease (cirrhosis);
Budd-Chiari syndrome;
urolithiasis;
gastritis;
idiopathic thrombocytopenic purpura;
hemolytic uremic syndrome;
systemic lupus erythematosus.

Most researchers consider HELLP syndrome as a complication or as an atypical variant of gestosis, believing that it is based on generalized arteriolospasm, combined with hemoconcentration and hypovolemia, the development of a hypokinetic type of blood circulation, endothelial damage and the occurrence of respiratory failure, including pulmonary edema.

In typical cases, HELLP syndrome develops in multiparous women with preeclampsia, over the age of 25 years, with a burdened obstetric history. Clinical manifestations occur in 31% of cases before delivery; in the postpartum period - in 69% of cases.

Quite convincing is the point of view that pregnancy is a case of allotransplantation, and HELLP syndrome as an autoimmune reaction manifests itself as an exacerbation in the postpartum period. The autoimmune mechanism of endothelial damage, hypovolemia with blood thickening and the formation of microthrombi with subsequent fibrinolysis (disseminated intravascular coagulation (DIC)) are the main stages of the development of HELLP syndrome in severe forms of gestosis.

The destruction of platelets leads to the release of thromboxanes and imbalance of the thromboxane-prostacyclin system, which causes: generalized spasm of arterioles with increased arterial hypertension (AH), cerebral edema and convulsions; deterioration of uteroplacental blood flow; increased platelet aggregation, fibrin and red blood cell deposition, mainly in the placenta, kidneys and liver. These changes cause profound dysfunction of these organs, creating a vicious circle that can only be broken at a certain stage by terminating the pregnancy.

HELLP syndrome is characterized by the presence of multiple organ disorders, in particular from:

Central nervous system: headache, blurred vision, hyperreflexia, convulsions. The cause of these disorders is vasospasm and hypoxia, and not cerebral edema, as previously thought.
Respiratory system: the lungs remain intact for a long time. Edema of the upper respiratory tract and pulmonary edema may develop (usually after delivery). The development of respiratory distress syndrome is often observed.
Of cardio-vascular system: generalized arteriolospasm leads to a decrease in circulating blood volume and tissue edema. The total peripheral vascular resistance and stroke volume increase, as a result of which the load on the left ventricle increases. Against this background, the development of diastolic dysfunction is possible.
Hemostasis systems: Thrombocytopenia, as well as qualitative disorders of platelet function, are common. In severe cases, the development of disseminated intravascular coagulation syndrome is often observed.
Liver: there is a decrease in the activity of liver enzymes with an increase in their level in the serum; areas of ischemia and even necrosis may develop. Spontaneous liver rupture is rare, but its outcome is almost always fatal.
Kidney: Proteinuria indicates vascular damage to the glomerulus. Oliguria is more often associated with hypovolemia and reduced renal blood flow. Preeclampsia often progresses to acute renal failure.

Clinical signs and symptoms include complaints of spontaneous pain and tenderness on palpation in the epigastrium and right hypochondrium, jaundice, hyperbilirubinemia, proteinuria, hematuria, hypertension, anemia, nausea, vomiting; There may be hemorrhages at the injection sites.

For diagnosing HELLP syndrome The following standard laboratory data are required:

hemolysis (determined by analyzing a peripheral blood smear);
increased bilirubin content;
increased levels of lactate dehydrogenase;
elevated levels of alanine aminotransferase and aspartate aminotransferase;
low platelet count (<100х10 9 /л).

In some cases, not the entire complex of classical signs of HELLP syndrome appears. Then, in the absence of hemolysis of erythrocytes, the name “ELLP syndrome” is used, in the absence of thrombocytopenia – “HEL syndrome”. It should be remembered that in 15% of patients with HELLP syndrome, hypertension may be absent or insignificant.

When carrying out differential diagnosis, it is necessary to take into account that thrombocytopenia and impaired liver function reach a maximum in HELLP syndrome 24-48 hours after birth, and in typical severe gestosis, on the contrary, there is a positive dynamics of these indicators during the first days of the postpartum period. Timely diagnosis of HELLP syndrome significantly improves the results of its intensive care. At the same time, according to A.P. Zilber (1999), sometimes slight thrombocytopenia or a moderate increase in the activity of liver enzymes in pregnant women “excites medical passions to diagnose HELLP syndrome.”

Early recognition of HELLP syndrome plays a very important role in preventing possible serious consequences for the life of the mother and child in the future. Treatment is carried out by an obstetrician-gynecologist together with an anesthesiologist-resuscitator, and if necessary, related specialists are involved - an ophthalmologist, a neurologist, etc.

V.V. Kaminsky et al. A detailed and clear algorithm of actions has been developed after the diagnosis of “HELLP syndrome” has been established, which allows us to answer the question: what to do? This algorithm includes:

elimination of decompensation of multiple organ failure;
it is possible to completely stabilize the patient’s condition;
prevention of possible complications for the mother and fetus;
delivery.

It should be remembered that the only pathogenetic treatment method is termination of pregnancy, i.e. delivery. Most authors emphasize that when a diagnosis of HELLP syndrome is made, pregnancy should be terminated within 24 hours, regardless of its duration. All other organizational and therapeutic measures are essentially preparation for delivery, which must be urgent, because during childbirth, as a rule, the severity of gestosis increases.

The method of delivery for a “mature” cervix is through the natural birth canal, otherwise - cesarean section. After the birth of the placenta, curettage of the uterine cavity is required.

It is necessary to constantly remember possible complications of HELLP syndrome, which is fraught with maternal mortality:

DIC syndrome and uterine bleeding;
placental abruption;
acute hepatic-renal failure;
pulmonary edema;
pleural effusion (exudative pleurisy);
respiratory distress syndrome;
subcapsular hematoma of the liver with its rupture and intra-abdominal bleeding;
retinal disinsertion;
cerebral hemorrhage.

On the part of the fetus, intrauterine growth retardation and intrauterine death are observed; newborns often develop bleeding and cerebral hemorrhages.

The main goals of pathogenetic therapy for HELLP syndrome: elimination of hemolysis and thrombotic microangiopathy, prevention of multiple organ multisystem dysfunction syndrome, optimization of neurological status and excretory function of the kidneys, normalization of blood pressure.

Intensive preoperative preparation, as well as intensive therapy after delivery, are aimed at many pathogenetic links and include the following components:

strictly individualized antihypertensive therapy;
reduction of hypovolemia, hypoproteinemia, intravascular hemolysis;
correction of metabolic acidosis;
appropriate infusion and transfusion therapy;
antispasmodics, antiplatelet agents;
stabilization of hemostasis indicators;
rheocorrection of blood (anticoagulants and antiplatelet agents, in particular low molecular weight heparins [fraxiparin], pentoxifylline [trental], etc.);
antibiotic therapy to prevent infectious complications (aminoglycosides are excluded, given their nephro- and hepatotoxicity);
hepatostabilizing therapy, in particular large doses of glucocorticosteroids - until hepatic cytolysis is stabilized and thrombocytopenia is eliminated;
protease inhibitors (contrical, gordox, trasylol);
hepatoprotectors, cerebroprotectors and nootropics, vitamin complex (in high doses);
magnesium therapy - according to the classical obstetric scheme;
according to appropriate indications - plasmapheresis, hemodialysis.

For delivery, exclusively endotracheal anesthesia with minimal use of hepatotoxic anesthetics is recommended, as well as prolonged artificial ventilation in the postoperative period with intensive differentiated therapy.

The list of references is in the editorial office

HELP syndrome is a rare pathology in women in late pregnancy. It is almost always discovered about a month before the onset of labor. In some women, signs of this syndrome appeared after childbirth. George Pritchard was the first to describe this pathology. It must be said that this rare syndrome occurs in only seven percent of women, but 75% of cases are fatal.

The name HELLP is an abbreviation of English words. Each letter is deciphered as follows:

H – destruction of red blood cells.
EL – increase in liver enzyme levels.
LP - a decrease in the level of red blood cells, which serve for blood clotting.

In medical practice, namely in obstetrics, HELP syndrome is understood as some abnormalities in the female body that do not allow a woman to become pregnant or bear a healthy baby without pathologies.

Etiology

To date, the exact causes of this syndrome have not yet been clarified. However, scientists continue to put forward various theories of its origin. Today there are already more than thirty theories, but not one can point to the fact that affects the appearance of pathology. Experts have noticed one pattern - such a deviation appears against the background of something that appeared late.

A pregnant woman suffers from swelling, which begins in the arms and legs, then moves to the face, then to the whole body. The level of protein in the urine increases, and blood pressure also increases. This condition is extremely unfavorable for the fetus, because aggressive antibodies to it are formed in the mother’s body. They negatively affect red blood cells and platelets, destroying them. In addition, the integrity of blood vessels and liver tissue is compromised.

As mentioned earlier, HELP syndrome occurs for currently unknown reasons.

However, you can pay attention to some factors that increase the risk of pathology:

diseases of the immune system;
heredity, when there is a lack of enzymes in the liver, that is, a congenital pathology;
changes in the number and purpose of lymphocytes;
formation in the blood vessels of the liver;
long-term use of medications without medical supervision.

When observing pathology, we can identify certain factors that are called provoking:

numerous births in the past;
the age of the woman in labor is more than twenty-five years;
pregnancy with multiple fetuses.

The hereditary factor has not been established.

Classification

Based on exactly what signs HELP syndrome exhibits, some experts have created the following classification:

obvious symptoms of intravascular thickening;
suspect signs;
hidden.

The classification of J. N. Martin has a similar principle: here the syndrome with the same name HELP is divided into two classes.

Symptoms

The first signs that appear are nonspecific, so it is impossible to diagnose the disease based on them.

A pregnant woman experiences symptoms such as:

nausea;
often vomiting;
dizziness;
pain in the side;
causeless anxiety;
fast fatiguability;
pain in the upper abdomen;
change in skin color to yellow;
the appearance of shortness of breath even with light exertion;
blurred vision, brain activity, fainting.

The first manifestations are observed against the background of large edema.

During the rapid development of the disease or in the case when medical care was provided too late, it develops, appears, the process of urination is disrupted, convulsions occur, and body temperature rises. In some situations, a woman may fall into a coma. A doctor can make an accurate diagnosis of HELP syndrome only based on laboratory test results.

There is also a pathology that appears after the birth resolution. The risk of its development increases when a woman had severe late toxicosis during pregnancy. In addition, a cesarean section or difficult labor may also be triggers. If a woman in labor has previously experienced the symptoms described above, then she should be taken under close supervision. This should be done by the medical staff of the maternity hospital.

Diagnostics

If a doctor suspects a pregnant woman has such a disease, he must write her a referral for laboratory tests, such as:

urine analysis - it can be used to find out the level and presence of protein, in addition, the functioning of the kidney is diagnosed;
taking blood for analysis to find out the level of hemoglobin, platelets and red blood cells, and the bilirubin indicator is also important;
ultrasound examination of the condition of the placenta, peritoneum, liver and kidneys;
computed tomography to avoid making a false diagnosis that has similar symptoms;
cardiotocography - determines the viability of the fetus and evaluates its heartbeat.

In addition to these studies, a visual examination of the patient and anamnesis is performed. The presence of signs such as yellow color of the skin, bruises from injections will help to more accurately establish the diagnosis.

Doctors often resort to the help of their colleagues working in other areas, for example, a resuscitator, gastroenterologist, or hepatologist.

When diagnosing this pathology, it is necessary to exclude the following diseases:

exacerbation;
different shapes (A, B, C);
cocaine addiction;
red and others.

Based on the diagnostic results, treatment tactics are determined.

Treatment

When a pregnant woman is diagnosed with HELP pathology, this is already an indication for urgent hospitalization. The main method of therapy is termination of pregnancy, because it is precisely because of this that this pathology arises.

However, there is a chance to save the child, because this condition in pregnant women manifests itself in the later stages, so the woman is induced for labor. In a situation where the uterus is ready and the gestation period is more than thirty-five weeks, a caesarean section is prescribed.

If the pregnancy is shorter, then the woman is prescribed glucocorticosteroids: they will help the fetal lungs open. But if there are signs such as heavy bleeding, high blood pressure, or bleeding in the brain, then an urgent caesarean section is necessary, and it does not matter how far along the pregnancy the woman is. The therapy provided stabilizes the woman’s condition and helps restore the baby’s health after surgery.

If the therapy method is correct, then the mother’s health will improve within a couple of days after the operation.

After this, the doctor must:

stabilize the patient's condition;
treat with antibiotics to prevent infectious diseases;
prescribe medications to normalize the functioning of the kidneys and liver, as well as to prevent the formation of blood clots;
stabilize blood pressure.

Before the expectant mother undergoes a cesarean section, she may be prescribed a procedure such as plasmapheresis - plasma is removed from the blood, but only a clearly designated volume is used.

This is done with a special sterile, and disposable, device that separates the plasma. This is a harmless procedure that does not cause any discomfort to the woman. The duration takes approximately two hours. After this, a blood transfusion is necessary.

Also, in preparation for the operation and immediately after it, the woman is prescribed medications to reduce blood pressure, liver failure, and kidney failure.

Only complex therapy will help with this, which will include drugs such as:

hormonal medications;
means for stabilizing the functioning of the liver;
medications that artificially reduce immunity.

After the operation, blood transfusion continues. The doctor also prescribes the use of lipoic and folic acid, vitamin C. If therapy is started on time and the operation is successful, then the prognosis is quite favorable. After delivery, all signs of pathology begin to disappear, however, relapse of the disease is high in all subsequent pregnancies.

Possible complications

The occurrence of complications from this pathology is quite common. Unfortunately, deaths cannot be ruled out. This applies not only to the mother, but also to the fetus.

The disease is dangerous due to the formation of blood clots and heavy bleeding in any location. In severe cases, hemorrhages may occur in the brain, and this is a malfunction of the central nervous system.

Disturbances in the kidneys and liver are also scary, because the consequences are such that the body is poisoned. Some cases of pathology end in coma, and it is not easy to get a woman out of this state.

It should be noted that pathologies may also occur in the fetus, because with this syndrome occurs.

This disease causes the following symptoms in a woman:

pain in the upper abdomen;
a sharp decrease in blood pressure;
dyspnea;
severe weakness.

The fetus experiences oxygen starvation, which leads to deviations in development, height and weight. In addition, the mother’s emerging ailments lead to diseases of the baby’s nervous system. Such children suffer, lag behind in physical and mental development, in addition, they...

When one-third of the placenta is separated, the fetus dies.

Prevention

Even if the health of the expectant mother before pregnancy is excellent, there is still a risk of pathology.

Therefore, a woman must follow the following rules of prevention:

consciously plan pregnancy, avoid unwanted conception;
carrying out therapeutic actions in identifying any diseases;
exercise more, maintain a clear daily routine;
after establishing the fact of pregnancy, visit the doctor according to the schedule;
regular health monitoring, that is, testing;
timely treatment of late toxicosis;
healthy eating;
drinking the required amount of fluid per day;
refuse heavy physical work, avoid;
compliance with the work/rest schedule;
Be sure to notify your doctor about taking medications for chronic diseases.

Self-medication is unacceptable.