Nurses should be aware that what is associated with HELLP syndrome
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Monitoring for magnesium toxicity is usually done by physical examination, which includes deep tendon reflexes, mental status, and urine output to ensure adequate clearance. Magnesium levels can be monitored as well, and the goal level is 4 to 7 g/dL. If eclamptic seizure occurs, a redose of magnesium sulfate of 4 to 6 grams intravenously can be given on top of the continuous infusion. In the setting of eclamptic seizures, magnesium sulfate is superior to other forms of seizure prophylaxis (i.e., benzodiazepines and phenytoin). In the setting of magnesium toxicity, which can result in lethargy (levels >8 g/dL) and cardiac arrest (levels >10 g/dL), calcium chloride 1 g intravenously or calcium gluconate 3 g intravenously should be administered. Although HELLP syndrome is highly morbid, it is by definition limited to pregnancy and should resolve within 72 hours after delivery. Show
In the event maternal improvement does not occur, ICU staff should consider alternative diseases. Differential diagnosis should include atypical hemolytic uremic syndrome, thrombotic thrombocytopenia purpura, and other autoimmune disease such as systemic lupus erythematosus. These diseases may be quiescent throughout life and may be newly triggered by pregnancy. View chapter on ClinicalKey Liver Disease in PregnancyJamilé Wakim-Fleming, in Current Clinical Medicine (Second Edition), 2010 HELLP SyndromeThe HELLP syndrome complicates 0.5% of pregnancies and the recurrence rate is high, approaching 20% in severe cases. It is characterized by microangiopathic hemolysis with burr cells and schistocytes on peripheral smear; elevated liver enzyme levels, with aspartate transaminase (AST) exceeding alanine aminotransferase (ALT) levels; and a platelet count lower than 100,000/mm3. The HELLP syndrome is more common in multiparous women and can manifest in 30% after delivery. Abdominal pain is the usual symptom, and rapid progression to disseminated intravascular coagulation, renal failure, subcapsular liver hematoma, and hepatic rupture are described. Maternal mortality is about 1% but reaches 60% in cases of hepatic rupture. Perinatal death is variable and can reach 37% when the syndrome occurs at an earlier stage of pregnancy. Immediate delivery is the definitive treatment for HELLP syndrome. HELLP syndrome is a potentially life-threatening disorder that’s usually associated with preeclampsia, a condition that occurs in 5–8 percent of pregnancies — most often after the 20th week of pregnancy. Preeclampsia can also occur earlier in pregnancy or, rarely, postpartum. HELLP syndrome is a disorder of the liver and blood that can be fatal if left untreated. The symptoms of HELLP syndrome are wide-ranging and vague, and can often be difficult to initially diagnose. The name HELLP syndrome is an acronym of three major abnormalities seen on the initial lab analysis. These include:
Hemolysis refers to a breakdown of red blood cells. In people with hemolysis, the red blood cells get broken down too soon and too rapidly. This may result in low red blood cell levels and can eventually lead to anemia, a condition in which the blood doesn’t carry enough oxygen to the rest of your body. Elevated liver enzymes indicate that your liver isn’t functioning properly. Inflamed or injured liver cells leak high amounts of certain chemicals, including enzymes, into your blood. Platelets are components of your blood that help with clotting. When platelet levels are low, you develop an increased risk of excessive bleeding. HELLP syndrome is a rare disorder, affecting less than 1 percent of all pregnancies. However, it is a major health concern and can be life-threatening to both the mother and the unborn baby. Prompt treatment and delivery of the baby are generally required for the best outcome. HELLP syndrome usually develops in the last trimester of pregnancy, but may occur earlier, or even present postpartum. The cause of symptoms is unknown. Some experts believe HELLP syndrome is a severe form of preeclampsia, a pregnancy complication that causes high blood pressure. Approximately 10–20 percent of women who develop preeclampsia will also develop HELLP syndrome. There are also certain factors that can increase your risk of developing HELLP syndrome, such as preexisting high blood pressure or diabetes, advanced maternal age, carrying multiples, such as twins, and having a previous history of preeclampsia. What are the symptoms of HELLP syndrome?HELLP syndrome symptoms are very similar to those of the stomach flu. The symptoms may seem to be “normal” symptoms of pregnancy. However, it’s important to see your doctor right away if you’re experiencing any flu-like symptoms during pregnancy. Only your doctor can ensure that your symptoms aren’t indicative of serious health issues. The symptoms of HELLP syndrome may vary from person-to-person, but the most common ones include:
You may also experience:
In rare cases, you may also have confusion and seizures. These signs and symptoms usually indicate advanced HELLP syndrome and should prompt immediate evaluation by your doctor. What are the risk factors for HELLP syndrome?The cause of HELLP syndrome is unknown, but there are certain factors that may increase your risk of developing it. Preeclampsia is the greatest risk factor. This condition is marked by high blood pressure, and it typically occurs during the last trimester of pregnancy. However, it may present earlier in the pregnancy or postpartum (in rare cases). Not all pregnant women with preeclampsia will develop HELLP syndrome. Other risk factors for HELLP include:
You’re also at a higher risk for HELLP syndrome if you had the condition during a previous pregnancy. One study showed that the risk of recurrence for hypertensive disorders, including preeclampsia and HELLP, in future pregnancies isabout 18 percent. How is HELLP syndrome diagnosed?Your doctor will perform a physical exam and order various tests if HELLP syndrome is suspected. During the exam, your doctor may feel for abdominal tenderness, an enlarged liver, and any excess swelling. These can be signs of a liver problem. Your doctor may also check your blood pressure. Certain tests can also help your doctor make a diagnosis. Your doctor may also order a:
How is HELLP syndrome treated?Once a HELLP syndrome diagnosis is confirmed, delivery of the baby is the best way to prevent complications, as this should stop progression of the disease. In many cases, the baby is born prematurely. However, your treatment may vary depending on the severity of your symptoms and how close you are to your due date. If your HELLP syndrome symptoms are mild or if your baby is less than 34 weeks old, your doctor may recommend:
During treatment, your doctor will monitor your red blood cell, platelet, and liver enzyme levels. Your baby’s health will also be watched closely. Your doctor may recommend certain prenatal tests that evaluate movement, heart rate, stress, and blood flow. You will be hospitalized for close monitoring. You may be given medications to help induce labor if your doctor determines that your condition requires immediate delivery of your baby. In some cases, a cesarean delivery is necessary. However, this can cause complications if you have blood-clotting issues related to low platelet levels. What is the long-term outlook for women with HELLP syndrome?Most women with HELLP syndrome will recover completely if the condition is treated early. Symptoms also improve significantly after the baby is delivered. Most symptoms and side effects will go away within days to weeks after delivery. It is important to follow up with your doctor after to delivery to evaluate for resolution of the disease. Perhaps the biggest concern is the impact HELLP syndrome can have on the baby. Most babies are delivered early when the mothers develop HELLP syndrome, so there’s often a greater risk of complications from premature delivery. Babies who are born before 37 weeks are carefully monitored in the hospital before they are able to go home. Possible complications of HELLP syndromeComplications associated with HELLP syndrome include:
Early treatment is the key to preventing these complications. However, some complications may occur even with treatment. Symptoms of HELLP syndrome can also affect you and your baby after delivery. Preventing HELLP syndromeHELLP syndrome isn’t preventable in most pregnant women, because the cause of the condition isn’t known. However, people can lower their risk for HELLP syndrome by maintaining a healthy lifestyle to prevent preexisting conditions that may increase the risk, such as diabetes or high blood pressure. This includes exercising regularly and eating a heart-healthy diet that consists of whole grains, vegetables, fruits, and lean protein. If you have these or other risk factors, regular routine prenatal care is important so that your doctor can evaluate you promptly if you begin to develop preeclampsia or HELLP. Some doctors may recommend taking a low-dose aspirin during a subsequent pregnancy for prevention, based on your individual care. It’s also important to contact your doctor immediately if you’re experiencing symptoms of HELLP syndrome. Early detection and treatment can help lower the risk of complications. What is HELLP syndrome associated with?HELLP syndrome is a potentially life-threatening disorder that's usually associated with preeclampsia, a condition that occurs in 5–8 percent of pregnancies — most often after the 20th week of pregnancy. Preeclampsia can also occur earlier in pregnancy or, rarely, postpartum.
What is the prominent symptom of the HELLP syndrome?Signs of HELLP syndrome include: The most common symptom is abdominal pain, usually in the right upper quadrant or mid-epigastric area.
Which of the following is complication of HELLP syndrome?Patients are at increased risk of preeclampsia or pregnancy-induced hypertension, in addition to preterm delivery, fetal growth restriction, and placental abruption in future pregnancies. Women with HELLP syndrome are also at increased risk of developing hypertension and cardiovascular disease.
What are nursing interventions for HELLP syndrome?Assist the client to a setting with intensive care facilities available. Administer magnesium sulfate per doctor's order to control seizures. To control the blood pressure, give Hydralazine as ordered. Avoid traumatizing the liver by abdominal palpation.
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