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Hellp syndrome: a definition based on three criteria
Hellp syndrome or HELLP syndrome, since it is an acronym, refers to severe liver damage, which most often occurs during pregnancy with pre-eclampsie, ou toxémie gravidique.
This syndrome is characterized by the association of three biological parameters: hemolysis, thrombocytopenia and hepatic cytolysis. Let’s detail these three very specific terms:
- hemolysis corresponds to the destruction of red blood cells, here in the liver;
- thrombocytopenia means a decrease in the quality of thrombocytes, or platelets in the blood;
- and hepatic cytolysis corresponds to an increase in hepatic enzymes linked to inflammation of the liver, and reflects the progressive destruction of liver cells.
It is also from these three criteria that the name of this syndrome derives, since the acronym HELLP means “Hemolysis, Elevated Liver enzyme, Low Platelets”, Or hemolysis, elevated liver enzymes, low platelets.
What are the symptoms of Hellp syndrome?
Most often, HELLP syndrome is a complication of preeclampsia, but in 15% of cases there is no pregnancy-induced hypertension, which complicates the diagnosis. It is also estimated that 10 to 20% of pregnant women with preeclampsia (which is already a fairly infrequent complication) will suffer from HELLP syndrome.
When it occurs against the background of preeclampsia, HELLP syndrome is therefore characterized by the same symptoms that this disease of pregnancy, namely:
- hypertension;
- too much protein in the urine (proteinuria);
- headaches (headache);
- edema of the hands, feet, or even the face;
- very sudden weight gain;
- visual disturbances (“flies” in front of the eyes);
- nausea, vomiting.
But other symptoms, less specific, can accompany a HELLP syndrome:
- flu-like symptoms ;
- abdominal pain (like a bar in the liver);
- jaundice (or jaundice);
- hypoglycemia;
- lack of sodium (hyponatremia);
- thromboembolic complications (phlebitis, stroke, pulmonary embolism);
- hemorrhage from delivery;
- acute renal failure ;
- or complications of preeclampsia (retroplacental hematoma, eclampsia crisis).
Note that Hellp syndrome occurs mainly in the third trimester of pregnancy, but can also, more rarely, appear in early or middle pregnancy, or in the postpartum (in 30% of cases all the same).
Hellp syndrome: comment pose-t-on le diagnostic?
If the symptoms indicated above help to make the diagnosis of HELLP syndrome, it will not be proven until its three indicators (hemolysis, thrombocytopenia and hepatic cytolysis) are revealed by a blood test.
The HELLP syndrome is then classified according to the decrease in the number of platelets (thrombocytopenia) in the blood: class I when the thrombocytopenia is severe, II when it is moderate, and III when it is weak.
Hellp syndrome: treatment and management
The treatment of HELLP syndrome is essentially based on termination of pregnancy, in other words the initiation of childbirth, most often by cesarean. Indeed, this syndrome endangers the life of the mother (subcapsular hematoma of the liver with risk of liver rupture, hemorrhage during delivery, eclampsia crisis, etc.) but also that of the fetus (retro-placental hematoma, risk of growth retardation in utero, extreme prematurity, death, etc.).
When the pregnancy is sufficiently advanced (around 34 weeks of amenorrhea), the onset of childbirth is therefore perceived as an adequate treatment, because like preeclampsia, the HELLP syndrome disappears on its own without sequel in the days following the pregnancy. ‘childbirth. However, it should be noted that epidural anesthesia is prohibited when the thrombocytopenia is moderate to severe, more precisely when there are less than 100 platelets / mm000 in the blood. General anesthesia must then be used to perform the cesarean section, or local or intravenous anesthetics if a vaginal birth is planned.
More conservative approaches exist, however, to avoid terminating the pregnancy at too early a stage. They consist in particular in injecting corticosteroids to accelerate the pulmonary maturation of the fetus in the event of need for triggering, and / or in prescribing antihypertensives to the mother-to-be.
A blood transfusion may also be necessary when the mother’s blood platelet count is too low.
The management of HELLP syndrome is therefore based on a good assessment of the risk / benefit balance for mother and unborn child from an induction of childbirth or close monitoring.
It should be noted that the monitoring and management of preeclampsia such as Hellp syndrome should preferably be carried out in a level 3 maternity unit, equipped with a neonatal resuscitation unit.