Abstract
Author(s): SÅawomir Suchocki, PrzemysÅaw Piec, MichaÅ Obst, Edyta Misiak, MaÅgorzata BaÅczerowska-Górska, Jan Oleszczuk
The acronym HELLP was coined in 1982 to describe a syndrome consisting of hemolysis, elevated liver enzyme levels and low platelet count. Its incidence rates from 0,1% to 0,6%. The incidence of HELLP syndrome among women with pre-eclampsia is 2-12% and among women with severe pre-eclampsia is 10-20%, however in 15% HELLP occurs without hypertension. HELLP probably is severe form of preeclampsia and has its origins in aberrant placental development, function, disordered immunologic process and ischemia-producing oxidative stress. Liver disfunction in HELLP syndrome is caused by apoptosis of hepatocytes induced by the Fas-Fas ligand system, a well-studied cell death system. That findings makes pathogenic mechanism of HELLP syndrome similar to SIRS. HELLP syndrome was defined by the presence of all three of the following criteria: hemolysis - characteristic peripheral blood smear and serum lactate dehydrogenase levels 600 U/L total serum bilirubin - serum aspartate aminotransferase levels 70 U/L, and platelet count <100,000/µl. Partial HELLP syndrome was defined by the presence of one or two features of HELLP but not the complete syndrome. HELLP syndrome can be classified on the basis of platelet count nadir: class I, less than 50,000 per mm3 (50 3 109 per L); class II, 50,000 to less than 100,000 per mm3 (50 to 100 3 109 per L); and class III, 100,000 to 150,000 per mm3 (100 to 150 3 109 per L). Patients with class I HELLP syndrome are at higher risk for maternal morbidity and mortality than patients with class 2 or 3 HELLP syndrome. The development of HELLP syndrome places the pregnant patient at significant risk for morbidity and mortality. Perinatal morbidity and mortality are substantially higher in pregnancies with severe preeclampsia complicated by HELLP syndrome. High-dose steroid therapy is basic treatment of antepartum and postpartum HELLP syndrome, and leeds to maternal and fetal benefit. Immediate cesarean delivery is not generally indicated or recommended. Corticosteroids in patients with HELLP syndrome increases chance to provide regional anesthesia during labor and delivery and to maximize the potential for vaginal delivery.