Current Management of HELLP Syndrome

Abstract

The major problems of HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets) are the fluctuation course of the disease, the unpredictable occurrence of severe maternal complications and the high maternal and perinatal mortality. Time-limited reversal of the laboratory parameters has been observed in 20-40% of cases ; however, the majority of patients shows a deterioration of the disease within 1-10 days. As no reliable clinical and laboratory indicators exist, as well as no precisely defined cut-off values in predicting the course and prognosis, the outcome of HELLP syndrome is unpredictable. The high maternal morbidity and mortality are mainly due to the development of disseminated intravascular coagulation (DIC) ; the frequency of DIC has been shown to increase significantly with the time interval between diagnosis and delivery. The management of HELLP syndrome has been controversial, with some authors recommending a conservative approach to induce fetal maturity in pregnancies below the 32nd week of gestation, whereas the majority recommend immediate delivery by caesarean section in patients with an unfavourable cervix irrespective of the gestational age. It is generally agreed that early diagnosis by laboratory screening methods is mandatory and that patients with the HELLP syndrome should be transferred to a perinatal centre. A literature review since 1990 clearly demonstrates that aggressive management is associated with a significant reduction in maternal and perinatal mortality. Conservative management is only justified cases of fetal immaturity under of following conditions : a) no evidence of progression of the disease, b) no suspected or manifested DIC, c) fetal well-being, and d) intensive monitoring of the patient in cooperation with experienced anaesthesiologists and neonatologists.