HELLP

subset of pre-eclampsia
Etiology Common in critically ill pregnant patients... Incidence 6% pregnancies?!
Epidemiology
Clinical presentation Symptoms: RUQ pain (liver haematoma)

Diagnostic criteria:
- haemolysis
- increased LDH (> 600 U/L)
- increased AST (>or= 70 U/L)
- low platelets < 100 x 10(9)/L.
Bloods: MAHA, raised LFTs, Thrombocytopenia
Pathogenesis endothelial and microvascular damage from platelet activation and increased vascular tone
Diagnostic investigations
Management Delivery if after 34/40 or to save maternal life
Treat DIC, multiorgan failure etc.
Impending bleeding doom
  • Escalate early (to whichever specialty should be stopping the bleed)
  • Right place - resus, and on to theatre? IR?
    Vasc access and bloods:
  • 2x large bore cannula
  • Crossmatch, FBC, coag screen, VBG, LFT
    Haemostatic rescuscitation:
  • TXA (not for UGIB/peptic ulcer disease)
  • Correct coagulopathy
  • Anticoagulant reversal
    Optimise clotting: keep warm, aim iCa >1.1 (10ml 10% Ca gluconate PRN)

See Massive haemorrhage



2g Mg - seizure prophylaxis or treatment
Antihypertensives - labetalol, hydralazine or nifedipine

Liver bleeding - control coagulopathy, embolisation
Might be similar phenotype to atypical HUS?
Complications Bleeding: haemorrhagic stroke, liver haemorrhage, placental abruption - which may cause placental abruption

https://litfl.com/hellp-syndrome/
https://emcrit.org/ibcc/preeclampsia/
https://www.rcemlearning.co.uk/reference/hypertensive-disorders-in-pregnancy-hellp/