HELLP Syndrome [hemolyisis, elevated liver enzymes and low platelets]: a review of the pathophysiology, diagnosis, management and anaesthetic considerations

ABSTRACT

HELLP syndrome [hemolysis, elevated liver enzymes, low platelets] is associated with poor maternal and fetal outcomes. Maternal mortality has been estimated as high as 24%. These patients are also at greater risks from pulmonary edema, adult respiratory distress syndrome [ARDS], abruption placentae, disseminated intravascular coagulopathy [DIC], ruptured liver hematomas, and acute renal failure [ARF]. Perinatal mortality is equally high ranging from 79 to 367 per 1000 live births, and neonatal complications correlate with the severity of maternal disease. Many clinicians view HELLP syndrome as an entity of preeclampsia, and with the varied symptomatology, the initial diagnosis may be obscured. Prodromal signs include 1] right upper quadrant and/or epigastric pain, 2] nausea and vomiting, 3] headache, 4] visual changes, 5] increased tendency to bleed from minor trauma, 6] jaundice, 7] diarrhea and 8] shoulder or neck pain. Prior to delivery, aggressive obstetric management is directed toward stabilization of the affected organ systems and timely interruption of the pregnancy in the early phase of accelerated disease progression. Definitive therapy is delivery. Parturients with HELLP syndrome are often critically ill; their infants are frequently premature and compromised. Management criteria should include a multidisciplinary approach in a tertiary care centre. The obstetric anesthesia personnel should petform a thorough preanaesthetic evaluation and have considerable knowledge of the pathophysiology of this syndrome. Unless significant coagulopathy is diagnosed, epidural anesthesia is preferred over general anesthesia, and spinal anesthesia is perhaps contraindicated