HELLP syndrome (HELLP syndrome) is a dangerous complication in the III trimester of pregnancy: causes, diagnosis, treatment

In the life of every person, a moment inevitably comes, which forces you to turn to outside help. Often assistants in such situations are health workers. This happens if the human body has occupied an insidious disease, and it is impossible to cope with it independently. Everyone knows that a happy state of pregnancy is not a disease, but it is the expectant mothers who particularly need medical and psychological help.

"Help!", Or Where did the name of the disease come from?

The call for help in different languages sounds different. For example, in English desperate Russian "Help!" Is pronounced as a "help". The syndrome of HELP (HELLP) is not accidentally almost in tune with the already international pleading for help.

Symptoms and consequences of this complication during pregnancy are such that urgent medical intervention is extremely necessary. The abbreviation HELLP stands for a whole range of health problems: in the liver, with blood coagulability and an increased risk of bleeding. In addition to those listed, HELLP-syndrome causes malfunctioning of the kidneys and blood pressure disorders, thereby greatly exacerbating the course of pregnancy.

The picture of the disease is so severe that the body denies the fact of procreation itself, an autoimmune failure occurs. This situation occurs when the female body is overloaded, when the defensive mechanisms refuse to work, the severe depression rolls over, the will to life's accomplishments and further struggle disappears. Blood does not coagulate, wounds do not heal, bleeding does not stop, and the liver is not capable of performing its functions. But this critical condition lends itself to medical correction.

Disease history

HELP syndrome was described at the end of the 19th century. But only in 1978, Goodlin associated this autoimmune pathology with preeclampsia during pregnancy. And in 1985, thanks to Weinstein, the disparate symptoms were combined under one name: HELLP-syndrome. It is noteworthy that in the domestic medical sources this serious problem is practically not described. Only a few Russian anaesthesiologists and specialists in the provision of resuscitation assistance discussed this terrible complication of gestosis in more detail.

Meanwhile, HELP-syndrome during pregnancy is rapidly gaining momentum and takes many lives.

We describe each complication separately.

Hemolysis

HELP syndrome primarily involves intravascular hemolysis. This formidable disease is characterized by total cell destruction. Destruction and aging of erythrocytes causes fever, jaundice of the skin, the appearance of blood in urine studies. The most life-threatening consequences are the risk of heavy bleeding.

The risk of thrombocytopenia

The next component of the abbreviation of this syndrome is thrombocytopenia. This condition is characterized by a decrease in platelets in the blood formula, which in time causes spontaneous bleeding. Such a process can be stopped only in a hospital setting, and during pregnancy this condition is especially dangerous. The cause may be severe immune disorders, resulting in an anomaly in which the body struggles with itself, destroying healthy blood cells. The threat of life is a violation of the coagulability of blood that has arisen against the background of a change in the number of platelets.

Terrible forerunner: increased hepatic enzymes

A complex of pathologies included in the HELP syndrome is crowned with such an unpleasant sign as an increase in liver enzymes. For expectant mothers this means that in one of the most important organs of the human body there are serious failures. After all, the liver not only cleanses the body of toxins and helps the digestive function, but also affects the psycho-emotional sphere. Often such an undesirable change is detected by a routine blood test, which is prescribed to a pregnant woman. In gestosis, complicated by HELP syndrome, the indicators significantly differ from the norm, revealing a threatening picture. Therefore, medical advice is the first procedure, mandatory for execution.

Third Trimester Features

3 trimester of pregnancy is very important for the further carrying of the fetus and delivery. Frequent complications are edema, heartburn and digestive dysfunction.

This is due to violations in the kidneys and liver. The enlarged uterus exerts a serious pressure on the digestive organs, because of which they begin to fail. But with gestosis, there may be conditions called preeclampsia and eclampsia, which aggravate pain in the epigastric region, provoke the appearance of nausea, vomiting, swelling, high blood pressure. Against the background of neurological complications, convulsive seizures may occur. Dangerous symptoms increase, sometimes almost instantaneously, causing great harm to the body, threatening the life of the future mother and fetus. Due to the severe course of gestosis, which often carries with it the 3rd trimester of pregnancy, there is often a syndrome with the spoken name of HELP.

Vivid symptomatology

HELLP-syndrome: clinical picture, diagnosis, obstetric tactics - the topic of today's conversation. First of all, it is necessary to identify a number of basic symptoms that accompany this formidable complication.

1. From the side of the central nervous system. The nervous system reacts to these disorders with convulsions, intense headaches, visual disturbances.
2. The work of the cardiovascular system is disrupted by tissue edema and reduced blood circulation.
3. Respiratory processes are largely unaffected, however, after the birth, pulmonary edema may occur.
4. On the part of hemostasis, thrombocytopenia and a functional component of the thrombocyte function are noted.
5. Decreased liver function, sometimes the death of its cells. Rarely is there a spontaneous rupture of the liver, which leads to a fatal outcome.
6. Disruption of the genitourinary system: oliguria, renal dysfunction.

HELP syndrome is characterized by a variety of symptoms:

• Unpleasant sensations in the liver;
• Vomiting;
• Acute headaches;
• Convulsive seizures;
• Feverish condition;
• A violation of consciousness;
• Lack of urination;
• Swelling of the tissues;
• Pressure jumps;
• Multiple hemorrhages in places of manipulation;
• Icterus.

Laboratory disease is manifested by thrombocytopenia, hematuria, detection of protein in urine and blood, decreased hemoglobin, increased bilirubin content in the blood test. Therefore, to clarify the final diagnosis, it is necessary to conduct the whole complex of laboratory studies.

How to recognize complications in time?

In order to timely identify and prevent formidable complications, and medical advice is provided, which it is recommended that future mothers come regularly. Specialist pregnant woman puts on the register, after which the changes that occur in the body of a woman during the whole period are closely monitored. Thus, the gynecologist timely detects unwanted deviations and takes appropriate measures.

Identify pathological changes can be through laboratory research. For example, urine analysis will help to detect a protein, if any. The increase in protein indices and the number of leukocytes indicates pronounced violations in the work of the kidneys. Among other things, there can be a sharp decrease in the amount of urine and a significant increase in edema.

Problems in the functioning of the liver are manifested not only by pain in the right hypochondrium, vomiting, but also by changes in the composition of the blood (an increase in the number of hepatic enzymes), and palpation clearly shows an increase in the liver.

Thrombocytopenia is also found in a laboratory study of the blood of a pregnant woman, for whom the threat of HELP syndrome is real.

If there is a suspicion of eclampsia and HELP syndrome, control of blood pressure is mandatory, as due to spasm of blood vessels and blood thickening, its indices can seriously increase.

Differential diagnostics

Fashionable diagnosis now HELP-syndrome in obstetrics has gained popularity, so often it is put wrongly. Often behind it are completely different diseases, no less dangerous, but more prosaic and common:

• gastritis;
• Viral hepatitis;
• Systemic lupus erythematosus;
• urolithiasis disease;
• Obstetric sepsis;
• Liver disease (fatty degeneration, cirrhosis);
• Thrombocytopenic purpura of unclear etiology;
• Kidney malfunction.

Therefore, diff. Diagnosis should take into account the variety of options. Accordingly, the above triad - liver hyperfermentemia, hemolysis and thrombocytopenia - does not always indicate the presence of this complication.

Causes of HELP syndrome

Unfortunately, the risk factors have not been adequately studied, but there are suggestions that the following causes can provoke HELP syndrome:

• Psychosomatic pathologies;
• Drug hepatitis;
• Genetic enzymatic changes in liver function;
• Multiple fertility.

In general, a dangerous syndrome occurs when there is insufficient attention to the complicated course of gestosis - eclampsia. It is important to know that the ailment behaves very unpredictably: it develops lightning fast, then disappears on its own.

Therapeutic events

When all the tests and diffusions were performed. Diagnostics, you can draw certain conclusions. When the diagnosis of "HELP-syndrome" is established, the treatment is aimed at stabilizing the condition of the pregnant and future children, as well as speedy delivery, regardless of the period. Medical measures are carried out with the help of an obstetrician-gynecologist, resuscitation team, an anesthesiologist. If necessary, other specialists are connected: a neurologist or an ophthalmologist. Firstly, multi-organ failure is eliminated , and preventive measures are taken to avoid possible complications.

Among the common phenomena complicating the course of medical intervention, we can distinguish:

• Placental detachment;
• Hemorrhage;
• Edema of the brain;
• Pulmonary edema;
• Acute renal insufficiency;
• Fatal changes and rupture of the liver;
• Unrestrained bleeding.

With a correctly diagnosed diagnosis and timely provided professional assistance, the probability of a complicated course tends to a minimum.

Obstetric strategy

The tactics practiced in obstetrics in relation to severe forms of gestosis, the more complicated the HELP syndrome, is unambiguous: the use of caesarean section. When mature uterus, ready for natural childbirth, use prostaglandins and mandatory epidural anesthesia.

In severe cases, with caesarean section, only endotracheal anesthesia is used.

Life after birth

Specialists noted that the disease occurs not only during the third trimester, but also can progress within two days after getting rid of the burden.

Therefore, HELP syndrome after childbirth - a phenomenon quite possible, which speaks in favor of close monitoring of the mother and child in the postpartum period. This especially applies to women in labor with a severe course of preeclampsia during pregnancy.

Who is to blame and what to do?

HELP syndrome is a violation of almost all organs and systems of the female body. During the disease there is an intensive outflow of vital forces, and the likelihood of a fatal outcome, as well as intrauterine pathologies of the fetus, is high. Therefore, already from the 20th week of the future mother, it is necessary to keep a diary of self-control, where to enter all the changes that occur in the body. Particular attention should be paid to the following points:

• Blood pressure: his jumps upward more than three times should alert;
• Metamorphosis weight: if it began to increase dramatically, perhaps the cause was swelling;
• Movement of the fetus: too intense or, conversely, frozen movements - an unequivocal reason to call a doctor;
• The presence of edema: a significant swelling of the tissues indicates renal dysfunction;
• Unusual abdominal pain: especially significant in the liver;
• Regular tests: everything that is appointed must be performed in good faith and on time, as it is necessary for the welfare of the mother and the future child.

All the alarming symptoms should be reported immediately to your doctor, as only a gynecologist is able to adequately assess the situation and make the only correct decision.