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Symptoms
HELLP syndrome may be preceded by clear signs of pre-eclampsia - most
typically high blood pressure, protein in the urine and swelling of hands,
feet or face. But, like eclampsia, it can also arise out of the blue
without any of the classic warning signs. The typical presenting symptom
is pain just below the ribs (‘epigastric pain’), sometimes accompanied
by vomiting and headache. This pain is sometimes confused with the
discomfort of heartburn, a very common problem in pregnancy. But, unlike
heartburn, the pain of HELLP syndrome is not burning, does not spread
upwards towards the throat and is not relieved by antacid. The pain is
often very severe and is associated with tenderness over the liver. It is
not uncommon for women with this pain to be diagnosed as suffering from
some other acute abdominal condition, typically inflammation of the gall
bladder (cholecystitis).
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When
does it occur?
As with eclampsia, HELLP syndrome is most likely to occur immediately
after delivery -sometimes developing with devastating speed. However, it
can arise at any stage during the second half of pregnancy - and some rare
cases have been recorded even earlier.
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What
are the risks?
HELLP syndrome may be associated with one or more of the following
problems:
-
Severely disturbed blood clotting function, leading to heavy,
uncontrollable bleeding, particularly after surgery;
-
Severe liver damage, which can lead to failure or even rupture of
this vital organ;
-
Severe kidney problems, including kidney failure;
-
Breathing difficulties, which may be severe enough for the mother to
need artificial ventilation;
-
Stroke (cerebral haemorrhage) with or without eclampsia
(convulsions).
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How
is it treated?
The diagnosis of HELLP syndrome can only be confirmed in hospital. And
emergency admission is essential for all suspected cases. Once the
syndrome is diagnosed the baby should be delivered as soon as the
mother’s condition is stable, regardless of the maturity of the baby,
since delivery is the only cure for this life-threatening condition. If
the blood clotting system is severely disturbed it may be necessary to
give transfusions of the platelets essential to clotting before delivery
can take place.
It is not uncommon for the symptoms to become worse -
or to develop for the first time -in the 48 hours following delivery, and
treatment in an intensive care unit may be necessary. All treatment is
aimed at supporting the mother’s systems which have failed (liver,
kidney, lungs, clotting) until such time as they have recovered enough to
cope on their own. Providing no permanent damage has occurred, the mother
should enjoy a full recovery. This may take as little as a few days or as
long as two to three months (not all of it spent in hospital) depending on
the severity of the mother’s problems.
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How
is the baby affected?
HELLP is a maternal problem which has no specific effects on the unborn
baby. However, as with all cases of severe pre-eclampsia, the baby may
suffer growth retardation and even distress as a result of the underlying
cause - a shortage of maternal blood flow to the placenta. But in most
cases of HELLP delivery is for the mother’s benefit, sometimes with
tragic results for babies who are too premature to survive outside the
womb.
Source: - Action for Pre-Eclampsia
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