Patients with HELLP syndrome should be treated prophylactically with magnesium sulfate to prevent seizures, whether hypertension is present or not.
Antihypertensive therapy should be initiated if blood pressure is consistently greater than 160/110 mm hg despite the use of magnesium sulfate. The goal is to maintain diastolic blood pressure between 90 and 100 mm hg.
Antihypertensive therapy should be initiated if blood pressure is consistently greater than 160/110 mm hg despite the use of magnesium sulfate. The goal is to maintain diastolic blood pressure between 90 and 100 mm hg.
The most commonly used antihypertensive agent has been
The most commonly used antihypertensive agent has been
hydralazine
Labetolol
Nifedipine
Between 38 -93 % of patients with HELLP syndrome receive some form of blood product.
Between 38 -93 % of patients with HELLP syndrome receive some form of blood product.
Patients with a platelet count greater than 40,000 per mm3 are unlikely to bleed.
Patients who undergo cesarean section should be transfused if their platelet count is less than 50,000 per mm3 ,
Patients who undergo cesarean section should be transfused if their platelet count is less than 50,000 per mm3 ,
Prophylactic transfusion of platelets at delivery does not reduce the incidence of postpartum hemorrhage or hasten normalization of the platelet count. .
Patients with DIC should be given fresh frozen plasma and packed red blood cells.
Pain relief with intravenous narcotics and local anesthesia is acceptable but certainly not optimal for pain control.
Pain relief with intravenous narcotics and local anesthesia is acceptable but certainly not optimal for pain control.
Epidural anesthesia has been controversial but it is the technique of choice when it can be accomplished safely. Insertion of an epidural catheter is generally safe in patients with a platelet count greater than 100,000 per mm3.
General anesthesia can be used when regional anesthesia is considered unsafe.
Complications
The mortality rate for women with HELLP syndrome is approximately 1.1 %
From 1 to 25 % of affected women develop serious complications such as DIC, placental abruption, adult respiratory distress syndrome, hepatorenal failure, pulmonary edema, subcapsular hematoma and hepatic rupture.
A significant percentage of patients receive blood products.
Complications
Infant morbidity and mortality rates range from 10 to 60 %, depending on the severity of maternal disease.
Infants affected by HELLP syndrome are more likely to experience intrauterine growth retardation and respiratory distress syndrome.
