From the Guidelines
Prompt delivery is desirable in the presence of worsening pre-eclampsia, gestational age at or beyond 32-34 weeks, evidence of fetal distress, or severe thrombocytopenia in patients with postpartum HELLP syndrome. Management of postpartum HELLP syndrome requires a multidisciplinary approach, with the cornerstone of treatment being blood pressure control using intravenous antihypertensives such as labetalol or hydralazine for severe hypertension, followed by oral medications like nifedipine or labetalol once stabilized 1.
Key Considerations
- Preoperative haematological investigations should include platelet count, white blood cell count, PCV, partial thromboplastin time, fibrinogen concentration, fibrin degradation products, peripheral blood smear, liver function tests, and serum concentrations of creatinine, urea, and uric acid 1.
- Platelet transfusion has been recommended if the platelet count is less than 50,000 mm-3 in patients for Caesarean section 1.
- Whole blood is recommended if the haemoglobin concentration is less than 10 g% 1.
- A urinary catheter should be passed for hourly monitoring of urinary output to diagnose acute renal failure 1.
- Magnesium sulfate should be administered for seizure prophylaxis with a loading dose of 4-6 g IV over 20-30 minutes, followed by a maintenance infusion of 1-2 g/hour for 24-48 hours.
- Close monitoring of laboratory values is essential, with serial assessment of complete blood count, liver enzymes, and coagulation studies every 6-12 hours until clear improvement is noted.
- Fluid balance must be carefully managed to prevent pulmonary edema while ensuring adequate organ perfusion.
- HELLP syndrome typically resolves within 48-72 hours postpartum, but complications like acute kidney injury, DIC, or hepatic rupture require immediate specialist intervention 1.
From the Research
Management of Postpartum HELLP Syndrome
The management of postpartum HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome involves several approaches, including:
- Corticosteroid therapy: Studies have shown that the administration of corticosteroids, such as dexamethasone, can improve platelet count and reduce liver enzyme abnormalities in patients with HELLP syndrome 2, 3, 4.
- Platelet transfusions: However, the addition of platelet transfusions to corticosteroid therapy may not increase the recovery of severe HELLP syndrome 3.
- Plasma exchange: Plasma exchange therapy has been successfully used in selected patients with HELLP syndrome who have organ failure or are refractory to treatment, and has been shown to improve treatment outcomes in patients with severe HELLP syndrome 5.
- Expectant management: Expectant management may be considered in some cases, but prompt recognition and treatment in tertiary centers is emphasized, as delayed or less than optimal diagnosis and treatment can adversely affect the prognosis 6.
Treatment Guidelines
Treatment guidelines for HELLP syndrome include:
- The use of high-dose corticosteroid therapy, such as dexamethasone, to improve platelet count and reduce liver enzyme abnormalities 2, 4.
- The consideration of plasma exchange therapy in patients with severe HELLP syndrome or organ failure 5.
- The use of platelet transfusions in patients with severe thrombocytopenia, but not as a routine treatment for HELLP syndrome 3.
- The importance of prompt recognition and treatment in tertiary centers to improve outcomes 6.