HELLP syndrome

HELLP syndrome is a serious, life-threatening form of pre-eclampsia with a typical laboratory triad. The incidence of the disease is reported as being 0.17-0.85% of ail live births. There has been, to date, neither reliable e arly recognition nor effective prevention of HELLP syndrome. As a result of endothelial dysfunction, activation of intravascular coagulation occurs wi th fibrin deposition in the capillaries and consecutive microcirculation di sorders. The disease manifests itself on average between 32-34 weeks' gesta tion. HELLP syndrome will occur postpartum in up to 30% of the cases. The c linical cardinal symptom of the disease is right upper quadrant pain or epi gastric pain accompanied with nausea, vomiting and malaise. In 20% of the c ases with HELLP syndrome there is no hypertension and 5-15% of the pregnant patients present a low level of proteinuria or none at all. The early reco gnition of hemolysis is most sensitively managed by the determination of th e serum haptoglobin. The increase of the aspartate transaminase (AST) and t he alanine transaminase (ALT) often precedes a decrease in platelets. The c ourse of HELLP syndrome is incalculable. It is universally agreed that a pr egnancy from 32-34 weeks should be immediately delivered. Before 32-34 week s, expectant management is generally possible in a perinatal center. The fr equency for a repeated hypertensive disease in pregnancy ranges from 27% to 48%.