What happens in the body
As with preeclampsia, the underlying cause is damage to the internal lining of blood vessels. Fibrin threads are deposited in small vessels, through which red blood cells pass and are mechanically destroyed - hemolysis develops. Platelets are actively consumed by these deposits, and their number in the blood decreases. The liver vessels become clogged, areas of the liver tissue suffer from a lack of blood supply, liver enzymes increase, and the liver capsule stretches, which gives the characteristic pain under the right rib. In severe cases, a hematoma forms under the capsule and can rupture.
- Destruction of red blood cells in small vessels
- Increased liver enzymes
- Decreased platelet count
- Impaired blood supply to the liver
- Stretching of the liver capsule and pain
- Risk of subcapsular hematoma and rupture
- Blood clotting disorders
Symptoms
The picture is often deceiving. The woman complains of pain in the epigastric region or under the right rib, nausea, sometimes vomiting, general weakness and a feeling as if she is getting the flu. Because of this, the condition is mistaken for food poisoning, exacerbation of gastritis or a viral infection, and precious time is lost. Headache and visual disturbances may occur. Blood pressure is not always elevated, and there may be no protein in the urine. The appearance of bruises, bleeding gums, darkening of urine and yellowing of the skin are also alarming.
- Pain under the right rib and in the epigastric region
- Nausea and vomiting
- Severe weakness and malaise
- Headache and visual disturbances
- Swelling and rapid weight gain
- Bruising and bleeding
- Yellow skin and dark urine
Diagnostics
The diagnosis is made by blood tests, and they need to be performed urgently. Three groups of indicators are assessed: signs of red blood cell destruction, which include increased LDH, changes in the blood smear and an increase in indirect bilirubin; increased liver enzymes ALT and AST; decrease in platelet count. Additionally, creatinine, protein in the urine, and coagulation parameters are checked. If there is severe pain under the right rib, an ultrasound of the liver is performed to exclude a subcapsular hematoma. Be sure to evaluate the condition of the fetus using CTG and ultrasound.
- Complete blood count with platelet count
- LDH and bilirubin as markers of hemolysis
- ALT and AST
- Creatinine and urea
- Protein in urine
- Coagulogram
- Ultrasound of the liver for severe pain
- CTG and ultrasound of the fetus
Treatment
Treatment is carried out in an obstetric hospital with an intensive care unit. The main and only radical method is delivery: if the pregnancy is close to full term and if the mother’s condition worsens, childbirth is not postponed. In the short term, it is sometimes possible to gain time to administer drugs that accelerate the maturation of the child’s lungs, but only if the woman’s condition is stable and under constant supervision. At the same time, magnesium sulfate is administered to prevent seizures, blood pressure is reduced, and platelets and blood components are transfused if necessary. Observation continues for several days after birth.
- Hospitalization in a hospital with intensive care
- Delivery as the main method of treatment
- Magnesium sulfate for seizure prevention
- Controlled reduction of blood pressure
- Transfusion of platelets and blood components as indicated
- Preparations for the maturation of the lungs of a premature fetus
- Surgical care for ruptured subcapsular hematoma
- Observation and control of tests in the postpartum period
Prognosis and subsequent pregnancies
With timely recognition and delivery, blood counts usually return to normal within a few days after birth. A delay in diagnosis is dangerous due to severe complications: placental abruption, coagulation disorders, acute renal failure, liver rupture. For a woman who has had HELLP syndrome, the next pregnancy is planned in advance and managed as a high-risk pregnancy, with early initiation of prophylaxis and more frequent monitoring. In the long term, such patients are recommended to monitor blood pressure, weight and metabolism.
- Normalization of tests in the first days after childbirth
- Risk of recurrence in next pregnancy
- Planning a pregnancy with a doctor
- Prophylaxis with low doses of acetylsalicylic acid as prescribed
- More frequent monitoring and control of tests
- Long-term control of blood pressure and cardiovascular health