6.1 C) Obstetrics And Gynaecology : Pregnancy Complications Of Pregnancy Hellp Syndrome

Front 1

HELLP = ?

Back 1

Haemolysis
Elevated Liver Enzymes
Low Platelets

Front 2

List types of Maternal morbidity with HELLP ?

Back 2

HELLP a more severe variant of Preeclampsia.
1-2 % maternal mortality
1. Cerebral oedema / herniation
2. Intracranial haemorrhage
3. Renal Failure
4. Liver : subcapsular haematoma / rupture
5. Pulmonary oedema

Front 3

Fetal morbidity and mortality with HELLP ?

Back 3

1. Placental abruption
2. Premature delivery [ 70%]
3. IUGR

Front 4

Which is incorrect regarding HELLP ?

A. It occurs in 5-10% of severe eclampsia
B. The classic triad of pre-eclampsia + RUQ pain + hypotension = hepatic haemorrhage / rupture
C. 10% develop DIC
D. Liver transaminases are usually < 500 IU.

Back 4

C. 40% HELLP patients develop DIC

Front 5

Management of HELLP ?

Back 5

1. Emergent Obstetrics Consult
2. Control blood pressure [ hydrallazine ]
3. Control seizures [ MgSO4]
4. Platelet transfusion [ Consult Haematology ]
5. Delivery ***

[ Steroids: Betamethasone 11.4 mg IMI - pre and post partum if < 34 weeks ]

Front 6

Which is incorrect regarding HELLP?
A. The anaemia is a microangiopathic haemolytic type.

B. HELLP is a form of pre-eclampsia
C. Low platelets of < 100 can be found in 5-10% of third Trimester

pregnancies
D. Platelet transfusion may be required.

Back 6

C. Platelet count 100-150

= "Gestational Thrombocytopenia"

Front 7

Which is incorrect regarding HELLP?

A. The abnormal serum AST is usually > 70 U/L but less than 500 U/L
B. Thrombocytopenia is found in most pre-eclampsia patients.

C. Treatment of HELLP is primarily supportive, but can require BP

lowering with hydrallazine. [+/- delivery of baby ]
D. Renal and Liver failure can occur in HELLP.

Back 7

B. Thrombocytopenia found in only 15-20% of

pre-eclampsia patients

ie. A normal platelet count does not exclude

pre-eclampsia.

Front 8

What are the 3 leading causes of death in HELLP Syndrome?

Back 8

1. Intracerebral haemorrhage
2. Cerebral infarction
3. Hepatic rupture

Front 9

What is the maternal mortality rate for HELLP?

Back 9

1% maternal mortality rate for HELLP

Front 10

What is the fetal mortality rate and causes for death in HELLP?

Back 10

Fetal Mortality rate for HELLP : Range 5-35%
- improved survival after 32 weeks

1. Placental abruption
2. Placental insufficiency
3. Premature labour and birth

Front 11

Treatment of HELLP?

Back 11

1. > 34 weeks = Immediate delivery

2. 27-34 weeks = Corticosteroids and delivery within 48 hours

3. < 27 weeks : Conservative for 48-72 hours

Manage Hypertension with hydrallazine.

Front 12

Which is incorrect regarding HELLP ?

A. A peripheral blood smear shows schistocytes.
B. The active treatment of hypertension begins when the BP is > 140/90
C. Preeclampsia complicates 5-10% pregnancies.
D. CTG is initiated emergently.

Back 12

B. Active treatment of Hypertension in HELLP

begins with BP > 160/110 mmHg