Review Note
Last Update: 03/27/2025 09:45 PM
Current Deck: ACG Part 2::Obstetrics
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Commit #309771
SS_OB 1.35 Discuss the pathophysiology and anaesthetic management of the following medical conditions particular to pregnancy:
- HELLP syndrome
- HELLP syndrome
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Commit #309771Pathophysiology:
- Usually associated with PET/eclampsia
- Haemolysis - a falling Hb concentration without evidence of overt bleeding,
- haemoglobinuria, elevated bilirubin in serum and urine, elevated lactate dehydrogenase (LDH). Least common element.
- Elevated liver enzymes - AST or ALT, epigastric or RUQ pain. May develop liver failure or hepatic rupture. Ddx acute fatty liver of pregnancy.
- Low platelets - platelets <100 × 10 /L are of concern, while a count <50 × 10 /L is indicative of severe disease
Management:
- Only definitive treatment is delivery of the placenta
- Steroids do no alter disease but help with lung maturity if fetus is premature
- Method of deliver depends of maternal condition, severe HELLP likely to need LSCS
- Coagulation abnormalities usually preclude neuraxial
- Prepare for major haemorrhage during delivery
- Further management = supportive:
- Replace blood loss
- ARDS, renal failure, DIC may develop
- Invasive monitoring likely prudent
- Once placenta delivered recovery in 24-48hrs