The clinical profile and the therapeutic management of the HELLP syndrome: integrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v10i14.22194

Keywords:

HELLP Syndrome; Managemen; Complications.

Abstract

This study has as objective to describe the clinical profile and therapeutic management of HELLP syndrome. The study has used as method an integrative literature review, developed through a search in the Pubmed database using the crossings of the descriptors in English “HELLP syndrome”, “complications”. To evaluate the research problem and its stratification, the PVO strategy was used. The strategy previously mentioned allowed us to formulate the following guiding question: What are the clinical manifestations of HELLP syndrome, and how does therapeutic management work? The pathophysiology of the disease is not known yet. However, it is believed to be caused by placental insufficiency and generalized endothelial dysfunction. Vague presentation is common; hypertension and proteinuria that characterize preeclampsia are usually absent when HELLP syndrome presents. It can present with nonspecific signs and symptoms, none of which are diagnostic and in most cases asymptomatic, but with symptoms such as persistent hyperreflexia, headache, confusion, abdominal pain, nausea and vomiting. Misdiagnosis and late recognition of HELLP syndrome are common due to its vague and variable presentation. When HELLP syndrome is identified, childbirth is necessary to avoid catastrophic maternal and neonatal outcomes. The identification of baseline parameters predictive of disease progression is, therefore, of great importance to define which obstetric approach should be prioritized.

References

Añez-Aguayo, M. Y. & Gracia, P. V. (2020). Dexamethasone in HELLP syndrome: experience in Bolivia. The Journal of Maternal-Fetal & Neonatal Medicine. 33(1):1-4.

Cadoret, F., Guerby, P., Cavaignac-Vitalis, M., Vayssiere, C., Parant, O. & Vidal, F. (2020). Expectant management in HELLP syndrome: predictive factors of disease evolution. The Journal of Maternal-Fetal & Neonatal Medicine. DOI: 10.1080/14767058.2019.1702956.

De Barros, J. F. S., Amorim, M. M., De Lemos, D. G. C. & Katz, L. (2021). Factors associated with severe maternal outcomes in patients with eclampsia in an obstetric intensive care unit: A cohort study. Medicine (Baltimore). 100(38): e27313.

Ditisheim, A. & Sibai, B. M. (2017). Diagnosis and Management of HELLP Syndrome Complicated by Liver Hematoma. Clinical Obstetrics and Gynecology. 60(1):190-197.

Fischer, J., Gerresheim, G. & Schwemmer, U. (2021). Vascular emergencies in pregnant patients : Peripartum hemorrhage, thromboembolic events and hypertensive diseases in pregnancy. Anaesthesist. 70(10): 895-908.

Ghelfia, A. M., Garavellia, F., Passarinob, F. A., Diodatia, S., Calcaterrab, M. G., Hailsb, E. A., Kilsteina, J. G., Galíndeza, J. O., Pacioccob, M. A. & Lassusb, M. N. (2020). Síndrome HELLP: características clínicas, analíticas y evolutivas observadas en dos años de experiência. Hipertensión y Riesgo Vascular. 37(4):152-161.

Hasan, N., McGrath, M., Cortes, G., Miller, J. & Deck, C. (2020). A Case Report on Managing Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP Syndrome) During a Rapid Response Code. Cureus. 12(10): e11028.

Janga, K. C., Chitamanni, P., Raghavan, S., Kumar, K., Greenberg, S. & Jana, K. (2020). Preeclampsia, HELLP Syndrome, and Postpartum Renal Failure with Thin Basement Membrane Nephropathy: Case Report and a Brief Review of Postpartum Renal Failure. Case Rep Obstet Gynecol. 2020: 3198728.

Jayawardena, L. & Mcnamara, L. (2020). Diagnosis and management of pregnancies complicated by haemolysis, elevated liver enzymes and low platelets syndrome in the tertiary setting. Internal Medicine Journal. 50(3):342-349.

Kongwattanakul, K.., Saksiriwuttho, P., Chaiyarach, S. & Thepsuthammarat, K. (2018). Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome. Int J Womens Health. 10:371–377.

Lam, M. T. C. & Dierking, E. (2017). Intensive Care Unit issues in eclampsia and HELLP syndrome. Int J Crit Illn Inj Sci. 7(3):136-141.

Lisonkova, S., Bone, Jeffrey, N., Muraca, G. M., Razaz, N., Wang, L. Q., Sabr, Y., Boutin, A., Mayer, C. & Joseph, K. S. (2021) Incidence and risk factors for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and eclampsia at preterm and term gestation: a population-based study. Am J Obstet Gynecol. 225(5):538.

Moura, C., Amaral, L., Mendes, J., Quintanilha, R., Bento, F. M., Maria Inês Leite, M. I. & Melo, A. (2019). Hepatic rupture in HELLP syndrome. J Surg Case Rep. 2019(10): rjz277.

Novotny, S., Lee-Plenty, N., Wallace, K., Kassahun-Yimer, W., Jayaram, A., Bofill, J. A. & Martin Jr, J. N. (2020). Acute kidney injury associated with preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome. Pregnancy Hypertens, 19:94-99.

Olié, V., Moutengou, E., Grave, C., Deneux-Tharaux, C., Regnault, N., Kretz, S., Gabet, A., Mounier-Vehier, C., Tsatsaris, V., Plu-Bureau, G. & Blacher, J. (2021). Prevalence of hypertensive disorders during pregnancy in France (2010-2018): The Nationwide CONCEPTION Study. J Clin Hypertens (Greenwich). 23(7): 1344-1353.

Stojanovska, V. & Zenclussen, A. C. (2020). Innate and Adaptive Immune Responses in HELLP Syndrome. Front Immunol.. 15;11:667.

Sandvoß, M., Potthast, A. B., Versen-Höynck, F. V. (2017). HELLP Syndrome: Altered Hypoxic Response of the Fatty Acid Oxidation Regulator SIRT 4. Reproductive Sciences. 24(4):568-574.

Turner, K. & Hameed, A. B. (2017). Hypertensive Disorders in Pregnancy Current Practice Review. Current Hypertension Reviews. 13(2):80-88.

Wade, A. N., Panchmatia, R. & Calderon, P. (2021). Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome With Severe Thrombocytopenia and Severe ADAMTS13 Activity Deficiency. Obstet Gynecol .137(5): 873-876.

Wallace, K., Harris, S., Addison, A. & Bean, C. (2018). HELLP Syndrome: Pathophysiology and Current Therapies. Curr Pharm Biotechnol. 19(10):816-826.

Published

09/11/2021

How to Cite

ALVES, A. K. R. .; SILVA, B. B. L. da .; ALVES, F. R. de O. .; SILVA, L. dos S. .; MACHADO, L. F. C. B. .; PINHO, A. M. .; FRANKLIN, F. L. A. A. .; IBIAPINA, M. de L. P. .; NORONHA, F. M. C. .; ALMEIDA, L. M. de V. .; GONÇALVES , S. I. de O. .; MEDEIROS, A. M. .; FORTES NETO, N. A. .; BUCAR, L. E. Q. .; RODRIGUES , I. G. . The clinical profile and the therapeutic management of the HELLP syndrome: integrative review. Research, Society and Development, [S. l.], v. 10, n. 14, p. e450101422194, 2021. DOI: 10.33448/rsd-v10i14.22194. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/22194. Acesso em: 20 jun. 2024.

Issue

Section

Health Sciences