A and HELLP syndrome. Complement activation induces dysregulation

A variant of preeclampsia.the etiology of HELLP and preeclampsia is not clear (disease of theories). Endothelial cells activation due to a release of placental factors and initiation of inflammatory and coagulation cascades. This is characterized by elevated lipid peroxides and oxidative stress. The complement system is a key mediator of systemic inflammation and is excessively activated in preeclampsia and HELLP syndrome. Complement activation induces dysregulation of angiogenic factors, mutation of complement system may explain etiology as some patient show mutation as aHUS. HELLP occur mostly at second and third trimesters as TTP but HUS occur more common postnatal.Elevated liver enzymes and hyperreflexia are common in HELLP whereas neurological abnormalities are most common in TTP.Platelet count more than 50000 × 109 / liter in HELLP and more decrease in TTP.HELLP is associated with increased maternal and neonatal complications. Maternal complication includes DIC which is the common complication as there are vascular endothelium activation and microthrombi formation, renal failure, abruption placenta, liver rupture and pulmonary edema. Neonatal complications include thrombocytopenia, IUGR, respiratory distress. Treatment monitor patient vital signs and immediate control of blood pressure and seizure. The patients with  suspected HELLP syndrome should receive parenteral magnesium sulfate as prophylaxis for seizure.3,23 The magnesium sulfate  loading dose of 6 g intravenous  over 20 min followed by a continuous infusion of 2 grams/hr  until 24-h postpartum.3 for recurrent seizures occur, an additional bolus of 2 g magnesium sulfate can be given over 3–5 min. . Hypertension is managed as preeclampsia. NICE recommends antihypertensive therapy for severe preeclampsia and HELLP syndrome if the blood pressure is ?160/110 mmHg. NICE recommends that the first line therapy for moderate hypertension should be labetalol. Alternative antihypertensive are methyldopa and nifedipine. For treatment of acute severe hypertension in pregnancy intravenous hydralazine, and labetalol are equally efficient. Corticosteroids can be given for antepartum and postpartum management in patients with HELLP. Steroids decrease the degree of intravascular endothelial injury.Dexamethasone is used for enhancing fetal lung maturity. The only cure for preeclampsia and HELLP is delivery. Timing, and method of delivery largely depend on clinical expert. Cesarean section should be considered in the patients with HELLP syndrome <32–34 weeks of gestation where long induction with cervical ripening agents is expected. In advanced cases with HELLP syndrome, Plasmapheresis with fresh frozen plasma could be used.


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