Contact Hours: 4
This educational activity is credited for 4 contact hours at completion of the activity.
Course Purpose
The purpose of this course is to provide healthcare professionals with a brief overview Preeclampsia and Hemolysis, Elevated Liver enzymes, and Low Platelet (HELLP) syndrome, their clinical presentations, risk factors, and treatment options.
Overview
Preeclampsia and Hemolysis, Elevated Liver enzymes, and Low Platelet (HELLP) syndrome are two serious pregnancy conditions that pose a substantial risk to the health of pregnant women and the fetus. Preeclampsia is a hypertensive disorder that usually develops after 20 weeks of gestation and is characterized by extremely high blood pressure and protein presence in the urine, and Hemolysis, Elevated Liver enzymes, and Low Platelet (HELLP) syndrome is a life-threatening variant of preeclampsia usually seen in the later stages of pregnancy or soon after childbirth. This course defines the cause, clinical presentation, and risk factors associated with Preeclampsia and HELLP syndrome. Additionally, it discusses treatment options and vital nursing considerations for both conditions that can be implemented to manage symptoms and improve health outcomes.
Course Objectives
Upon completion of the independent study, the learner will be able to:
- Describe preeclampsia and its four subtypes.
- Describe HELLP syndrome and its classifications.
- Identify risk factors for preeclampsia and HELLP syndrome.
- Review the signs and symptoms of preeclampsia and HELLP syndrome.
- Differentiate between preeclampsia and HELLP syndrome and their treatment options.
Policy Statement
This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.
Disclosures
Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.
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| Abnormal Placentation | Also known as placenta accreta, occurs in about one in 500 births and refers to a condition where the placenta grows deeply into the wall of the uterus. |
| Acute Renal Failure | A condition when an abrupt reduction in kidneys’ ability to filter waste products occurs within a few hours or a few days. |
| Antiangiogenic | A substance that reduces the growth of new blood vessels needed by tumors to grow and metastasize. |
| Aspartate Aminotransferase (AST) | A blood test that checks for liver damage. |
| Bronchopulmonary Dysplasia | A serious lung condition that affects mostly babies who are born more than 10 weeks before their due date, weigh less than two and a half pounds, have breathing problems at birth and need long-term breathing support and oxygen. |
| Cerebral Edema | A buildup of fluid around the brain. |
| Cerebral Hemorrhage | Uncontrolled bleeding inside the brain, most often linked to high blood pressure. |
| Cryoprecipitate | A portion of plasma, the liquid part of blood. |
| Disseminated Intravascular Coagulation (DIC) | A rare blood clotting disorder that can cause organ damage and uncontrollable bleeding. |
| Eclampsia | A life-threatening condition during pregnancy or shortly after giving birth characterized by the development of seizures. |
| End-Organ Dysfunction | Damage occurring in major organs fed by the circulatory system. |
| Fetal Growth Restriction (FGR) | Condition in which an unborn baby (fetus) is smaller than expected for the number of weeks of pregnancy (gestational age). |
| Fresh Frozen Plasma | A blood product made from the liquid portion of whole blood. |
| Gestation | The process or period of developing inside the womb between conception and birth. |
| Gestational Hypertension | Occurs when there is high blood pressure during pregnancy without protein the urine. |
| Hemolysis, Elevated Liver Enzymes, And Low Platelet (HELLP) | A life-threatening condition that occurs in pregnant women or soon after delivery that can cause high blood pressure, seizures, stroke, or liver rupture. |
| Hepatic Infarction | A rare condition that occurs when the blood supply to the liver is blocked, leading to tissue damage and cell death. |
| Hyperreflexia | Muscles have an increased or overactive reflex response. |
| Hypertension | High pressure in the arteries (vessels that carry blood from the heart to the rest of the body). |
| Infection | A disease that can spread from one person to another through direct or indirect contact. |
| Lactate Dehydrogenase (LDH) | A t looks for signs of damage to the body’s tissues. |
| Liver Failure | A condition in which the liver is unable to perform its normal metabolic functions. |
| Liver Rupture | Occurs when the liver is damaged and the blood vessels in the liver are torn, causing internal bleeding. |
| Maternal Death | Death of a pregnant mother due to complications related to pregnancy, |
| Meningitis | An infection and inflammation of the fluid and membranes surrounding the brain and spinal cord. |
| Necrotizing Enterocolitis | An inflammation in the intestines (usually the colon) that can be life-threatening if not treated right away. |
| Nulliparous | A woman that has never given birth. |
| Percutaneous Embolization | A minimally invasive procedure that involves the injection of an embolic agent into a blood vessel to block the flow of blood to a specific area of the body. |
| Perinatal | Relating to the time, usually a number of weeks, immediately before and after birth. |
| Perinatal Death | The death of a fetus or a newborn in the perinatal period that commences at 24 completed weeks’ gestation and ends before seven completed days life. |
| Periventricular Leukomalacia | A softening of white brain tissue near the ventricles. |
| Placental Abruption | A premature separation of the placenta from the uterus. |
| Placental Ischemia | A condition where the placenta does not receive enough blood flow, which can lead to complications during pregnancy. |
| Placental Malperfusion | Represents a recognizable pattern of placental injury related to altered uterine and intervillous blood flow. |
| Platelet Count | Measures the average platelet level in a person’s blood. |
| Postpartum Preeclampsia | A rare condition that occurs when a woman has high blood pressure and excess protein in her urine soon after childbirth. |
| Preeclampsia | A pregnancy complication characterized by high blood pressure and signs of kidney damage. |
| Preterm Delivery | The birth of a baby before the 37th week of pregnancy. |
| Proteinuria | An excess of proteins in urine. |
| Puerperal Period | The period of adjustment after childbirth during which the mother’s reproductive system returns to normal; generally, lasts six to eight weeks. |
| Pulmonary Edema | A condition where fluid accumulates in lung tissues. |
| Pulmonary Hemorrhage | A rare condition caused by bleeding into the lower respiratory tract, usually the alveoli. |
| Respiratory Distress Syndrome | Occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in the lungs. |
| Retinopathy of Prematurity | An eye disease in some premature babies born before 31 weeks. |
| Seizures | Sudden, uncontrolled electrical disturbance in the brain which can cause changes in behavior, movements, feelings, and consciousness. |
| Sepsis | An infection of the blood stream resulting in a cluster of symptoms such as drop in a blood pressure, increase in heart rate and fever. |
| Serotonin | A chemical messenger (neurotransmitter) that helps brain and nervous system cells communicate. |
| Spiral Arteries | Small arteries which temporarily supply blood to the endometrium of the uterus during the luteal phase of the menstrual cycle. |
| Thrombocytopenia | A condition where abnormally low levels of platelets are observed. |
| Thromboxane A | A type of thromboxane that is produced by activated platelets during hemostasis and has prothrombotic properties. |
Preeclampsia and Hemolysis, Elevated Liver enzymes, and Low Platelet (HELLP) syndrome are two serious pregnancy conditions that pose a substantial risk to the health of pregnant women and the fetus. Preeclampsia is a hypertensive disorder that usually develops after 20 weeks of gestation and is characterized by very high blood pressure (hypertension) and protein presence in the urine (proteinuria).1 Generally, HELLP syndrome is considered a more severe form of preeclampsia.2 However, recent studies have shown that 15 – 20% of women with HELLP syndrome have neither hypertension nor proteinuria, which puts forth the recommendation that both should be considered separate disorders.1, 2 Yet, findings vary and are inconclusive, with some studies suggesting maternal morbidity risk is higher in HELLP syndrome. Other findings have shown no significant difference in perinatal and maternal outcomes.1,2
Regardless of the precise definition, these hypertensive concerns can cause life-threatening complications and, if not treated immediately, can increase the risk of maternal and fetal mortality. In the United States (US), 5 – 8% of pregnant women develop preeclampsia, and 15% develop HELLP syndrome3.
Despite its rarity, preeclampsia is one of the top six causes of maternal mortality, accounting for 16% of maternal deaths in the US, and is the leading cause of intensive care unit (ICU) admissions in the puerperal period; the six weeks after childbirth4.
Health database analysis has shown that cases of preeclampsia in the country have risen drastically.4 This is particularly alarming and makes it more critical to increase awareness, improve early diagnostic methods and develop treatment options to decrease the incidence.
This course defines the cause, clinical presentation, and risk factors associated with Preeclampsia and HELLP syndrome. Additionally, it discusses treatment options and vital nursing considerations for both conditions that can be implemented to manage symptoms and improve health outcomes.
Preeclampsia is a multi-system progressive disorder that is most often seen after 20 weeks of pregnancy. It is characterized by either the new onset of hypertension, proteinuria, and excessive swelling, or the new onset of hypertension, end-organ dysfunction with or without proteinuria.4, 5 Clinically, new-onset hypertension refers to women who had normal blood pressure before pregnancy and then saw an increase above 140/90 mmHg (stage 2 hypertension) during pregnancy.1
Preeclampsia can be divided into the following four subtypes:5
- Early onset preeclampsia
- Is seen before the 34th week of gestation. This type of preeclampsia is seen in 10% of cases and is more likely to result in fetal growth restriction and placental malperfusion.
- Late-onset preeclampsia
- Is seen after the 34th week of gestation.
- Postpartum Preeclampsia
- Occurs 48 hours to 6 weeks after delivery and can happen regardless of whether a woman has high blood pressure or preeclampsia during pregnancy.
- Chronic hypertension with preeclampsia
- Is seen in women with hypertension pre-pregnancy or elevated blood pressure after 12 weeks postpartum. In this type of preeclampsia, hypertension worsens or becomes resistant, with a new onset of proteinuria and possible organ dysfunction.
The four subtypes can be classified as mild or severe depending on blood pressure, degree of proteinuria, and other clinical findings.
Gestational Hypertension
It is important to note that while gestational hypertension is considered an early or mild form of preeclampsia, it is not the same condition. Gestational hypertension is elevated blood pressure in pregnant women who previously had normal blood pressure. In most cases, it does not affect the mother or fetus. The blood pressure usually returns to normal 12 weeks after birth.1,5 However, severe gestational hypertension can result in preterm birth or fetal growth restriction. It can also later develop into preeclampsia.1
Preeclampsia vs. Eclampsia
Both preeclampsia and eclampsia are pregnancy-related hypertensive disorders, such that women with preeclampsia can develop seizures and coma if the seizure is severe enough to affect brain function. This condition is known as eclampsia, a life-threatening medical emergency that requires immediate treatment to increase chances of survival.6 Additionally, eclampsia can develop after delivery. In approximately 33% of eclampsia cases, this happens within 48 – 72 hours after the woman has given birth.6
When Is Preeclampsia Likely to Occur?
Certain risk factors increase the likelihood of both early-onset and late-onset preeclampsia, with some more significant than others, as explained below.
History of Preeclampsia
Women with a history of preeclampsia are among the most at risk of developing the condition again in subsequent pregnancies.4,7 Additionally, the severity of previous cases of preeclampsia can strongly impact the likelihood of preeclampsia recuring. Women with severe preeclampsia in their second trimester have been found to have a recurrence rate of up to 65%. In comparison, women with milder symptoms only had a 5 – 7% risk of recurrence. Less than 1% of women with a normal first pregnancy was found to develop preeclampsia in their second pregnancy.4,7
Preexisting Medical Conditions
Women with underlying medical conditions are more susceptible to developing preeclampsia. These conditions include a history of chronic hypertension, pre-gestational diabetes or insulin resistance, chronic kidney disease, vascular disease, pre-pregnancy obesity, and abnormal lipid metabolism.1, 4,7
Also, the presence of certain autoimmune disorders, such as antiphospholipid syndrome and systemic lupus erythematosus, can increase the risk of developing preeclampsia.8 There are also a few hereditary and genetic factors that may indicate an increased risk, such as a family history of preeclampsia and the pregnant woman herself being born preterm or with low birth weight.9,10
Pregnancy Specific Factors
Several pregnancy-specific factors have been shown to increase the likelihood of preeclampsia. Nulliparous women, those who have not had a pregnancy beyond 20 weeks, are at a higher risk of developing preeclampsia. This includes women who have had a miscarriage and elective abortion.11, 12
Other pregnancy-specific factors include pregnancies with multiple babies, advanced maternal age above 35 and the presence of certain complications in previous pregnancies, such as fetal growth restriction, placental abruption, and stillbirth.4, 7
The exact cause of preeclampsia is still not completely understood. Current research points to abnormal placentation; the abnormal formation of the placenta. This issue is believed to play a significant role in the complication seen with preeclampsia.13
In pregnancy, the placenta is a critical multi-functional organ that passes oxygen and nutrients to the fetus and removes fetal waste. However, any abnormalities in formation can create abnormal placental blood vessels, particularly the remodeling of spiral arteries in the uterus, which fail to dilate properly.14 This vasoconstriction strongly affects how blood is circulated through the placenta, drastically increasing blood pressure throughout the maternal circulation. Eventually, this leads to other systemic problems, such as impairments in protein filtration in the kidneys, hence proteinuria. Other complications include hepatic, neurologic, pulmonary, cardiac, and hematologic dysfunction.15
These underdeveloped blood vessels can also cause placental ischemia (restricted blood flow to the placenta), which in turn causes hypoxia and oxidative stress as the fetus no longer receives optimal levels of oxygen and nutrients.16, 17 While the downstream effect of abnormal placentation is better understood, the trigger that causes this abnormal development, and subsequent events, is still unclear.
Pregnant women who develop preeclampsia often present with a sudden new onset of severe headaches with no history of headaches or migraines. These headaches are often unresponsive to medication. The early sign of a headache is typically followed by other symptoms, such as blurred vision or visual disturbances, upper abdominal pain (epigastric pain), chest or shoulder pain, nausea or vomiting, shortness of breath, perceived swelling in limbs, lower back pain, sudden weight gain, hyperreflexia (overactive muscle reflex response), and anxiety.1, 4
A physical exam and laboratory testing are necessary to confirm the diagnosis. In patients nearing 20 weeks gestation, preeclampsia is considered when an elevated blood pressure reading of 140/90 mm Hg is seen.1 For patients past 20 weeks gestation, a minimum of two blood pressure measurements taken 4 hours apart should be performed.1
Tests on blood and urine samples in positive cases often show proteinuria, where more than 300mg of protein is passed daily and the protein-to-creatinine ratio is over 0.3 mg/dl. Additionally, the platelet count will be low and renal and liver function will be impaired. Disseminated intravascular coagulation (DIC) may also be present.The fetal assessment may reveal growth concerns which may be indicative of fetal growth restriction.1, 4, 5
Treatment and management for preeclampsia depends on when it develops and its severity. If the pregnancy has reached 37 weeks or later, delivering the fetus is the definitive treatment regardless of severity, as it avoids further complications.1 However, if the fetus is under 37 weeks, then the severity and fetal development should be considered for the best health outcomes.1
In mild preeclampsiawhere fetal growth is normal, healthcare professionals may wait to deliver the fetus. Bed rest is often recommended to increase blood flow to the placenta and lower blood pressure. Both the mother and fetus are closely monitored.1
Pregnancy-safe medications such as beta-blockers and anticonvulsants may also be prescribed to control blood pressure to prevent eclampsia. Corticosteroids may also be given to promote fetal lung development so that in the case of an emergency delivery, the fetus has a better chance of survival outside the womb.1
In cases of severe preeclampsia with more serious symptoms, the pregnant woman may be admitted to the hospital for continuous monitoring. Treatment may include intravenous medication to control the blood pressure and prevent seizures. Once the woman has reached 34 weeks, it is recommended that the fetus be delivered as soon as medically possible to lower the risks of further complications.1
Note that even after delivery, symptoms may continue or become apparent, such as with postpartum preeclampsia. Therefore, the blood pressure must be closely monitored in the 12 weeks following delivery. Normally symptoms of preeclampsia resolve within 6 – 8 weeks.1
Studies have shown that pregnant women may suffer long-term complications of preeclampsia, such as cerebrovascular disease, chronic hypertension, and cardiovascular complications contributing to increased mortality, end-stage renal disease and adverse outcomes in subsequent pregnancies. 1, 4 Women who have suffered from preeclampsia may require ongoing treatment to manage these health problems.
Hemolysis, Elevated Liver enzymes, and Low Platelet (HELLP) syndrome is a life-threatening variant of preeclampsia usually seen in the later stages of pregnancy or soon after childbirth.2 Its name is an acronym for its primary symptoms:
- for Hemolysis, a natural biological process that causes red blood cells to break down. However, it can lead to hemolytic anemia if it becomes unregulated or excessive.19
- for Elevated Liver enzymes which indicates liver dysfunction20
- for Low Platelet count, which can lead to thrombocytopenia; a platelet deficiency in the blood, which can result in impaired blood clotting, bruising, and internal bleeding.21
It is critical to note that HELLP syndrome can present without the classic complications of preeclampsia; hypertension and proteinuria.2, 3 If this occurs, HELLP syndrome symptoms may be misdiagnosed as another medical condition, such as acute hepatitis, acute fatty liver disease, gastritis, gallbladder disease, and even the flu.2
Complications of HELLP Syndrome
Immediate complications from HELLP syndrome include eclampsia, placental abruption, DIC, acute renal failure, severe ascites, pulmonary edema, cerebral edema, liver rupture, liver failure, hepatic infarction, cerebral hemorrhage, infection and sepsis, fetal growth restriction, preterm delivery, perinatal death, and maternal death. 2, 23
Considering the prevalence of HELLP syndrome, statistical analysis has shown it is rare, occurring in 0.5 – 0.9% of all pregnancy cases. Of these cases, 70% occur in the third trimester and the remaining within 48 hours of delivery.2, 18, 23
HELLP Syndrome Classification
HELLP syndrome is classified based on its severity. Specific blood tests assess the condition of the maternal blood vessels, liver, and other organs, by measuring specific levels of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and platelet count.2, 18
Aspartate aminotransferase (AST) is an enzyme normally produced in low quantities by the liver. High levels indicate liver damage.20 Lactate dehydrogenase (LDH) is another enzyme produced by multiple organs, including the kidneys and liver. It is released when cells are damaged or destroyed. Higher-than-normal levels can signify tissue disease or damage.22 A platelet countlower than normal may indicate complications such as DIC-related bleeding.
There are three classes of HELLP syndrome, with the lowest class being the most life-threatening:2, 18
| Class I | Severe | AST ≥ 70 IU/L LDH ≥ 600 IU/L Platelet count ≤ 50,000/uL |
| Class II | Moderate | AST ≥ 70 IU/L LDH ≥ 600 IU/L Platelet count 50,000 – 100,000/uL |
| Class III | Mild | AST ≥ 40 IU/L LDH > 600 IU/L Platelet count 100,000 – 150,000/uL |
When HELLP Syndrome is Likely to Occur
Studies have shown that 20% of women with preeclampsia will develop HELLP syndrome, which is why many of the risk factors associated with preeclampsia are also associated with this condition. 24 The most common risk factors include a history of preeclampsia or eclampsia, pre-pregnancy or chronic hypertension, pre-pregnancy diabetes or insulin resistance, chronic kidney disease, vascular disease, pre-pregnancy obesity, abnormal lipid metabolism, and certain autoimmune disorders.24 A family history of preeclampsia, nulliparity, multifetal pregnancy, advanced maternal age (above 35) and prior pregnancy complications also increase the risk of HELLP syndrome. 24
The exact trigger of HELLP syndrome is currently unknown.2, 18 Still, it is understood to be a systemic inflammatory disorder that sets off cascading events in the body. In most cases, there is much similarity with preeclampsia, such as poor or abnormal placenta development and the failed remodeling of spiral arteries.2,25 However, in HELLP syndrome, the resulting activation of internal processes is more pronounced, leading to more medical issues along with hypertension and proteinuria. There is also greater liver inflammation and multi-organ dysfunction. Research shows that the ensuing placenta ischemia from these remodeling failures increases the release of antiangiogenic factors that prevent new blood vessels from forming and, in turn, damages tissues system wide. 2, 18, 25
Abnormal oxidation of fatty acids by the fetus has also been noted. Here, metabolic intermediates from the fetus enter the maternal circulation causing vascular, kidney, and liver dysfunction. This damage also activates the coagulation cascade, which results in the adhesion of platelets on damaged sites. This causes excessive platelet use and rapidly decreasing platelet count, which results in thrombocytopenia.2, 25 Additionally, these platelets release compounds such as thromboxane A and serotonin, which causes vasospasm, vasoconstriction, further tissue damage, and necrosis. As red blood cells pass through the platelet-fibrin-rich capillaries, they are broken down, leading to hemolytic anemia.2, 25 The combination of all these processes results in hepatic necrosis and multi-organ multi vascular injury, which manifests as HELLP syndrome.
While these events explain most HELLP syndrome cases, it does not explain the 15 – 20% of HELLP syndrome patients who do not have elevated blood pressure or protein in their urine. Some suggestions are other pathways affected, which are still unknown.2
The physical signs and symptoms of HELLP syndrome are remarkably like preeclampsia and often begin with new-onset headaches that persist and are medication resistant.2 Other common symptoms include blurred vision or other vision issues such as seeing double, flashing lights, auras, or halos. Patients may also suffer from breathing issues, including shortness of breath, difficulty breathing, gasping for air, and pain when taking a deep breath.2, 18, 25
Body pains and tenderness are also experienced, with the shoulder, chest, upper abdomen, and upper right side being the most common sites. Nausea or vomiting and indigestion with pain after eating may also be present. 2, 18, 25 Other noteworthy symptoms include unexplained bleeding such as nosebleeds, swelling, especially of the face or hands, rapid weight gain, malaise or fatigue, and body spasms. 2, 18, 25
If a patient in the third trimester of pregnancy or immediately postpartum less than seven days and presents with any of the following symptoms, testing should be performed to establish a diagnosis:2, 18
- Hypertension is confirmed by blood at or above 140/90 mm Hg.
- Proteinuria is confirmed if more than 300 mg of protein is passed daily, or protein-to-creatinine ratio is over 0.3 mg/dl
- Hemolysis is confirmed if at least two of the following findings are established:
- Serum bilirubin >1.2 mg/dl
- Peripheral smear with schistocytes and burr cells
- LDH more than twice the upper normal level or low serum haptoglobin (<25mg/dL)
- Severe anemia (hemoglobin < 8 – 10 g/dL)
- Elevated liver enzymes are confirmed if ALT or AST are more than twice the upper normal level.
- A low platelet count is confirmed if blood samples show counts less than 100,000 cells/microL
Patients who meet any of the above criteria should be considered to have partial HELLP syndrome and must be monitored for progression of symptoms.
The treatment options for HELLP syndrome are primarily supportive, as there is no cure for this condition. At most, symptoms can be managed to prevent further organ damage. Hospitalization is recommended to provide immediate maternal and neonatal care.2
If the fetus is at or beyond 37 weeks gestation, prompt delivery is considered the only effective treatment by cesarean section, regardless of the HELLP syndrome class. Generally, symptoms diminish once the placenta is delivered.2, 26 However, if the fetus is under 34 weeks, corticosteroids are often prescribed to promote fetal lung development to improve the chances of survival after a preterm delivery.2, 26 Other medical and surgical interventions may be recommended depending on the symptoms and severity of tissue damage, including intravenous medication to manage hypertension and pain, and anticonvulsants to prevent seizures. 2, 18, 26
Vasopressor support should be considered, in addition to blood and platelet transfusions to restore levels. Fresh frozen plasma and cryoprecipitate may also be transfused. In case of liver rupture, a liver transplant may be recommended, and in the case of hepatic bleeding, percutaneous embolization of the hepatic arteries may be necessary. 2, 18, 26
Among the most serious concerns of preeclampsia and HELLP Syndrome are fetal growth restriction, stillbirth, and neonatal death. In a fetus who is small for gestational age, there is an increased risk of 35% in preeclampsia and approximately 40% in HELLP syndrome of fetal loss.1, 2, 4
Even if the infant survives, there is still the likelihood of numerous neonatal complications that may result in extended hospitalization in the neonatal intensive care unit (NICU) and long-term health concerns that continue to adulthood, as explained below.
Neonatal Complications
Immediately after birth, the baby may suffer from a wide array of life-threatening complications, including internal bleeding, bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing enterocolitis, respiratory distress syndrome, retinopathy of prematurity, sepsis, meningitis, pulmonary hemorrhage, and hematological abnormalities.1,2,4,7
Long-Term Cognitive and Behavioral Concerns
As preeclampsia and HELLP syndrome can put a fetus in distress in-utero, it can cause impaired fetal development, where the brain and other organs do not fully develop and mature. After birth, this may result in cognitive delays and behavioral concerns such as lower IQ or cognitive impairments, disorders in executive functioning, cerebral palsy, depression, anxiety, hyperactivity, and schizophrenia.1,2,4,7
Physical Health Concerns
Other long-term effects of fetal distress from preeclampsia and HELLP syndrome include the development of chronic conditions such as cardiovascular disease, coronary heart disease, elevated blood pressure and hypertension, stroke, respiratory problems such as asthma or chronic lung disease, lowered bone density in adulthood, overall decreased growth, blindness, and deafness.1,2,4,7
Cases of preeclampsia and HELLP syndrome are difficult to predict. While certain risk factors increase the likelihood of developing either of these conditions, there is no definitive screening test.1, 2 At most, screening practices can identify high-risk pregnancies by checking blood pressure and protein levels in the urine. Additionally, fetal growth can be closely monitored for signs of restrictive growth. In the case of any concern, antenatal care can be adjusted to prevent symptoms from progressing.3, 4, 18
Other preventative measures that can be taken to reduce the risk of fetal complications include lifestyle changes a woman can make before pregnancy to reduce the risks of developing either preeclampsia or HELLP syndrome. These lifestyle changes include consuming a nutrient-rich diet and maintaining a healthy weight.26
Secondary preventative medical interventions are currently under research that can be used to disrupt known pathophysiological mechanisms of these disorders before they are established and avoid complications.27, 28 For example, low-dose aspirin has been suggested for women with a history of preeclampsia after 12 weeks of pregnancy to reduce the likelihood of recurrence.27
A pregnant or postpartum woman with preeclampsia or HELLP syndrome can rapidly deteriorate and become critically ill, resulting in life-threatening medical emergencies. Once symptoms present, management and monitoring are critical.1, 2 The pregnant woman’s blood pressure must be monitored closely, along with oxygen saturation. Blood and urine samples must also be sent for testing regularly to check platelet count, liver function, and protein levels. Neurological exams must be performed frequently to prevent any impairments in consciousness. 1, 2, 26
Medications may be prescribed to reduce high blood pressure and prevent seizures, which must be administered routinely. If anticonvulsants are given, the patient’s reflexes should also be monitored.
In addition to the mother’s health, fetal health must also be monitored. This includes regularly checking fetal heart rate to ensure the fetus is not in distress and monitoring fetal growth to check for signs of growth restriction or any other abnormalities. 1, 2, 26
If there is any altered state of consciousness, decreased urine output, or consistent elevated blood pressures, healthcare providers must begin treatment immediately to reduce the severity of preeclampsia or HELLP syndrome.1, 2, 26
Preeclampsia and HELLP syndrome are high-risk pregnancy-related medical conditions that can threaten the life of a mother and her unborn child. Prompt diagnosis and immediate intervention are necessary to prevent the progression of these disorders and avoid short and long-term complications that can affect both the mother and the fetus.
Hypertension and proteinuria are the most common symptoms of these diseases, and any new onset or spike in levels must be investigated as quickly as possible. Given the fact that HELLP syndrome can manifest without preeclampsia, it is critical to assess any questionable symptoms a pregnant or postpartum patient presents with.
Awareness and education play a key role in managing the disorders if a patient is diagnosed with hypertension, preeclampsia, HELLP syndrome during pregnancy. Pregnant or postpartum patients with a better understanding of the possible signs of progression are more likely to seek treatment sooner. For patients with more serious presentations, hospitalization may be the best course of treatment. With supportive intervention and coordination, positive outcomes can be achieved.
- Eclampsia/Preeclampsia. (n.d.). SpringerReference. https://doi.org/10.1007/springerreference_95465Sakhy, Y. (2023). Hepatic infarct complicating HELLP syndrome. Radiopaedia.org. https://doi.org/10.53347/rid-159064
- Salvi, P., Gaikwad, V., & Ali, R. (2021). Clinical correlation of platelet indices in Preeclamptic patients without HELLP syndrome. International Journal of Pharmaceutical Sciences and Medicine, 6(3), 62-75. https://doi.org/10.47760/ijpsm.2021.v06i03.006
- Kınay, T., Küçük, C.,Kayıkçıoğlu, F., & Karakaya, J. (2015). Severe Preeclampsia versus HELLP Syndrome: Maternal and Perinatal Outcomes at <34 and ≥34 Weeks’ Gestation. Balkan Medical Journal, 32(4), 359-363. https://doi.org/10.5152/balkanmedj.2015.15777
- Shih, Tiffany & Peneva, Desi & Xu, Xiao & Sutton, Amelia & Triche, Elizabeth & Ehrenkranz, Richard & Paidas, Michael & Stevens, Warren. (2015). The Rising Burden of Preeclampsia in the United States Impacts Both Maternal and Child Health. American journal of perinatology. 33. 10.1055/s-0035-1564881.
- Roberts, J. M., Rich-Edwards, J. W., McElrath, T. F., Garmire, L., & Myatt, L. (2021). Subtypes of Preeclampsia: Recognition and Determining Clinical Usefulness. Hypertension, 77(5), 1430–1441. https://doi.org/10.1161/hypertensionaha.120.14781
- Sharma, N. (2019). Introductory chapter: The multiple etiologies of Preeclampsia. Prediction of Maternal and Fetal Syndrome of Preeclampsia. https://doi.org/10.5772/intechopen.86177
- 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. International Journal of Women’s Health, Volume 10, 371–377. https://doi.org/10.2147/ijwh.s168569
- Bartsch, E., Medcalf, K. E., Park, A. L., & Ray, J. G. (2016). Clinical risk factors for preeclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ, 353, i1753. https://doi.org/10.1136/bmj.i1753
- Nilsson, E., Salonen Ros, H., Cnattingius, S., & Lichtenstein, P. (2004). The importance of genetic and environmental effects for preeclampsia and gestational hypertension: a family study. BJOG: An International Journal of Obstetrics and Gynaecology, 111(3), 200–206. https://doi.org/10.1111/j.1471-0528.2004.00042x.x
- Tsujimoto, Y., Kataoka, Y., Banno, M., Taito, S., Kokubo, M., Masuzawa, Y., & Yamamoto, Y. (2021). Association of low birthweight and premature birth with hypertensive disorders in pregnancy. Journal of Hypertension, Publish Ahead of Print. https://doi.org/10.1097/hjh.0000000000003020
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