Irrinki Vasundhara Jyothi 1 , Katadi Venkata Sudha Madhuri 2
BACKGROUND HELLP syndrome is an acronym for Haemolysis (H), Elevated Liver Enzymes (EL) and Low Platelet (LP). This is a rare complication of preeclampsia (10-15%). HELLP syndrome may develop even without hypertension. This syndrome is manifested by nausea, vomiting, epigastric or right upper quadrant pain along with haematological changes. Parenchymal necrosis of liver causes elevation in hepatic enzymes (AST and ALT >70 IU/L, LDH >600 IU/L) and bilirubin (>1.2 mg/dL). There may be subcapsular haematoma formation (which is diagnosed by CT scanning) and abnormal peripheral blood smear. Eventually, liver may rupture to cause sudden hypotension due to haemoperitoneum. Periportal haemorrhagic necrosis of the liver occurs due to thrombosis of the arterioles. The necrosis is seen at the periphery of the lobule. There may be subcapsular haemorrhage. Hepatic insufficiency seldom occurs because of the capacity and regenerative ability of liver cells. Liver function tests are especially abnormal in women with HELLP syndrome. A sincere effort has been put to study the HELLP syndrome incidence and its clinical prognosis and to understand its outcome. MATERIALS AND METHODS Forty patients were selected whose BP was recorded more than 140/80 mmHg after twenty weeks of gestation. Peripheral smear were taken to check for haemolysis or elevated indirect bilirubin or elevated LDH levels were checked, elevated liver enzymes and decreased platelet count <1,00,000/cumm was noted. Incidence of HELLP syndrome was found and various clinical features presented and the complications faced by the patients were recorded. Prompt treatment was given and the outcome of the disease was noted. All the statistical analysis was done using the latest SPSS software 2015 (California). RESULTS The mean age of the study group was found to be 26.72 years with a standard deviation of 5.62 years. In our study, the mean haemoglobin level was found to be 6.41 gm%, which is very low compared to the values got by the study conducted by Ashwini Mallesara et al. 1 This may be due to the fact that the other study managed to get 320 patients, whereas in our study only 40 patients were considered. The mean platelet count and reticulocyte count in our study was found to be 1.48 lakhs/cc3 and 89600/cc3 , respectively. Again, the values that we got were very less compared to that of the other study. This maybe purely due to the number difference or we in our study were able to study the more serious variety of the disease. Six patients were confirmed to have haemolysis in our study. The other biochemical values that we got in our study is as follows; mean bilirubin was found to be 3.42 mg/dL, mean AST was found to be 152.59 micrograms per litre, mean ALT was found to be 149.94 micrograms per litre and mean LDH levels were found to be 1022 micrograms per litre. The foetal complications that we recorded were intrauterine growth retardation, intrauterine death, preterm delivery, acute respiratory distress syndrome. The other study did not find any of the acute respiratory distress syndrome even though they have reported preterm delivery pointing towards the fact that the steroids have been given to the mother well in advance so as to make the lungs of the foetus matured. The maternal complications reported by us are DIC, hepatic failure, abruptio placenta, sepsis and stroke. CONCLUSION This study shows how dangerous this disease is to both the mother and the child. Even though, the pregnancy is thought to be a physiological process, it has its own complications
