Management options

The treatment of HELLP syndrome is supportive; delivery of the placenta is the definitive treatment.

Women should be delivered as soon as the maternal condition has been optimised, usually by Caesarean section. Recommendations vary regarding pre- or perioperative platelet transfusion, with some centres suggesting platelet transfusion if the platelet count is below 50 x 109/l and others not giving platelets until the count falls below 20 x 109/l.

The benefits of invasive pressure monitoring must be balanced against the potential hazards, and the antecubital fossa approach to the central veins is recommended if possible. Careful fluid balance is important, and bladder catheterisation is mandatory.

Regional anaesthesia is relatively contraindicated in the presence of thrombocy-topenia, but ultimately the anaesthetist must choose the anaesthetic technique which he or she judges to be the safest in the circumstance. The choice of regional anaesthesia in a woman with a platelet count of less than 80 x 109/l should be made only by an experienced consultant obstetric anaesthetist.

If general anaesthesia is used, attempts must be made to attenuate the hypertensive response to intubation, usually by use of an intravenous opioid as part of the induction sequence (see Chapter 81, hypertension, pre-eclampsia and eclampsia, p. 189). Tracheal intubation should be carried out as atraumatically as possible.

There is no specific treatment for HELLP syndrome other than symptomatic treatment of the associated complications, although there is some evidence to support steroid, therapy, e.g. two doses of dexamethasone 10 mg 12 hours apart followed by 5 mg at 24 and 36 hours. Plasma exchange has been reported to be useful anecdotally, although the evidence for it is weak. Women with HELLP syndrome should be managed in a high-dependency or intensive therapy environment. Postnatal management is entirely supportive.

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