a serious pregnancy complication?

Hellp syndrome occurs during pregnancy Where in the days following childbirth. “It is a microangiopathy linked to damage to the micro-vessels. Hellp syndrome is in most cases associated with other pathologies of pregnancy, in particular preeclampsia and pregnancy hypertension,” explains Dr Pénager. This disease involves the maternal and fetal vital prognosis.

The mechanism of appearance of Hellp syndrome is not entirely known, but it is known that in women who develop this pathology during pregnancy, it is linked to a poor vascularization of the placenta. “The latter, by reflex, will then synthesize molecules which will act not only on the vessels of the placenta in order to boost their vascularization, but on all the vessels of the body”, explains the specialist. If the average term of appearance of a Hellp syndrome is around 33 weeks of amenorrhea, it can occur as early as 22 weeks, before the stage of fetal viability. “But we don’t see any sooner”, recalls Dr. Pénager. In some cases, it can conversely occur after childbirth, even after pregnancy without any problems.

The symptoms of Hellp syndrome: how to recognize it?

The definition of Hellp syndrome is biological “The diagnosis of Hellp syndrome is made thanks to a blood test which will show three characteristic signs: thrombocytopenia, hepatic cytolysis and hemolysis. There is a decrease in platelets and hemoglobin by hemolysis. Red blood cells are destroyed due to vessel damage. And there is also hepatic cytolysis, that is to say a destruction of liver cells leading to an increase in enzymes (ASAT / ALAT)”explains Dr. Pénager.

However, certain clinical signs may suggest Hellp syndrome, in particular in a context of hypertension or preeclampsia. The latter is a pregnancy disease characterized by the presence of an abnormal amount of protein in the urine and by high blood pressure. It also happens that Hellp syndrome is idiopathic, with no underlying cause. “We can think of a Hellp syndrome in the face of a patient who complains of violent epigastric pain in the bar, has nausea, vomiting., explains the gynecologist. These are the most common clinical signs.

What are the risks for mother and child?

When it sets in, Hellp syndrome can cause major bleeding disorders. It is for this reason that it is sometimes discovered because there is a hemorrhage of deliverance. The Hellp syndrome makes put the mother at serious risk. “There may be damage to the liver with the formation of a subcapsular hematoma. If it bursts, it can cause massive bleeding.”explains Dr Pénager.

On the biological level, disorders of the coagulation factors are observed. There is also a risk of multivisceral damage (cardiac, cerebral, renal, etc.). “Many molecules are released into the blood, certain mechanisms run amok which can lead to multiple thrombosis”, adds the specialist. There is also a risk of fetal death by retroplacental hematoma or related to prematurity. Even once the baby is born, he is fine. There is no risk that the child will develop a similar syndrome.

Treatment of Hellp syndrome

“There is no specific medicine for Hellp syndrome. Once it triggers; the only way to treat it is at birth and therefore fetal extraction and removal of the placenta.”, explains Dr Pénager. When it occurs before the threshold of viability, it is necessary to perform a medical termination of pregnancy (IMC) for maternal rescue.
The birth must be as fast as possible, either by caesarean section or possibly by trying to trigger a birth by natural means. But it depends on the term of the pregnancy and the stage of the Hellp syndrome.
“Then the patient is taken care of in intensive care to monitor her clinical and biological state, to set up treatments to stabilize the maternal state”details the gynecologist. “This intensive care and close monitoring aim to maintain the mother until the syndrome resolves after the birth of the baby. The parameters deteriorate then gradually return to normal. Hellp syndrome evolves and resolves on its own after a few days.”she adds.

In a majority of cases, there is no no sequelae for the mother, but however disorders may persist after severe organ damage (kidney failure, neurological disorders, etc.). After a first episode of Hellp syndrome, a whole assessment will be carried out in order to look for an underlying disease (especially autoimmune). These patients are more at risk of developing this syndrome again during a future pregnancy, the latter will therefore be monitored more closely.

Thanks to Cécile Pénager, gynecologist-obstetrician