In the life of every person, a moment inevitably comes, which forces one to turn to outside help. Often assistants in such situations are health workers. This happens if the human body has occupied an insidious disease, and it is not possible to cope with it independently. Everyone knows that a happy state of pregnancy is not a disease, but it is the expectant mothers who especially need medical and psychological help.
"Help!", Or Where did the name of the disease
The call for help in different languages sounds different. For example, in English, desperate Russian "Help!" pronounced as "help". It is no coincidence that HELLP syndrome is practically in tune with the international plea for help that has already become international.
The symptoms and consequences of this complication during pregnancy are such that urgent medical intervention is urgently needed. The abbreviation HELLP stands for a whole range of health problems: in the work of the liver, with blood clotting and an increased risk of bleeding. In addition to the above, HELLP syndrome causes malfunctioning of the kidneys and blood pressure disorders, thereby significantly aggravating the course of pregnancy.
The picture of the disease is so severe that the body denies the fact of childbearing, and an autoimmune failure occurs. Such a situation arises with the total overload of the female body, when the protective mechanisms refuse to work, the most severe depression develops, the will to life accomplishments and further struggle disappears. Blood does not clot, wounds do not heal, bleeding does not stop, and the liver is unable to perform its functions. But this critical condition lends itself to medical correction.
Disease history
HELP syndrome was described at the end of the 19th century. But only in 1978 did Goodlin associate this autoimmune pathology with preeclampsia during pregnancy. And in 1985, thanks to Weinstein, disparate symptoms were combined under one name: HELLP syndrome. It is noteworthy that in domestic medical sources this serious problem is practically not described. Only a few Russian anesthetists and resuscitation specialists examined this formidable complication of gestosis in more detail.
Meanwhile, the HELP syndrome during pregnancy is rapidly gaining momentum and takes many lives.
We describe each complication separately.
Hemolysis
HELP syndrome primarily includes intravascular hemolysis. This formidable disease is characterized by total cellular destruction. The destruction and aging of red blood cells causes fever, yellowness of the skin, and the appearance of blood in urine studies. The most life-threatening consequences are the risk of heavy bleeding.
The danger of thrombocytopenia
The next component of the abbreviation for this syndrome is thrombocytopenia. This condition is characterized by a decrease in platelets in the blood formula, which over time causes spontaneous bleeding. You can stop this process only in a hospital, and during pregnancy this condition is especially dangerous. The cause may be gross immune disorders that entailed an anomaly in which the body fights with itself, destroying healthy blood cells. A threat to life is a violation of blood coagulation that has arisen against a background of a change in the number of platelets.
Terrible harbinger: increased liver enzymes
A complex of pathologies included in the HELP syndrome is crowned by such an unpleasant symptom as an increase in liver enzymes. For expectant mothers, this means that in one of the most important organs of the human body, serious failures occur. After all, the liver not only cleanses the body of toxins and helps the digestive function, but also affects the psycho-emotional sphere. Often such an undesirable change is detected during a routine blood test, which is prescribed to a pregnant woman. With gestosis complicated by HELP syndrome, the indicators differ significantly from the norm, revealing a threatening picture. Therefore, medical consultation is the first mandatory procedure.
Features of the third trimester
3rd trimester of pregnancy is very important for further gestation and delivery. Common complications are swelling, heartburn, and digestive dysfunction.
This is due to impaired kidney and liver function. An enlarged uterus exerts serious pressure on the digestive organs, because of which they begin to fail. But with gestosis, conditions called preeclampsia and eclampsia can occur , which exacerbate the pain in the epigastric region, provoke the appearance of nausea, vomiting, edema, and high blood pressure. Against the background of neurological complications, convulsive seizures may occur. Dangerous symptoms increase, sometimes almost instantly, causing great harm to the body, threatening the life of the expectant mother and fetus. Due to the severe course of gestosis, which often carries with it the 3rd trimester of pregnancy, a syndrome often occurs with the talking name HELP.
Vivid symptomatology
HELLP-syndrome: the clinical picture, diagnosis, obstetric tactics - the topic of today's conversation. First of all, it is necessary to identify a number of main symptoms that accompany this formidable complication.
- From the side of the central nervous system. The nervous system responds to these disorders with convulsions, intense headaches, visual disturbances.
- The cardiovascular system is disturbed due to tissue edema and low blood circulation.
- Respiratory processes are generally not impaired, but pulmonary edema may occur after childbirth.
- On the part of hemostasis, thrombocytopenia and a violation of the functional component of platelet function are noted.
- Decreased liver function, sometimes the death of its cells. Spontaneous rupture of the liver is rarely observed , which entails a fatal outcome.
- Genitourinary disorders: oliguria, renal dysfunction.
HELP syndrome is characterized by a variety of symptoms:
- unpleasant sensations in the liver;
- vomiting
- sharp headaches;
- convulsive seizures;
- fever;
- impaired consciousness;
- urinary insufficiency;
- swelling of the tissues;
- pressure surges;
- multiple hemorrhages in the places of manipulation;
- jaundice.
Laboratory disease is manifested by thrombocytopenia, hematuria, detection of protein in the urine and blood, decreased hemoglobin, and an increase in bilirubin in the blood test. Therefore, to clarify the final diagnosis, it is necessary to carry out the whole complex of laboratory tests.
How to recognize complications in time?
In order to identify and prevent formidable complications in time, a medical consultation is carried out, at which future mothers are recommended to come regularly. The pregnant woman is registered, after which changes that occur in the woman’s body during the entire period are closely monitored. Thus, the gynecologist will promptly detect unwanted deviations and take appropriate measures.
Pathological changes can be detected using laboratory tests. For example, a urinalysis will help detect protein, if any. An increase in protein indicators and the number of leukocytes indicates pronounced violations in the work of the kidneys. Among other things, there may be a sharp decrease in the amount of urine and a significant increase in edema.
Problems in the work of the liver are manifested not only by pain in the right hypochondrium, vomiting, but also by a change in the composition of the blood (an increase in the number of liver enzymes), and palpation clearly shows an increase in the liver.
Thrombocytopenia is also detected in a laboratory study of the blood of a pregnant woman for whom the threat of HELP syndrome is real.
If you suspect the occurrence of eclampsia and the HELP syndrome, blood pressure control is mandatory, since due to vasospasm and blood clotting, its indicators can seriously increase.
Differential diagnosis
Today's diagnosis of HELP syndrome in obstetrics has gained popularity, so it is often mistakenly put. Often, completely different diseases are hidden behind it, no less dangerous, but more prosaic and common:
- gastritis;
- viral hepatitis;
- systemic lupus erythematosus;
- urolithiasis disease;
- obstetric sepsis;
- liver diseases (fatty degeneration, cirrhosis);
- thrombocytopenic purpura of unknown etiology;
- renal failure.
Therefore, diff. Diagnostics should take into account a variety of options. Accordingly, the triad indicated above - liver hyperenzymemia, hemolysis and thrombocytopenia - do not always indicate the presence of this complication.
Causes of HELP syndrome
Unfortunately, risk factors are not well understood, but there are suggestions that the following reasons can provoke HELP syndrome:
- psychosomatic pathologies;
- drug hepatitis;
- genetic enzymatic changes in the liver;
- multiple pregnancy.
In general, a dangerous syndrome occurs with insufficient attention to the complicated course of gestosis - eclampsia. It is important to know that the disease behaves very unpredictably: it either develops with lightning speed, then disappears on its own.
Therapeutic measures
When all the analyzes and differential. diagnosis, you can draw certain conclusions. When a diagnosis of "HELP syndrome" is established, the treatment is aimed at stabilizing the state of the pregnant woman and the unborn child, as well as early delivery, regardless of the term. Medical events are carried out with the help of an obstetrician-gynecologist, resuscitation team, anesthetist. If necessary, other specialists are connected: a neurologist or an ophthalmologist. First of all, multiple organ failure is eliminated , and preventive measures are provided to avoid possible complications.
Among the common phenomena that complicate the course of drug intervention, we can distinguish:
- placental exfoliation;
- hemorrhage;
- cerebral edema;
- pulmonary edema;
- acute renal failure;
- fatal changes and rupture of the liver;
- indomitable bleeding.
With a correct diagnosis and timely professional assistance, the likelihood of a complicated course tends to a minimum.
Obstetric strategy
The tactics practiced in obstetrics in relation to severe forms of gestosis, especially complicated by HELP syndrome, are unequivocal: the use of cesarean section. With a mature uterus, ready for natural childbirth, prostaglandins and mandatory epidural anesthesia are used.
In severe cases, when performing a caesarean section, exclusively endotracheal analgesia is used.
Life after childbirth
Experts noted that the disease occurs not only during the third trimester, but also can progress within two days after getting rid of the burden.
Therefore, the HELP syndrome after childbirth is a completely possible phenomenon, which speaks in favor of close monitoring of the mother and child in the postpartum period. This is especially true of women in labor with severely occurring preeclampsia during pregnancy.
Who is to blame and what to do?
HELP syndrome is a violation of the work of almost all organs and systems of the female body. During the disease, an intensive outflow of vitality occurs, and a high probability of death, as well as intrauterine pathologies of the fetus. Therefore, starting from the 20th week, the expectant mother needs to keep a diary of self-control, where to record all the changes that occur in the body. Particular attention should be paid to the following points:
- blood pressure: its jumps upward more than three times should alert;
- metamorphoses of weight: if it began to increase sharply, edema may have become the cause;
- fetal movement: too intense or, conversely, frozen movements - a definite reason to see a doctor;
- the presence of edema: significant swelling of the tissues indicates renal dysfunction;
- unusual abdominal pain: especially significant in the liver;
- regular tests: everything that is prescribed must be done in good faith and on time, as this is necessary for the benefit of the mother herself and the unborn child.
All alarming symptoms should be immediately reported to your doctor, since only a gynecologist is able to adequately assess the situation and make the only right decision.