Hypertensive complications in pregnancy: HELLP Syndrome and its clinical correlation with Pre-Eclampsia

Abstract

HELLP syndrome is a severe condition affecting pregnant women, characterized by hemolysis, elevated liver enzymes, and thrombocytopenia. This study aims to explore the epidemiology, pathophysiology, clinical manifestations, diagnosis, treatment options, and prevention of this syndrome in relation to gestational hypertension and preeclampsia. A search for articles was conducted in the PubMed, SciELO, and CAPES journal databases, using descriptors “Pre-Eclampsia,” “HELLP Syndrome,” and “Hypertension Syndrome,” within the time frame of 2004 to 2024. The syndrome is commonly associated with preeclampsia or eclampsia, but its etiology is uncertain, though it is believed to involve systemic inflammation and an exacerbated immune response. The prevalence ranges from 0.5% to 0.9%, with most cases occurring in the third trimester. Mortality can reach up to 24%, with a perinatal mortality rate of 40%. Common symptoms include headache, nausea, epigastric pain, and visual disturbances, and complications include Disseminated Intravascular Coagulation, Acute Renal Failure, premature placental abruption, and adverse maternal-fetal outcomes, with maternal death occurring in 24% of cases and perinatal mortality ranging from 8% to 37%. Diagnosis is made through clinical presentation and laboratory tests, with findings such as elevated Lactate Dehydrogenase levels, reduced hemoglobin, and schistocytes (indicative of hemolysis), thrombocytopenia, and elevated liver enzymes, in addition to imaging studies like ultrasound and magnetic resonance imaging to assess the liver. Treatment is predominantly supportive, focusing on stabilizing the patient's condition and fetal monitoring, and may involve medication for hypertension, blood transfusions, and consultations with specialists. If diagnosed after 34 weeks of gestation, delivery is recommended, with corticosteroids administered for fetal lung maturation. Preventive measures include low-dose aspirin, calcium supplementation for cases of inadequate dietary intake, a low-fat and high-fruit-and-vegetable diet, vitamin C and E supplementation, regular physical exercise, and regular prenatal and blood pressure monitoring. Thus, HELLP syndrome encompasses a clinical picture that can be mistaken for a healthy pregnancy but is prone to rapid progression to severe and fatal complications for both mother and fetus, necessitating regular prenatal monitoring to detect signs and symptoms and timely intervention.