|April 2005 · Vol. 17, No. 4
Best Practices for Diagnosis and Management of Preeclampsia
A practical plan to detect and manage HELLP syndrome
How to minimize the risk of serious morbidity, including tips on distinguishing HELLP from other conditions, stabilizing the patient, and managing labor, delivery, and the postpartum period.
HELLP syndrome is more likely when hypertension or preeclampsia is diagnosed before 34 weeks
HELLP syndrome sometimes appears for the first time postpartum in women who had no evidence of preeclampsia before or during labor
In women with true HELLP, delivery can only be delayed for up to 48 hours for corticosteroid administration—and then only if both mother and fetus are stable
Avoid pudendal block because of the risk for bleeding and hematoma formation in this area
Profound hypovolemic shock in a previously hypertensive patient may be a sign of rupture of a liver hematoma
A sudden drop in blood pressure to hypotensive levels can signify severe hemolysis, unrecognized intraperitoneal blood loss, or sepsis
All women with preeclampsia require close monitoring of vital signs, fluid intake and output, lab values, and pulse oximetry for at least 48 hours after delivery
Professor and Chairman Department of Obstetrics and Gynecology University of Cincinnati College of Medicine
Here’s a disturbing fact: If it looks like HELLP syndrome, and impairs the patient like HELLP syndrome, it isn’t necessarily HELLP syndrome. A plethora of diagnostic criteria from different investigators over the years has confused the issue of what constitutes this syndrome—not to mention how to manage it.
A management issue has also attracted recent attention: use of corticosteroids either antepartum to enhance maternal status so that epidural anesthesia can be administered, or postpartum to improve platelets. Such improvements are only transient, however, and we lack definitive data on the benefits.