Complications
Occurs in as many as 21% of patients.
Thrombocytopenia (<100 × 10³/L [<100,000/microlitre]), elevations of prothrombin time (≥14s), increased fibrinogen split products (≥40 mg/L [40 micrograms/mL]), and decreased fibrinogen (<8.82 micromol/L [<300 mg/dL]) are diagnostic.
Should be suspected in any patient with abnormal bleeding and/or abnormal coagulation studies. Management is supportive, with transfusion of blood, fresh frozen plasma, cryoprecipitate, and platelets as indicated to correct the coagulation abnormalities.
Frequently associated with placental abruption.
Occurs in 16% of patients. Should be suspected in cases of vaginal bleeding, abdominal pain, and non-reassuring fetal status. It may precede or follow the development of disseminated intravascular coagulation. Full blood count and coagulation studies should be checked in any patient with a suspected abruption.
Occurs in 2% to 8% of patients, although it has been reported in the past to occur in up to 20% of patients in some series.[105]
Oliguria (<1.5 mL/kg/hour) followed by elevation in serum creatinine makes the diagnosis. In severe cases, there may also be electrolyte derangements and metabolic acidosis. Even in cases of progression to acute tubular necrosis, with delivery and adequate supportive care, the condition is reversible in 80% of cases. However, the recovery rate is only 20% in women with pre-existent renal pathology.
Maternal renal failure usually further deteriorates postpartum, before improving, and clinical alertness should be maintained.[106]
Doubling of serum creatinine within 48 hours is suggestive of progression to bilateral renal cortical necrosis and the need for dialysis. Patients with acute renal failure should be carefully monitored during magnesium sulfate administration to avoid magnesium toxicity.
Long-term sequelae are possible; however, 2 small studies encompassing a total of 33 affected women did not find any difference in renal function at 5 years' follow-up.[107][108]
Infection, severe systolic hypertension, and anaemia are independent risk factors for AKI; elevated serum creatinine is an independent predictor of maternal mortality. Most patients with AKI completely recover renal function, but up to 20% have residual injury. Renal biopsy should be performed in patients with prolonged AKI to determine the renal prognosis and to guide appropriate treatment.[109][110]
Occurs in 6% of patients.
Should be suspected when the patient complains of shortness of breath, chest pain, or difficulty breathing. Signs may include decreased oxygen saturation, tachypnoea, and basal crackles on lung auscultation. Oxygen should be given to maintain oxygen saturation above 94%. Diuresis is usually necessary; however, these patients are intravascularly depleted and unguided aggressive diuresis has the risk of significant hypovolaemia. Women with severe pre-eclampsia and multi-system organ failure (liver dysfunction, serum creatinine >1.36 mg/dL, refractory hypertension, pulmonary oedema) should have their fluid replacement therapy guided by a pulmonary artery catheter in an intensive care unit.[111] Acute respiratory distress syndrome may also aggravate the course of HELLP syndrome.
Occurs in approximately 1% of patients.
Usually involves the right hepatic lobe. Symptoms include severe right upper quadrant (RUQ) or epigastric pain, nausea, and vomiting. Low haematocrit, transaminases >500 IU/L, and signs of coagulopathy may be associated. A RUQ ultrasound, a computed tomography scan, or magnetic resonance imaging should be able to confirm the presence of a haematoma. Care is supportive in most cases, with administration of blood products for correction of anaemia and coagulopathy. If the patient's pain abruptly ceases and hypotension develops, capsular rupture should be suspected. This is a surgical emergency, requiring immediate exploratory laparotomy and/or interventional radiography.[112]
Indicator of reduced hepatic glycogenolysis and terminal hepatic failure. May lead to coma and can be fatal.
May develop in cases of HELLP syndrome that worsen significantly postpartum. Should be differentiated from intra-abdominal bleeding. Large-volume ascites portends a high potential for cardiopulmonary complications soon after delivery.[113]
Use of this content is subject to our disclaimer