THE MANAGEMENT OF
PREECLAMPSIA COMPLICATED BY
HELLP SYNDROME
Didi DANUKUSUMO
Division of Maternal and Fetal Medicine
Department of Obstetrics and Gynecology
Fatmawati Hospital, Jakarta
INDONESIA
Tutor : Dr. Rita KABRA
Department of Reproductive Health and Research
World Health Organization, Geneva
Switzerland

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INTRODUCTION
Fatmawati Hospital in Jakarta, Indonesia
Tertiary referral hospital
MMR 502.2/ 100,000 in 2002
The two leading causes
PPH (66.7%)
Preeclampsia complicated by HELLP
syndrome (22.2%)

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HELLP syndrome is a special type of severe
preeclampsia that constitutes a management dilemma
for obstetricians.
Iatrogenic preterm delivery increases the risk of adverse
neonatal outcome.
The high maternal and perinatal morbidity that can result
from this entity mandates continuing efforts to find an
effective treatment.
Prolongation of pregnancy, in theory, is favorable for the
fetus whereas it remains controversial whether the
maternal condition is further jeopardized by expectant
management.

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OBJECTIVE :
To review the management of Preeclampsia
complicated by HELLP syndrome.

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Clinical Signs and Symptoms Of Preeclampsia
complicated by HELLP syndrome
Blood Pressure
> 160 mmHg systolic
> 110 mmHg diastolic
Pulmonary edema
Dyspnea
Chest discomfort
Tachypnea
Tachycardia
Pulmonary rate
CXR : diffuse haziness in the lung fields with perihiliar “butterfly” appearance
Oliguria
< 500 ml per 24h
Symptoms of end organ involvement
Headache or visual disturbance
Clonus or deep tendon hyperreflexia
Epigastric or Right upper quadrant pain
Fetal involvement
Fetal growth impairment
Oligohydramnios
Absence of fetal movements
Absent or reversed umbilical end-diastolic Doppler flow velocity waveforms
Modified from Bolte (2001) .

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Laboratory Diagnostic Criteria for HELLP
syndrome*
Hemolysis
Abnormal peripheral smear : schistocytes, burr cells and
polychromasia
Total bilirubin level > 12 mg/dL
Lactate dehydrogenase level > 600U/L
Lactate dehydrogenase level > 600U/L
Elevated liver function
Serum aspartate amino transferase level > 70U/L
Lactate dehydrogenase level >600 U/L
Low platelet count
Platelet count < 100 000/mm3
*) The Laboratory diagnostic criteria used at the University of Tennessee
Division of Maternal Fetal Medicine, Memphis TN. Witlin and Sibai (1999)

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MANAGEMENT OF PRE-ECLAMPSIA
COMPLICATED BY HELLP SYNDROME
Conservative management
Immediate termination
controversial
The only known cure
delivery
Expectant management has been reported with good
success
The goal for managing preeclampsia/HELLP syndrome is
protect the mother and fetus
prevent disease progression to eclampsia.

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Durig P, Ferrier C, Schneider H, 1999.
Universitäts-Frauenklinik, Inselspital Bern.
Conservative management in the case of
a HELLP-syndrome is not yet
recommended as it has not been validated
in prospective controlled studies

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Curtin WM., Weinstein L., 1999
Department of Obstetrics and Gynecology,
Medical College of Ohio, Toledo, USA.
Aggressive management of HELLP syndrome
with expeditious delivery appears to yield the
lowest perinatal mortality rates

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Gardeil F., Gaffney G., Morrison JJ., 2001.
Department of Obstetrics & Gynaecology,
University College Hospital Galway.
Conservative management is not an
option when HELLP syndrome occurs long
before fetal viability has been reached

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Document Outline

• THE MANAGEMENT OFPREECLAMPSIA COMPLICATED BY HELLP SYNDROME
• INTRODUCTION
• OBJECTIVE :
• Laboratory Diagnostic Criteria for HELLP syndrome*
• MANAGEMENT OF PRE-ECLAMPSIA COMPLICATED BY HELLP SYNDROME
• Curtin WM., Weinstein L., 1999Department of Obstetrics and Gynecology,Medical College of Ohio, Toledo, USA.
• Gardeil F., Gaffney G., Morrison JJ., 2001.Department of Obstetrics & Gynaecology, University College Hospital Galway.
• Haddad B., Barton JR., Livingston JC., Chahine R., Sibai BM. Am. J. Obstet. Gynecol. 2000 .
• van Pampus MG., Wolf H, Westenberg SM, van der Post JAM, Bonsel GJ., Treffers PE. Eur. J. Obstet & Gynecol and Rep Biol 199
• Sibai BM., Mercer BM., Schiff E., Friedman SA. Am.J.Obstet.Gynecol. 1994.
• High Care Unit for treatment HELLP syndrome, Fatmawati HospitalJakarta, Indonesia.
• The Conservative Treatment
• INDICATION FOR TERMINATION

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