Anda di halaman 1dari 5

DAVAO DOCTORS COLLEGE

Gen. Malvar St., Davao City

Summer 2010

A Related Reading on the

Disturbances of

OB cases

_______________________________

In Partial Fulfillment of the Requirements

In Nursing Care Management

103

________________________________

By: Jomer D. Dalona BSN 3- 13A

Submitted to: Annalee

M. Abuda,

RN

May 2010
Jomer D. Dalona May 26,
2010

BSN 3- 13A Related


Reading

HELLP Syndrome and Pregnancy: Understanding hellp


syndrome
By Gina Roberts-Grey

At almost 28 weeks pregnant, 30-year-old Michelle Berndt of Nashua, N.H.,


was having a complication-free pregnancy. Feeling great, eating right and ensuring
time for physical activity, Berndt and her husband were anxiously awaiting the birth
of their first child. With less than one week until her next routine prenatal
examination, Berndt tried to ignore the signs that something might not be quite
right. "I assumed my sudden weight gain was just part of being pregnant and that
my chest pain was a bad case of indigestion," she says.

After almost a day of progressively increasing chest pain and difficulty


breathing, Berndt relented and agreed to go to the emergency room. "I felt silly,"
she says. "I thought I should be able to tolerate some heartburn or indigestion."

With no history of high blood pressure or preeclampsia, being diagnosed with


Hemolysis, Elevated Liver, Low Platelet, or HELLP, syndrome, Berndt and her
husband found themselves in a situation they were completely unaware of and
unprepared for. Devastated and terrified for the health and safety of both Michelle
and their unborn child, the Berndts were reeling from the tests and medication
being administered.

They contemplated trying to speed up her delivery with Pitocin. Berndt's


condition continued to deteriorate and she and her husband were told she needed
to have an emergency C-section. "I couldn't believe that Michelle had developed
such a serious complication that we knew nothing about," says Bill Berndt.

HELLP syndrome is a placental disease that is considered to be a variant of


the complication preeclampsia. HELLP occurs when vasospasms occur in the body
and blood vessels act like a muscle relaxing and contracting. Blood passes through
the relaxing and contracting veins, causing damage to a special lining in the veins.
As damage occurs, red blood cells and platelets try to heal the damage and create
clots over the damage. The clots grow and begin to stress the body as it works to
push the blood past this damage. HELLP affects mainly the liver because it is
deprived of oxygen due to the clots.

Although women of diverse backgrounds and ethnicities have been affected


by HELLP syndrome, HELLP occurs earlier and is more prevalent in Caucasian
mothers-to-be.
Although women who have a history of preeclampsia are thought to be at a
slightly higher risk for developing HELLP, medical experts agree women do not need
to have a history of preeclampsia, and otherwise completely healthy individuals can
develop HELLP.

Dr. John T. Repke, professor and chairman of the Department of Obstetrics


and Gynecology at Penn State College of Medicine, Milton S. Hershey Medical
Center, explains that HELLP indicators may be tough to spot. "Symptoms can be
very subtle," says Dr. Repke, echoing what Berndt and many other women who've
had HELLP have experienced. "Someone might not feel quite right or HELLP may
present as the flu."

A combination of symptoms such as mild to moderate elevation of blood


pressure, right upper quadrant pain, excessive weight gain and fluid retention or
bruising easily are reasons to consult your physician. "An otherwise normally
healthy individual might not have any history of HELLP or preeclampsia and not
realize they are experiencing some of its symptoms," says Dr. Repke.

Encouraging expectant women to temper alertness for HELLP with an


empowering attitude to discuss any concerns with their health care providers, Dr.
Repke urges mothers-to-be to pay attention to their bodies and how they are
feeling. "Discussing any concerns with a doctor can ease your mind as well as
diagnose a complication," he says.

Dr. Repke also notes you should inform your doctor if you have a first-degree
relative such as your mother or sister who had preeclampsia. "This can slightly
increase a woman's chances of developing preeclampsia or HELLP," he says.

"The primary therapy of HELLP is support of the mother," says Dr. Repke.
Because HELLP is considered to be a placental disease, once delivery occurs, there
is generally an improvement. "With effective supportive care, all manifestations of
HELLP resolve themselves after delivery," adds Dr. Repke.

Because the earlier a child is born, the greater the chance for life-threatening
complications to the baby, a doctor might try to delay delivery as long as possible,
provided this does not further jeopardize the mother's safety. There has been some
controversy about different tactics designed to keep HELLP at bay. "Some high
doses of steroids have been experimented with and the jury is still out as to
whether these offer effective medical management of HELLP," says Dr. Repke.

Many former HELLP patients fear having more children is not an option. Dr.
Baha M. Sibai, professor of OB/GYN at the University of Cincinnati, explains HELLP
recurrence may be 10 to 50 percent. However, Dr. Sibai says the risk of having
HELLP again is 5 percent, and the risk of having preeclampsia in a subsequent
pregnancy is at least 20 percent.

"Each patient must evaluate their own level of risk for subsequent
pregnancies," says Dr. Repke. Discussing all of the facts, risks and personal
priorities with your team of health care professionals will be the only method to
determine whether or not to have a post HELLP child.

HELLP itself does not generally pose immediate health risks to a child. "The
need for an expeditious delivery at a premature age is what generates risks for a
baby," says Dr. Sibai. "The earlier the onset of HELLP, the greater risk to a baby."

"Very rarely, metabolic disorders can manifest in the mother that can be
inherited by the child that mimic HELLP," says Dr. Repke. "As far as we know, HELLP
poses no direct repercussions for children."

Talk to your doctor to determine if you might be at risk for HELLP or if you
should undergo some of the tests and screenings that can alert you to any problems
that may arise. Most health care experts agree a liver function test and platelet
level blood test should be periodically performed in a woman going through a
pregnancy who already had HELLP.

REFERENCE: Roberts-Grey, G., 2010. HELLP Syndrome and Pregnancy:


Understanding hellp syndrome.

Pregnancy Today. January 26, 2010.

SUMMARY:

A 30-year-old pregnant Michelle Berndt of Nashua, N.H. believed that she


was having a complication-free pregnancy until all of a sudden she experienced
weight gain and chest pain. When rushed to ER, she was diagnosed with Hemolysis,
Elevated Liver, Low Platelet, or HELLP, syndrome.

HELLP syndrome is a placental disease that is considered to be a variant of


the complication preeclampsia. HELLP occurs when vasospasms occur in the body
and blood vessels act like a muscle relaxing and contracting. Blood passes through
the relaxing and contracting veins, causing damage to a special lining in the veins.
As damage occurs, red blood cells and platelets try to heal the damage and create
clots over the damage. The clots grow and begin to stress the body as it works to
push the blood past this damage. HELLP affects mainly the liver because it is
deprived of oxygen due to the clots.

Medical experts agree women do not need to have a history of preeclampsia,


and otherwise completely healthy individuals can develop HELLP. A combination of
symptoms such as mild to moderate elevation of blood pressure, right upper
quadrant pain, excessive weight gain and fluid retention or bruising easily are
reasons to consult your physician. With regards to treatment, the earlier a child is
born, the greater the chance for life-threatening complications to the baby. all
manifestations of HELLP resolve themselves after delivery.

The Risk Factors for HELLP Syndrome are the following:

 Carrying more than one baby.


 Being a teenager or over 40 years old and having your first child.
 High blood pressure, kidney disease or diabetes.
 Malnutrition or obesity.
 Carrying a baby with non-immune hydrops.
 Having a diagnosed autoimmune disorder or a diagnosed clotting
disorder.

In order to prevent HELLP Syndrome, a pregnant woman should undergo


some of the tests and screenings that can alert her to any problems that may arise.

REFERENCE: Roberts-Grey, G., 2010. HELLP Syndrome and Pregnancy:


Understanding hellp syndrome.

Pregnancy Today. January 26, 2010