Diagnosis and management of hemolysis, elevated liver enzymes, and low platelets syndrome

Pregnancies complicated by HELLP syndrome require a well-formulated management plan. The development of this syndrome after 34 weeks' gestation or with documentation of maternal or fetal compromise is an indication for delivery. Vaginal delivery can be accomplished in most cases; however, if cesarean section is required, subfascial drains and preoperative platelet transfusion for platelet counts of less than 40,000/mm(3) can reduce the incidence of complications. AFLP, TTP, or HUS may present with signs, symptoms, and laboratory abnormalities that may be confused with HELLP syndrome. Thorough investigation is warranted because of the differences in proper management among these various complications of pregnancy. It is advisable that patients with complications of HELLP syndrome, such as pulmonary edema, acute renal failure, liver rupture, or extreme prematurity, be referred to a tertiary care center where maternal and neonatal facilities are available. Expectant management in patients with HELLP syndrome remote from term and the use of corticosteroids to improve postpartum maternal outcome remain experimental.