ICU Management of HELLP Syndrome

Abstract

HELLP syndrome can be an extremely serious and complex multisystem disorder involving much more than just hypertension. Special considerations in obstetric and anesthetic management are necessary. Hopefully, continued investigation and new findings might lead to a better understanding of the etiology and pathophysiologic changes of the syndrome and allow improved capabilities in prevention, diagnosis and treatment, thus minimizing the morbidity and mortality currently associated with this syndrome and its complications. Women with HELLP syndrome are often critically ill. Their infants are frequently premature with compromised conditions. There is no ideal anesthetic for these patients; however, certain management criteria should be observed. These include early diagnosis, hospitalization in a tertiary care center, and a multidisciplinary approach with active involvement of the obstetric anesthesia care team. The obstetric anesthesia personnel must obtain a thorough pre-anesthetic evaluation and be knowledgeable about the pathophysiologic changes in the parturient with HELLP syndrome. The presence of HELLP syndrome is associated with life-threatening maternal and fetal complications. Despite the voluminous literature on this subject, there is an urgent need for a uniform definition and diagnostic criteria for this syndrome. Pregnancies complicated by this syndrome require a well-formulated management plan.