HELLP syndrome
ICD-10 O14.2 · ICD-11 JA24.2

First-Line Treatment of HELLP Syndrome

HELLP syndrome is associated with significant maternal morbidity and mortality, requiring prompt, structured management. Patients remote from term require care at a tertiary care center with neonatal and obstetric intensive care expertise. The first-line protocol prioritizes delivery timing, seizure prophylaxis, and management of acute severe hypertension.

Treatment Approach

Management begins with maternal stabilization followed by delivery, regardless of gestational age. Seizure prevention is a central component of care. Acute severe hypertension requires expeditious antihypertensive therapy. Gestational age at delivery determines additional interventions in the full protocol.

Complete agent selection, dosing, sequencing, and route of administration are detailed in the full structured regimen below.

Clinical Goals

Within 7 days after delivery: platelet count above 100,000 ×10&sup9;/L with a rising trend, and a decreasing trend in liver enzyme values.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1097/AOG.0000000000003891

  1. Considering the serious nature of this entity, with increased rates of maternal morbidity and mortality, many authors have concluded that women with HELLP syndrome should be delivered regardless of their gestational age.
  2. Because the management of patients with HELLP syndrome requires the availability of neonatal and obstetric intensive care units and personnel with special expertise, patients with HELLP syndrome who are remote from term should receive care at a tertiary care center.
  3. Magnesium sulfate should be used for the prevention and treatment of seizures in women with gestational hypertension and preeclampsia with severe features or eclampsia.
  4. Antihypertensive treatment should be initiated expeditiously for acute-onset severe hypertension (systolic blood pressure of 160 mm Hg or more or diastolic blood pressure of 110 mm Hg or more, or both) that is confirmed as persistent (15 minutes or more).
  5. With supportive care alone, 90% of patients with HELLP syndrome will have platelet count more than 100,000 ×10&sup9;/L and reversed trend (decrease) in liver enzymes values within 7 days after delivery.
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