HELLP syndrome: Incidence and Clinical management in the Tropics

The continuum of pre-eclampsia/eclampsia accounts for about one third of maternal deaths in developing countries1. There is multi-systemic involvement in preeclampsia/eclampsia and haemolysis, abnormal liver function tests and thrombocytopaenia have been recognized as complications of pregnancy for many years. The acronym HELLP syndrome was coined by Weinstein (1982) 2 when he described 29 cases of severe pre-eclampsia/eclampsia complicated by haemolysis, elevated liver enzymes and low platelets. He proposed that HELLP syndrome was a severe consequence of hypertension in pregnancy and that women were being misdiagnosed. HELLP syndrome is a life-threatening complication of pre-eclampsia. Both conditions may occur during the latter stages of pregnancy, during parturition or in the puerperium. Differential diagnoses that have to be considered are haemolytic uraemic syndrome, thrombotic thrombocytopaenic purpura, hepatic encephalopathy, viral hepatitis and disseminated intravascular coagulopathy from other aetiologies3. In the Tropics, the co-existence of severe malaria with HELLP syndrome may further darken maternal prospects for survival 4,5. IFEMED Journal Vol. 14 (1) 2008: pp. 25-2