Ami's HELLP Related Links
Definitive therapy for patient with HELLP is delivery of the placenta. Pregnancy is allowed to continue as long as there is no evidence of compromise in the mom or baby is detected. There is debate as to when the fetus should be delivered when PIH/HELLP are present. It all depends on the gestational age the degree of PIH/HELLP that the mother has. Delivery after 34 weeks is usually recommended immediately if there is evidence of PROM, IUGR or maternal of fetal distress. Delivery before 34 weeks is more complicated to deal with. Patients with persistent severe PIH or other signs of maternal or fetal deterioration are delivered within 24 hours regardless of gestational age or fetal lung maturity.
Magnesium sulfate therapy is administered intravenously to reduce central nervous system irritability and prevent seizures. Magnesium reduces hyper reflexia, reduced acetylcholine transmission at the neuromuscular junction, mild vasodilatation, mild sedation, and decreased uterine contractility, all of which enhance uterine blood flow. Unfortunately magnesium can cross the placenta where it may produce respiratory depression, hypotonia, and apnea in the baby.
General measures include bed rest and strict control and frequent monitoring of arterial blood pressure, blood sugars, coagulation status and acid base balance, Hypoglycemia may be profound and should be anticipated. (HELLP). If the PIH/HELLP is mild then: bedrest at home or hospital, home BP monitoring daily urine dipstick of protein. Fetal counts twice a week doc checkups. If it is severe then: the mother should be hospitalized , magnesium drip administered along with hydrazine and corticosteriods. Non-stress tests and contraction stress tests should be continuously used.
Bed rest on the left side to relieve pressure from the uterus on the aorta. Frequent doc visits. Checking blood pressure, urine and weight at every visit. Charting fetal movement. Sonograms, ultra soundís, non-stress tests or contraction stress tests are highly recommended. Smoking is discouraged.
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