HELLP Syndrome: Obstetric Emergency, Diagnosis, and Management | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Le syndrome HELLP est une complication s\u00e9v\u00e8re de la grossesse avec h\u00e9molyse, enzymes h\u00e9patiques \u00e9lev\u00e9es et thrombocytop\u00e9nie. 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With an incidence of 0.5 to 0.9 % of all pregnancies + 10 to 20 % of cases of severe pre-eclampsia, HELLP syndrome is a medical and obstetric emergency with significant maternal morbidity - major hemorrhagic risk (due to thrombocytopenia + DIC) + subcapsular hematoma and hepatic rupture + acute renal failure + pulmonary edema + hemorrhagic stroke + placental abruption + and maternal mortality of 1 to 3 % (in developed countries), rising to 10 to 25 % in countries with limited resources. The pathophysiology is common to pre-eclampsia: dysfunction and activation of placental vascular endothelium \u2192 systemic vasospasm + activation of coagulation \u2192 thrombotic microangiopathy \u2192 mechanical hemolysis of erythrocytes in microvessels (schizocytes) + hepatic sinusoidal thrombi \u2192 hepatocyte ischemia \u2192 elevated transaminases + consumption thrombocytopenia. The only definitive treatment is delivery - the decision to deliver urgently vs. defer delivery to allow fetal lung maturation (corticosteroids) is the central therapeutic dilemma, guided by the severity of the maternal picture and gestational age.\n <\/div>\n\n <h2>Crit\u00e8res diagnostiques \u2014 Classification de Tennessee (Sibai) et Mississippi<\/h2>\n <ul class=\"co-list\">\n <li><strong>H\u00e9molyse (H) :<\/strong> frottis sanguin avec schizocytes (fragments \u00e9rythrocytaires par cisaillement microvasculaire) + LDH \u2265 600 UI\/L + bilirubine totale \u2265 20 \u00b5mol\/L + haptoglobine effondr\u00e9e (< 0,25 g\/L) + Coombs direct n\u00e9gatif (h\u00e9molyse m\u00e9canique non immune)<\/li>\n <li><strong>\u00c9l\u00e9vation des enzymes h\u00e9patiques (EL) :<\/strong> AST \u2265 70 U\/L (2\u00d7 ULN) and\/or elevated ALT and\/or LDH \u2265 600 U\/L (reflects both hemolysis and liver cell damage)<\/li>\n <li><strong>Thrombocytop\u00e9nie (LP) :<\/strong> plaquettes < 100 000\/\u00b5L (classe 1 de Mississippi) + plaquettes 100 000\u2013150 000\/\u00b5L (classe 2) + plaquettes > 150 000\/\u00b5L (classe 3 \u2014 syndrome ELLP partiel sans thrombocytop\u00e9nie franche)<\/li>\n <li><strong>Mississippi Classification (Prognosis):<\/strong> classe 1 (plaquettes < 50 000\/\u00b5L \u2014 la plus s\u00e9v\u00e8re) + classe 2 (50 000\u2013100 000\/\u00b5L) + classe 3 (100 000\u2013150 000\/\u00b5L)<\/li>\n <li><strong>Partial HELP<\/strong> presence of only 1 or 2 components (EL + LP without frank hemolysis = ELLP syndrome + or H only) \u2192 risk of evolution to complete HELLP \u2192 close monitoring<\/li>\n <\/ul>\n\n <h2>Clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Sympt\u00f4mes :<\/strong> epigastric pain or right upper quadrant pain (70\u201390% % \u2014 cardinal sign \u2014 compression of the hepatic capsule by edema + sinusoidal thrombi) + nausea + vomiting + malaise + headaches + visual disturbances + hypertension may be absent in 15\u201320 % of cases (normotensive HELLP) \u2192 do not rule out HELLP based on the absence of hypertension<\/li>\n <li><strong>Pain location:<\/strong> epigastrium + right hypochondrium (epigastric bar) \u2192 radiation to the right shoulder or back \u2192 Spiegel's sign (pain on palpation of the right hypochondrium) + alarm sign if intense right scapular pain \u2192 subcapsular liver hematoma (imminent rupture)<\/li>\n <li><strong>Pr\u00e9-\u00e9clampsie concomitante :<\/strong> present in 85 % of cases (hypertension + proteinuria) + but 15 % of HELLP are normotensive without proteinuria \u2192 never exclude HELLP based on the absence of classic pre-eclampsia<\/li>\n <li><strong>HELP post-partum<\/strong> 25-30% of cases occur within 48 hours of delivery (rarely up to 7 days postpartum) \u2192 epigastric pain + vomiting + malaise + liver function tests + platelet count systematically checked postpartum if suspected<\/li>\n <\/ul>\n\n <h2>Complications maternelles redout\u00e9es<\/h2>\n <ul class=\"co-list\">\n <li><strong>H\u00e9matome sous-capsulaire du foie + rupture h\u00e9patique (< 2 %) :<\/strong> the most severe complication + severe abdominal pain + right shoulder radiation + hemorrhagic shock + maternal mortality 50\u201386% % in case of rupture + diagnosis: hepatic ultrasound + abdominal CT scan + treatment: hepatic arterial embolization + or surgery (hepatic packing)<\/li>\n <li><strong>CIVD (coagulation intravasculaire diss\u00e9min\u00e9e \u2014 20 %) :<\/strong> Prolonged PT + low fibrinogen + elevated D-dimers + major postpartum hemorrhage + bleeding at puncture site + massive transfusion<\/li>\n <li><strong>Insuffisance r\u00e9nale aigu\u00eb (7\u201315 %) :<\/strong> Oliguria + elevated creatinine + acute tubular necrosis due to renal ischemia + dialysis if severe<\/li>\n <li><strong>\u0152d\u00e8me pulmonaire (6\u20138 %) :<\/strong> water overload + increased vascular permeability + hypoalbuminemia \u2192 SpO2 + chest X-ray + O2 + diuretics (with caution)<\/li>\n <li><strong>D\u00e9collement placentaire (15\u201320 %) :<\/strong> Abdominal pain + vaginal bleeding + fetal distress \u2192 urgent delivery<\/li>\n <li><strong>AVC h\u00e9morragique (< 1 %) :<\/strong> Severe thrombocytopenia + uncontrolled hypertension \u2192 severe headaches + neurological deficit \u2192 neurosurgical emergency<\/li>\n <\/ul>\n\n <h2>Support<\/h2>\n <ul class=\"co-list\">\n <li><strong>Principe fondamental \u2014 accouchement = seul traitement d\u00e9finitif :<\/strong> la gu\u00e9rison du HELLP n\u00e9cessite l'accouchement et l'\u00e9vacuation du placenta \u2192 toute d\u00e9cision de temporisation (pour maturation pulmonaire) doit \u00eatre pes\u00e9e contre le risque maternel \u2192 \u00e2ge gestationnel \u2265 34 SA \u2192 accouchement imm\u00e9diat recommand\u00e9 + \u00e2ge gestationnel 27\u201334 SA \u2192 cortico\u00efdes (b\u00e9tam\u00e9thasone 12 mg IM \u00d7 2 doses \/ 24 h) + si stabilisation clinique + accouchement dans 24\u201348 h + \u00e2ge gestationnel < 27 SA \u2192 discussion au cas par cas en centre de r\u00e9f\u00e9rence<\/li>\n <li><strong>Sulfate de magn\u00e9sium IV \u2014 pr\u00e9vention et traitement des convulsions (\u00e9clampsie) :<\/strong> dose de charge 4\u20136 g IV en 15\u201320 min + perfusion d'entretien 1\u20132 g\/h \u2192 pr\u00e9vention de l'\u00e9clampsie + neuroprotection f\u0153tale si < 32 SA + surveiller : r\u00e9flexes ost\u00e9o-tendineux (disparition si toxicit\u00e9) + fr\u00e9quence respiratoire (> 12\/min) + diur\u00e8se (> 25 mL\/h) + magn\u00e9s\u00e9mie (cible 2\u20133,5 mmol\/L) + antidote si surdosage : gluconate de calcium 1 g IV lentement<\/li>\n <li><strong>Contr\u00f4le de la pression art\u00e9rielle :<\/strong> objectif : PAS < 160 mmHg + PAD < 110 mmHg \u2192 lab\u00e9talol IV 20\u201380 mg bolus (ou perfusion) + ou hydralazine 5\u201310 mg IV + ou nif\u00e9dipine \u00e0 lib\u00e9ration rapide 10\u201320 mg per os + \u00e9viter les IEC et ARA II (contre-indiqu\u00e9s en grossesse)<\/li>\n <li><strong>Transfusions and blood products:<\/strong> concentr\u00e9s de plaquettes si plaquettes < 20 000\/\u00b5L (ou < 50 000\/\u00b5L avant c\u00e9sarienne) + plasma frais congel\u00e9 si CIVD + fibrinog\u00e8ne si fibrinog\u00e8ne < 1,5 g\/L<\/li>\n <li><strong>Cortico\u00efdes \u00e0 hautes doses (d\u00e9xam\u00e9thasone) :<\/strong> used to accelerate fetal lung maturation if premature (betamethasone or dexamethasone 12 mg IM x 2 \/ 24 h) + some studies suggest a benefit for maternal thrombocytopenia (dexamethasone 10 mg IV x 2\/12 h) but the data are contradictory \u2192 non-standard use for maternal indication alone<\/li>\n <li><strong>Mode d'accouchement :<\/strong> Vaginal delivery preferred if cervical conditions are favorable and there are no obstetric contraindications. Case-by-case decision with the obstetrics team. Cesarean section if fetal emergency, unfavorable cervix, or severe prematurity.<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>Le syndrome HELLP doit \u00eatre \u00e9voqu\u00e9 devant toute douleur \u00e9pigastrique ou de l'hypocondre droit survenant apr\u00e8s la 20e semaine de grossesse + ou dans le post-partum imm\u00e9diat \u2014 m\u00eame en l'absence d'hypertension art\u00e9rielle ou de prot\u00e9inurie. Le bilan minimal (NFS + plaquettes + ASAT + ALAT + LDH + bilirubine + frottis sanguin + cr\u00e9atinine + TP) doit \u00eatre r\u00e9alis\u00e9 en urgence. Un retard diagnostique expose \u00e0 des complications catastrophiques (rupture h\u00e9patique + CIVD).<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgence obst\u00e9tricale \u2014 composer le 911<\/div>\n <p>Composer le 911 ou se rendre imm\u00e9diatement aux urgences obst\u00e9tricales si une femme enceinte (ou ayant accouch\u00e9 dans les 7 jours) pr\u00e9sente une douleur \u00e9pigastrique ou sous-costale droite intense + des naus\u00e9es + vomissements + des c\u00e9phal\u00e9es s\u00e9v\u00e8res + des troubles visuels + ou une chute des plaquettes (ecchymoses + p\u00e9t\u00e9chies) \u2014 ces signes \u00e9voquent un syndrome HELLP, urgence obst\u00e9tricale n\u00e9cessitant un accouchement en urgence dans la majorit\u00e9 des cas. Toute suspicion de douleur de l'\u00e9paule droite + \u00e9tat de choc chez une femme enceinte doit \u00e9voquer une rupture h\u00e9patique sur HELLP \u2014 urgence chirurgicale absolue. Clinique Omicron oriente vers les urgences obst\u00e9tricales appropri\u00e9es. Pour prendre rendez-vous en consultation pr\u00e9natale, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron assurent le suivi pr\u00e9natal incluant la surveillance de la pression art\u00e9rielle + de la prot\u00e9inurie + des \u0153d\u00e8mes \u00e0 chaque consultation, prescrivent un bilan urgent (NFS + plaquettes + LDH + transaminases + bilirubine + cr\u00e9atinine) en cas de suspicion de HELLP, orientent imm\u00e9diatement vers les urgences obst\u00e9tricales de niveau tertiaire d\u00e8s la suspicion du diagnostic, assurent le suivi post-partum pr\u00e9coce (7\u201310 jours) pour d\u00e9pister un HELLP post-natal, et \u00e9duquent les femmes \u00e0 risque (ant\u00e9c\u00e9dent de pr\u00e9-\u00e9clampsie ou HELLP) sur les signes d'alerte lors des grossesses ult\u00e9rieures. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin, d'un obst\u00e9tricien ou d'un m\u00e9decin de m\u00e9decine maternelle-f\u0153tale. Le syndrome HELLP est une urgence obst\u00e9tricale n\u00e9cessitant une prise en charge hospitali\u00e8re imm\u00e9diate dans un centre de niveau tertiaire avec soins intensifs n\u00e9onataux. Le seul traitement curatif est l'accouchement.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Syndrome HELLP : urgence obst\u00e9tricale, diagnostic et prise en charge | Clinique Omicron Obst\u00e9trique & M\u00e9decine maternelle-f\u0153tale & Soins intensifs Syndrome HELLP Le syndrome HELLP \u2014 acronyme anglais pour Hemolysis (h\u00e9molyse) + Elevated Liver enzymes (enzymes h\u00e9patiques \u00e9lev\u00e9es) + Low Platelets (thrombocytop\u00e9nie) \u2014 est une complication obst\u00e9tricale s\u00e9v\u00e8re survenant g\u00e9n\u00e9ralement entre la 27e et la… <a href=\"https:\/\/cliniqueomicron.ca\/en\/syndrome-hellp\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">HELLP Syndrome: Obstetric Emergency, Diagnosis, and Management | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Syndrome HELLP | Brossard | Clinique Omicron","_metasync_otto_description":"Syndrome HELLP Syndrome HELLP est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Syndrome Hellp | Clinique Omicron Qu\u00e9bec","_metasync_otto_og_description":"Syndrome HELLP Syndrome HELLP est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","_metasync_otto_twitter_title":"Syndrome Hellp | Clinique Omicron","_metasync_otto_twitter_description":"Syndrome HELLP Syndrome HELLP est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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\n\t\t\t\t\t\n\n\n\n\nHELLP Syndrome: Obstetric Emergency, Diagnosis, and Management | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Le syndrome HELLP est une complication s\u00e9v\u00e8re de la grossesse avec h\u00e9molyse, enzymes h\u00e9patiques \u00e9lev\u00e9es et thrombocytop\u00e9nie. Pr\u00e9-\u00e9clampsie s\u00e9v\u00e8re, accouchement urgent, magn\u00e9sium et soins intensifs au Qu\u00e9bec.\">\n<meta name=\"keywords\" content=\"syndrome HELLP, HELLP diagnostic, HELLP traitement, HELLP pr\u00e9-\u00e9clampsie, HELLP accouchement, syndrome HELLP grossesse, HELLP thrombocytop\u00e9nie, HELLP h\u00e9molyse, HELLP magn\u00e9sium, syndrome HELLP Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=dump');\n\n.co-wrap * {\n font-family: 'Poppins', sans-serif;\n box-sizing: border-box;\n}\n.co-wrap {\n max-width: 1100px;\n margin: 0 auto;\n padding: 30px 0 60px;\n margin-top: 10px;\n}\n.co-label {\n font-family: 'Cinzel', serif;\n font-size: 14px;\n font-weight: bold;\n letter-spacing: 1px;\n text-transform: uppercase;\n color: #4D6577;\n margin-bottom: 14px;\n display: block;\n}\n.co-wrap h1 {\n font-size: 32px;\n font-weight: 500;\n color: #323C52;\n margin: 0 0 22px;\n line-height: 1.2;\n letter-spacing: 0.5px;\n}\n.co-intro {\n font-size: 16px;\n font-weight: 400;\n line-height: 1.75;\n color: #4D6577;\n margin-bottom: 36px;\n padding-bottom: 32px;\n border-bottom: 1px solid rgba(77,101,119,.2);\n}\n.co-wrap h2 {\n font-size: 20px;\n font-weight: 600;\n color: #323C52;\n margin: 32px 0 12px;\n letter-spacing: 0.3px;\n}\n.co-wrap p {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.7;\n margin-bottom: 14px;\n}\n.co-list {\n list-style: none;\n padding: 0;\n margin: 12px 0 24px;\n}\n.co-list li {\n font-size: 15px;\n font-weight: 400;\n color: #4D6577;\n padding: 10px 14px 10px 38px;\n margin-bottom: 8px;\n border-radius: 6px;\n position: relative;\n background: rgba(77,101,119,.06);\n border-left: 3px solid #4D6577;\n}\n.co-list li::before {\n content: \"\u2713\";\n position: absolute;\n left: 12px;\n font-weight: 700;\n color: #4D6577;\n}\n.co-table {\n width: 100%;\n border-collapse: collapse;\n margin: 14px 0 22px;\n font-size: 14px;\n border-radius: 8px;\n overflow: hidden;\n}\n.co-table thead tr {\n background: #323C52;\n color: #fff;\n}\n.co-table thead th {\n padding: 11px 16px;\n text-align: left;\n font-weight: 600;\n font-size: 13px;\n}\n.co-table tbody tr:nth-child(even) {\n background: rgba(77,101,119,.06);\n}\n.co-table tbody tr:nth-child(odd) {\n background: #fff;\n}\n.co-table td {\n padding: 10px 16px;\n color: #4D6577;\n border-bottom: 1px solid rgba(77,101,119,.12);\n font-size: 14px;\n vertical-align: top;\n}\n.co-table td:first-child {\n font-weight: 600;\n color: #323C52;\n}\n.co-infobox {\n display: flex;\n gap: 12px;\n background: rgba(77,101,119,.06);\n border-radius: 8px;\n border-left: 4px solid #4D6577;\n padding: 14px 18px;\n margin: 18px 0 28px;\n font-size: 14px;\n font-weight: 400;\n color: #4D6577;\n line-height: 1.65;\n}\n.co-infobox .ico {\n font-size: 18px;\n flex-shrink: 0;\n}\n.co-urgence {\n background: #fff8f8;\n border-left: 5px solid #c0392b;\n border-radius: 6px;\n padding: 20px 26px;\n margin: 24px 0 32px;\n}\n.co-urgence .co-urgence-titre {\n font-size: 13px;\n font-weight: 700;\n color: #c0392b;\n letter-spacing: 1.5px;\n text-transform: uppercase;\n margin-bottom: 10px;\n}\n.co-urgence p {\n color: #5a2020;\n font-size: 14px;\n margin: 0 0 10px;\n line-height: 1.7;\n}\n.co-urgence p:last-child {\n margin-bottom: 0;\n}\n.co-disclaimer {\n font-size: 13px;\n color: #8a9aaa;\n font-style: italic;\n border-top: 1px solid rgba(77,101,119,.15);\n padding-top: 24px;\n margin-top: 40px;\n line-height: 1.6;\n}\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n\n <span class=\"co-label\">Obst\u00e9trique & M\u00e9decine maternelle-f\u0153tale & Soins intensifs<\/span>\n <h1>HELLP syndrome<\/h1>\n\n <div class=\"co-intro\">\n Le syndrome HELLP \u2014 acronyme anglais pour <strong>H<\/strong>hemolysis <strong>E<\/strong>Elevated <strong>L<\/strong>liver enzymes (elevated liver enzymes) + <strong>L<\/strong>Oh <strong>P<\/strong>latelets (thrombocytopenia) - is a severe obstetric complication usually occurring between the 27th and 37th week of pregnancy (or post-partum in 30 % of cases) constituting a severe form of pre-eclampsia with hematological and hepatic target organ involvement, or a separate entity depending on the authors. With an incidence of 0.5 to 0.9 % of all pregnancies + 10 to 20 % of cases of severe pre-eclampsia, HELLP syndrome is a medical and obstetric emergency with significant maternal morbidity - major hemorrhagic risk (due to thrombocytopenia + DIC) + subcapsular hematoma and hepatic rupture + acute renal failure + pulmonary edema + hemorrhagic stroke + placental abruption + and maternal mortality of 1 to 3 % (in developed countries), rising to 10 to 25 % in countries with limited resources. The pathophysiology is common to pre-eclampsia: dysfunction and activation of placental vascular endothelium \u2192 systemic vasospasm + activation of coagulation \u2192 thrombotic microangiopathy \u2192 mechanical hemolysis of erythrocytes in microvessels (schizocytes) + hepatic sinusoidal thrombi \u2192 hepatocyte ischemia \u2192 elevated transaminases + consumption thrombocytopenia. The only definitive treatment is delivery - the decision to deliver urgently vs. defer delivery to allow fetal lung maturation (corticosteroids) is the central therapeutic dilemma, guided by the severity of the maternal picture and gestational age.\n <\/div>\n\n <h2>Crit\u00e8res diagnostiques \u2014 Classification de Tennessee (Sibai) et Mississippi<\/h2>\n <ul class=\"co-list\">\n <li><strong>H\u00e9molyse (H) :<\/strong> frottis sanguin avec schizocytes (fragments \u00e9rythrocytaires par cisaillement microvasculaire) + LDH \u2265 600 UI\/L + bilirubine totale \u2265 20 \u00b5mol\/L + haptoglobine effondr\u00e9e (< 0,25 g\/L) + Coombs direct n\u00e9gatif (h\u00e9molyse m\u00e9canique non immune)<\/li>\n <li><strong>\u00c9l\u00e9vation des enzymes h\u00e9patiques (EL) :<\/strong> AST \u2265 70 U\/L (2\u00d7 ULN) and\/or elevated ALT and\/or LDH \u2265 600 U\/L (reflects both hemolysis and liver cell damage)<\/li>\n <li><strong>Thrombocytop\u00e9nie (LP) :<\/strong> plaquettes < 100 000\/\u00b5L (classe 1 de Mississippi) + plaquettes 100 000\u2013150 000\/\u00b5L (classe 2) + plaquettes > 150 000\/\u00b5L (classe 3 \u2014 syndrome ELLP partiel sans thrombocytop\u00e9nie franche)<\/li>\n <li><strong>Mississippi Classification (Prognosis):<\/strong> classe 1 (plaquettes < 50 000\/\u00b5L \u2014 la plus s\u00e9v\u00e8re) + classe 2 (50 000\u2013100 000\/\u00b5L) + classe 3 (100 000\u2013150 000\/\u00b5L)<\/li>\n <li><strong>Partial HELP<\/strong> presence of only 1 or 2 components (EL + LP without frank hemolysis = ELLP syndrome + or H only) \u2192 risk of evolution to complete HELLP \u2192 close monitoring<\/li>\n <\/ul>\n\n <h2>Clinical presentation<\/h2>\n <ul class=\"co-list\">\n <li><strong>Sympt\u00f4mes :<\/strong> epigastric pain or right upper quadrant pain (70\u201390% % \u2014 cardinal sign \u2014 compression of the hepatic capsule by edema + sinusoidal thrombi) + nausea + vomiting + malaise + headaches + visual disturbances + hypertension may be absent in 15\u201320 % of cases (normotensive HELLP) \u2192 do not rule out HELLP based on the absence of hypertension<\/li>\n <li><strong>Pain location:<\/strong> epigastrium + right hypochondrium (epigastric bar) \u2192 radiation to the right shoulder or back \u2192 Spiegel's sign (pain on palpation of the right hypochondrium) + alarm sign if intense right scapular pain \u2192 subcapsular liver hematoma (imminent rupture)<\/li>\n <li><strong>Pr\u00e9-\u00e9clampsie concomitante :<\/strong> present in 85 % of cases (hypertension + proteinuria) + but 15 % of HELLP are normotensive without proteinuria \u2192 never exclude HELLP based on the absence of classic pre-eclampsia<\/li>\n <li><strong>HELP post-partum<\/strong> 25-30% of cases occur within 48 hours of delivery (rarely up to 7 days postpartum) \u2192 epigastric pain + vomiting + malaise + liver function tests + platelet count systematically checked postpartum if suspected<\/li>\n <\/ul>\n\n <h2>Complications maternelles redout\u00e9es<\/h2>\n <ul class=\"co-list\">\n <li><strong>H\u00e9matome sous-capsulaire du foie + rupture h\u00e9patique (< 2 %) :<\/strong> the most severe complication + severe abdominal pain + right shoulder radiation + hemorrhagic shock + maternal mortality 50\u201386% % in case of rupture + diagnosis: hepatic ultrasound + abdominal CT scan + treatment: hepatic arterial embolization + or surgery (hepatic packing)<\/li>\n <li><strong>CIVD (coagulation intravasculaire diss\u00e9min\u00e9e \u2014 20 %) :<\/strong> Prolonged PT + low fibrinogen + elevated D-dimers + major postpartum hemorrhage + bleeding at puncture site + massive transfusion<\/li>\n <li><strong>Insuffisance r\u00e9nale aigu\u00eb (7\u201315 %) :<\/strong> Oliguria + elevated creatinine + acute tubular necrosis due to renal ischemia + dialysis if severe<\/li>\n <li><strong>\u0152d\u00e8me pulmonaire (6\u20138 %) :<\/strong> water overload + increased vascular permeability + hypoalbuminemia \u2192 SpO2 + chest X-ray + O2 + diuretics (with caution)<\/li>\n <li><strong>D\u00e9collement placentaire (15\u201320 %) :<\/strong> Abdominal pain + vaginal bleeding + fetal distress \u2192 urgent delivery<\/li>\n <li><strong>AVC h\u00e9morragique (< 1 %) :<\/strong> Severe thrombocytopenia + uncontrolled hypertension \u2192 severe headaches + neurological deficit \u2192 neurosurgical emergency<\/li>\n <\/ul>\n\n <h2>Support<\/h2>\n <ul class=\"co-list\">\n <li><strong>Principe fondamental \u2014 accouchement = seul traitement d\u00e9finitif :<\/strong> la gu\u00e9rison du HELLP n\u00e9cessite l'accouchement et l'\u00e9vacuation du placenta \u2192 toute d\u00e9cision de temporisation (pour maturation pulmonaire) doit \u00eatre pes\u00e9e contre le risque maternel \u2192 \u00e2ge gestationnel \u2265 34 SA \u2192 accouchement imm\u00e9diat recommand\u00e9 + \u00e2ge gestationnel 27\u201334 SA \u2192 cortico\u00efdes (b\u00e9tam\u00e9thasone 12 mg IM \u00d7 2 doses \/ 24 h) + si stabilisation clinique + accouchement dans 24\u201348 h + \u00e2ge gestationnel < 27 SA \u2192 discussion au cas par cas en centre de r\u00e9f\u00e9rence<\/li>\n <li><strong>Sulfate de magn\u00e9sium IV \u2014 pr\u00e9vention et traitement des convulsions (\u00e9clampsie) :<\/strong> dose de charge 4\u20136 g IV en 15\u201320 min + perfusion d'entretien 1\u20132 g\/h \u2192 pr\u00e9vention de l'\u00e9clampsie + neuroprotection f\u0153tale si < 32 SA + surveiller : r\u00e9flexes ost\u00e9o-tendineux (disparition si toxicit\u00e9) + fr\u00e9quence respiratoire (> 12\/min) + diur\u00e8se (> 25 mL\/h) + magn\u00e9s\u00e9mie (cible 2\u20133,5 mmol\/L) + antidote si surdosage : gluconate de calcium 1 g IV lentement<\/li>\n <li><strong>Contr\u00f4le de la pression art\u00e9rielle :<\/strong> objectif : PAS < 160 mmHg + PAD < 110 mmHg \u2192 lab\u00e9talol IV 20\u201380 mg bolus (ou perfusion) + ou hydralazine 5\u201310 mg IV + ou nif\u00e9dipine \u00e0 lib\u00e9ration rapide 10\u201320 mg per os + \u00e9viter les IEC et ARA II (contre-indiqu\u00e9s en grossesse)<\/li>\n <li><strong>Transfusions and blood products:<\/strong> concentr\u00e9s de plaquettes si plaquettes < 20 000\/\u00b5L (ou < 50 000\/\u00b5L avant c\u00e9sarienne) + plasma frais congel\u00e9 si CIVD + fibrinog\u00e8ne si fibrinog\u00e8ne < 1,5 g\/L<\/li>\n <li><strong>Cortico\u00efdes \u00e0 hautes doses (d\u00e9xam\u00e9thasone) :<\/strong> used to accelerate fetal lung maturation if premature (betamethasone or dexamethasone 12 mg IM x 2 \/ 24 h) + some studies suggest a benefit for maternal thrombocytopenia (dexamethasone 10 mg IV x 2\/12 h) but the data are contradictory \u2192 non-standard use for maternal indication alone<\/li>\n <li><strong>Mode d'accouchement :<\/strong> Vaginal delivery preferred if cervical conditions are favorable and there are no obstetric contraindications. Case-by-case decision with the obstetrics team. Cesarean section if fetal emergency, unfavorable cervix, or severe prematurity.<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>Le syndrome HELLP doit \u00eatre \u00e9voqu\u00e9 devant toute douleur \u00e9pigastrique ou de l'hypocondre droit survenant apr\u00e8s la 20e semaine de grossesse + ou dans le post-partum imm\u00e9diat \u2014 m\u00eame en l'absence d'hypertension art\u00e9rielle ou de prot\u00e9inurie. Le bilan minimal (NFS + plaquettes + ASAT + ALAT + LDH + bilirubine + frottis sanguin + cr\u00e9atinine + TP) doit \u00eatre r\u00e9alis\u00e9 en urgence. Un retard diagnostique expose \u00e0 des complications catastrophiques (rupture h\u00e9patique + CIVD).<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Urgence obst\u00e9tricale \u2014 composer le 911<\/div>\n <p>Composer le 911 ou se rendre imm\u00e9diatement aux urgences obst\u00e9tricales si une femme enceinte (ou ayant accouch\u00e9 dans les 7 jours) pr\u00e9sente une douleur \u00e9pigastrique ou sous-costale droite intense + des naus\u00e9es + vomissements + des c\u00e9phal\u00e9es s\u00e9v\u00e8res + des troubles visuels + ou une chute des plaquettes (ecchymoses + p\u00e9t\u00e9chies) \u2014 ces signes \u00e9voquent un syndrome HELLP, urgence obst\u00e9tricale n\u00e9cessitant un accouchement en urgence dans la majorit\u00e9 des cas. Toute suspicion de douleur de l'\u00e9paule droite + \u00e9tat de choc chez une femme enceinte doit \u00e9voquer une rupture h\u00e9patique sur HELLP \u2014 urgence chirurgicale absolue. Clinique Omicron oriente vers les urgences obst\u00e9tricales appropri\u00e9es. Pour prendre rendez-vous en consultation pr\u00e9natale, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron assurent le suivi pr\u00e9natal incluant la surveillance de la pression art\u00e9rielle + de la prot\u00e9inurie + des \u0153d\u00e8mes \u00e0 chaque consultation, prescrivent un bilan urgent (NFS + plaquettes + LDH + transaminases + bilirubine + cr\u00e9atinine) en cas de suspicion de HELLP, orientent imm\u00e9diatement vers les urgences obst\u00e9tricales de niveau tertiaire d\u00e8s la suspicion du diagnostic, assurent le suivi post-partum pr\u00e9coce (7\u201310 jours) pour d\u00e9pister un HELLP post-natal, et \u00e9duquent les femmes \u00e0 risque (ant\u00e9c\u00e9dent de pr\u00e9-\u00e9clampsie ou HELLP) sur les signes d'alerte lors des grossesses ult\u00e9rieures. Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin, d'un obst\u00e9tricien ou d'un m\u00e9decin de m\u00e9decine maternelle-f\u0153tale. Le syndrome HELLP est une urgence obst\u00e9tricale n\u00e9cessitant une prise en charge hospitali\u00e8re imm\u00e9diate dans un centre de niveau tertiaire avec soins intensifs n\u00e9onataux. Le seul traitement curatif est l'accouchement.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Syndrome HELLP : urgence obst\u00e9tricale, diagnostic et prise en charge | Clinique Omicron Obst\u00e9trique & M\u00e9decine maternelle-f\u0153tale & Soins intensifs Syndrome HELLP Le syndrome HELLP \u2014 acronyme anglais pour Hemolysis (h\u00e9molyse) + Elevated Liver enzymes (enzymes h\u00e9patiques \u00e9lev\u00e9es) + Low Platelets (thrombocytop\u00e9nie) \u2014 est une complication obst\u00e9tricale s\u00e9v\u00e8re survenant g\u00e9n\u00e9ralement entre la 27e et la… <a href=\"https:\/\/cliniqueomicron.ca\/en\/syndrome-hellp\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">HELLP Syndrome: Obstetric Emergency, Diagnosis, and Management | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Syndrome HELLP | Brossard | Clinique Omicron","_metasync_otto_description":"Syndrome HELLP Syndrome HELLP est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","_metasync_otto_keywords":"","_metasync_otto_og_title":"Syndrome Hellp | Clinique Omicron Qu\u00e9bec","_metasync_otto_og_description":"Syndrome HELLP Syndrome HELLP est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. Nos professionnels de la sant\u00e9 \u00e0...","_metasync_otto_twitter_title":"Syndrome Hellp | Clinique Omicron","_metasync_otto_twitter_description":"Syndrome HELLP Syndrome HELLP est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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