Table of contents
HELLP syndrome
What's new
Updated 2023 EASL guidelines for the diagnosis and management of HELLP syndrome.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of HELLP syndrome are prepared by our editorial team based on guidelines from the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ 2024), the European Association for the Study of the Liver (EASL 2023,2017), the American Association for the Study of Liver Diseases (AASLD 2021), the American College of ...
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Screening and diagnosis
Diagnostic investigations
Liver tests: as per EASL 2023 guidelines, obtain serum liver tests as abnormalities are frequently associated with an adverse maternal outcome in HELLP syndrome. Do not use liver test results in isolation to guide care.
B
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Abdominal ultrasound
Medical management
Corticosteroids: as per SOMANZ 2024 guidelines, do not administer corticosteroids for the management of HELLP syndrome.
D
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Antihypertensive therapy
Magnesium sulfate
Therapeutic procedures
Platelet transfusion
As per EASL 2023 guidelines:
Be aware of the higher prevalence of hepatic hemorrhage or hematoma in patients with HELLP syndrome and markedly reduced platelet count (≤ 20×10⁹/L).
B
Consider administering platelet transfusion in pregnant patients with a platelet count < 100×10⁹/L to reduce the risk of abnormal coagulation and adverse maternal outcomes associated with preeclampsia.
B
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Delivery
Plasmapheresis
Surgical interventions
Specific circumstances
Patients with acute fatty liver of pregnancy: as per EASL 2017 guidelines, perform prompt delivery of the fetus as the treatment of choice in patients with HELLP and acute fatty liver of pregnancy, especially in case of elevated lactate levels and hepatic encephalopathy. Offer screening for putative fatty acid defects.
B