BoardsBridgeHELLP Syndrome: Anesthetic Implications & Peripartum Management
Hemolysis, Elevated Liver enzymes, Low Platelets — severe preeclampsia variant requiring maternal stabilization, seizure prophylaxis, and timely delivery.
HELLP syndrome is a severe preeclampsia spectrum disorder featuring microangiopathic hemolysis, hepatocellular injury, and thrombocytopenia that demands magnesium seizure prophylaxis, blood pressure control, correction of coagulopathy, and definitive delivery after maternal stabilization.
If you forget
HELLP = Hemolysis, Elevated Liver enzymes, Low Platelets (headline)
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Key numbers
- Platelets <50,000/μL = avoid neuraxial anesthesia (Class 1 HELLP)
- MgSO4 4–6 g IV load over 15–20 min, then 1–2 g/hr maintenance infusion
- Therapeutic serum Mg 4–7 mEq/L; DTRs lost >10 mEq/L, respiratory depression/arrest >12-15 mEq/L; reverse with calcium gluconate 1 g IV
- BP threshold ≥160/110 mmHg sustained = acute treatment (labetalol 20 mg IV q10min)
- Fibrinogen <150–200 mg/dL = cryoprecipitate 10 U pooled
- Platelets <20,000/μL or active bleeding → transfuse; transfuse <50,000/μL before cesarean when bleeding or trend falling
- Continue MgSO4 for 24 h postpartum to cover delayed eclampsia risk
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ACOG Pb222 Hypertension Pregnancy 2020 · ASA Obstetric Anesthesia 2016
Re-review cadence: 12 months from reviewed date.
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Card ID: hellp-syndrome · Path: aba.ob.preeclampsia-hypertensive.hellp-syndrome