How can I monitor and manage potential complications of HELLP syndrome in the postpartum period?

Monitoring and managing potential complications of HELLP syndrome in the postpartum period involves close clinical and laboratory follow-up.

• Laboratory monitoring: Measure platelet count, liver transaminases, and serum creatinine 48 to 72 hours after birth or step-down from critical care to assess resolution or progression of HELLP syndrome.
• If these biochemical and haematological indices remain abnormal, repeat measurements should be done as clinically indicated until results normalize.
• Urinary monitoring: Perform a urinary reagent-strip test 6 to 8 weeks postpartum to check for ongoing proteinuria.
• Women with persistent proteinuria (1+ or more) at 6 to 8 weeks should have a further review at 3 months postpartum to assess kidney function.
• Consider referral to a specialist for kidney assessment if kidney function remains abnormal at 3 months.
• Clinical review: Offer all women who had pre-eclampsia or HELLP syndrome a medical review with their GP or specialist 6 to 8 weeks after birth to monitor for complications and counsel on cardiovascular risk reduction.
• Advise women on lifestyle modifications to reduce long-term cardiovascular and renal risks, including smoking cessation, maintaining a healthy weight, and managing blood pressure.

Intrapartum and postpartum care considerations: Be aware that women with HELLP syndrome are at increased risk of bleeding complications postpartum, so monitor for postpartum haemorrhage and manage accordingly.

These steps help detect and manage complications such as thrombocytopenia, liver dysfunction, renal impairment, and ongoing hypertension, which are common in HELLP syndrome postpartum.

Close multidisciplinary collaboration including haematology and nephrology specialists may be required depending on severity and persistence of abnormalities.

References: ¹,²