Pre-eclampsia and HELLP syndrome

Pre-eclampsia, eclampsia and HELLP syndrome are discussed in this article. The most recent theory on the pathophysiology of these conditions, the various risk factors and how knowledge of these may help in the management of these conditions are also discussed. Current measures used for prophylaxis in the form of low-dose aspirin, and low molecular weight heparin (LMWH) are discussed, together with a rationale for their use. Pre-pregnancy counselling is advocated for those at high risk of developing pre-eclampsia and particularly for those with previous severe early-onset or with a poor obstetric history related to pre-eclampsia in order to instigate appropriate plans for the management of future pregnancies. The use of magnesium sulphate has been shown to reduce the incidence of eclampsia by 50%, and recent evidence has suggested that calcium supplementation reduces the risk of pre-eclampsia in women with dietary calcium deficiency. Counselling following a pregnancy complicated by pre-eclampsia, eclampsia or HELLP is useful with regards to the associated increased risk of cardiovascular disease and chronic hypertension in later life.