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Franck Boston/Hemera/ Thinkstock EMSWORLD.com | JUNE 2015 41 ening complication of pregnancy thought to be a variant or complication of preeclamp- sia. Both of these conditions usually occur during the third trimester or soon after childbirth. HELLP is a multisystem dis- ease that results in generalized vasospasm, microthrombi formation and coagulation defects. Untreated, HELLP syndrome can lead to maternal end-organ failure as well as fetal demise. HELLP syndrome occurs in approxi- mately 0.1%–0.8% of all pregnancies and in 10%–20% of women with severe preeclamp- sia or eclampsia. 2 Up to 30% of women who develop HELLP syndrome do so after child- birth, typically within 48 hours. A previous history of preeclampsia, eclampsia or HELLP syndrome is a risk factor for HELLP, as is a family history of it. One study found about 7% of women who experienced the syndrome developed HELLP in a subsequent pregnancy, 18% developed preeclampsia, and 18% developed gestational hypertension. 3 Half or more of pregnant females affected by the syndrome have had multiple childbirths. The pathophysiology of HELLP syndrome is poorly understood. What is known is that the activation of the coagulation cascade, secondary to influence from the placenta, plays a major role. When activated by thrombin, fibrinogen polymerizes into strands of fibrin, which form meshlike barriers in small blood vessels such as the arterioles, capillaries and venules. These fibrin barriers act like strainers through which red blood cells are forced, resulting in their destruction. This results in the microangiopathic (small blood vessel) hemolytic anemia characteristic of the syndrome. Platelets adhere to the fibrin structures, particularly in the liver, leading to low platelet counts. Clot formation in the hepatic vasculature leads to decreased hepatic perfusion and subsequent ischemia and, if uncorrected, infarction and liver fail- ure. Liver dysfunction and failure result in the elevated liver enzymes characteristic of HELLP syndrome. Uncorrected, liver failure will lead to fetal death if the patient has not yet delivered and maternal death unless the problem is corrected or a liver transplant performed. Additional complications associated with HELLP include disseminated intravascu- lar coagulation (DIC), abruptio placentae, acute renal failure, pulmonary edema, liver infarction and liver hematoma or rupture with hemorrhage. 5 Other liver disorders unique to preg- nancy include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, preeclampsia and acute fatty liver of preg- nancy (see sidebar). 6 These disorders have characteristic clinical features and timing of onset (see Table 1) and may also progress to severe liver dysfunction. 7 Signs and Symptoms The signs and symptoms of HELLP typical- ly appear in the third trimester of pregnan- cy, between 28–36 weeks' gestation. That said, second-trimester or even postpartum onset of HELLP is not uncommon. In one study, 70% of all cases of HELLP occurred peripartum (close to the end of pregnancy), A doula is a nonmedical person who assists a woman before, during, and after a childbirth. These trained and experienced professionals provide physical, emotional, and informational support to the mother and family. YOU PROTECT US, WE PROTECT YOUR FLEET & BOTTOM LINE ! Reduce Insurance Premiums & Legal Costs by Using the Dual-Vision XC 2+1 to Absolve Your Drivers in Accidents Rosco's Dual-Vision XC 2+1 has the capacity to deter unsafe driving behavior through its ability to continuously record video and provide instant feedback. The Dual-Vision XC 2+1 AER is the most effcient windshield based, three (3) camera capable, continuous and event recording device. It has 160+ hours of continuous recording capability and the ability to precisely identify and save three types of events (G-force, Speed, Panic Button). With no monthly fees, free frmware and software upgrades, and powerful DV-Pro ® feet database management software, Dual-Vision XC 2+1 is revolutionizing windshield based recording, again. Compact, Low Cost, Continuous Video Recording System o s c o ' s D u a l C C 90-21 144th Place, Jamaica, New York 11435 TEL (800) 227-2095 • FAX (718) 297-0323 Info@Roscomirrors.com www.roscomirrors.com www.roscovision.com A CENTURY OF AUTOMOTIVE VISION SAFET Y ROSCO V I S I O N S Y S T E M S ® For More Information Circle 32 on Reader Service Card