Sgt university faculty Of nursing

Lesson plan
On
HELLP Syndrome
Submitted to :- Submitted by :-

Ms .Akoijam Mamta Devi Ms.Ajnesh kumari

Associate Professor M.Sc Nsg 1st year

Department of OBG nursing

SGT University , gurugram

IDENTIFICATION DATA :-

Name of student teacher :- Ajnesh kumari

Topic Of Teaching :- HELLP syndrome

Teaching Method :- Student interactive session

Date & Time :-

Duration Of Teaching :- 45 min

Name Of Group :- M.sc nursing 2nd year

Size Of Group :-

Language :- Hindi & English

A.V Aids :- PPT’s

Supervisor :- Ms Akoijam Mamta Mam

Previous knowledge of the group :-The Group has some knowledge regarding

HELLP syndrome.
GENERAL OBJECTIVES :- After completion of seminar student will be able :-

1. To explain brief introduction about HELLP syndrome .

2. To explain the complication and its management of HELLP syndrome.

SPECIFIC OBJECTIVES :-

1. To Introduce the topic about HELLP syndrome.

2. To defined the topic about HELLP syndrome.
3. To discuss about the incidence of HELLP syndrome.
4. To describe the etiology of HELLP syndrome.
5. To enumerate the clinical features of HELLP syndrome.
6. To classify the HELLP syndrome.
7. To explain the pathophysiology of HELLP syndrome.
8. To determine the diagnosis of HELLP syndrome.
9. To explain the management of HELLP syndrome.
10. To describe the complication of HELLP syndrome.
SS.NO.. TIME SPECIFIC Content TEACHING A .V Evaluation
OBJECTIVES LEARNING AIDS
ACTIVITY
1. 1min To introduce yourself. Self- P
introduction O
I am Ajnesh W
M.Sc. (N) 2nd E
year student R
going to present
the topic of
HELLP P
syndrome O
2. 2min Introduction I
HELLP syndrome is a series of symptoms that N What is
To Introduce the make up a síndrome that make up a syndrome HELLP
topic about HELLP that can affect pregnant women.HELLP Student teacher syndrome.
syndrome. syndrome is thought to be a variant of will be able to
preeclampsia, but it may be an entity all on its give introduction P
own.There are still many questions about the about topic . R
serious condition of HELLP syndrome. E
S
E
3. 3min To defined the topic DEFINITION N
about HELLP A combination of the breakdown of red blood T
Student teacher
syndrome. cells(hemolysis),elevated liver enzymes(EL),and A What is the
will be able to
low platelet count(LP) occurring in pregnancy. T full form of
defined the topic.
Or I HELLP.
A subset of severe pre-eclampsia with O
laboratory evidence of hemolysis, hepatic N
dysfunction and thrombocytopenia.
 INCIDENCE Student teacher P Discuss
4. 1min To discuss about the  10% in severe pre – eclampsia will be able to O about the
incidence of HELLP  50% in eclampsia. discuss about the W incidence of
syndrome.  Secondary phenomenon in complicated incidence of the E HELLP
sepsis. topic. R syndrome.

ETIOLOGY
5. 3min To describe the The cause is still unclear to many doctors and Student teacher Describe the
etiology of often HELLP syndrome is misdiagnosed. will be able to etiology of
Intrauterine Growth  Excessive body weight increase . describe the P Intrauterine
Restriction.  Pulse pressure amplification. etiology of O Growth
 Systole pressure > 140 mmhg, but HELLP I Restriction?
diastole pressure < 90 mmhg. syndrome. N
 Ophthalmic disorders T

CLINICAL FEATURES
6. 2min To enumerate the These often come on quickly. They include: Student teacher Enumerate
clinical features of Fatigue, Blurred vision, Sudden weight gain, will be able to the clinical
HELLP syndrome. Swelling ,especially in the face and hands, enumerate the features of
clinical features P
headache ,Nausea or vomiting, seizures, pain in HELLP
upper part of abdomen ,Nosebleed. of HELLP R syndrome?
syndrome. E
S
E
Clasification of the HELLP Syndrome based N
7. 3min To classify the on the platelet count: Student teacher T Classify the
HELLP syndrome.  Class 1 – Platelet count <50 000/mm3. will be able to A HELLP
 Class 2 - Platelet count between 50 000 - classify the T syndrome
100 000/mm .3 HELLP I
 Class 3 - Platelet count <between 100 syndrome. O
000 -150 000/mm3. N
 Hemolysis + Liver disfunction
 PATHOPHYSIOLOGY P
Causal agentes : Increase in volume., Fetal O
8. 5min To explain the presence / decidual cell?, Vasospasm?, Student teacher W Explain the
pathophysiology of Deficiente vascular repair?, Idiopathic? will be able to E pathophysiol
HELLP syndrome. explain the R ogy of
Vasculo-endothelial Disorder pathophysiology HELLP
of HELLP syndrome?
Platelet Agregation/Consumption syndrome.

Fibrin Activation/Consumption P
O
Selective organic Isquemia/nsuficiency I
N
Variable Manifestations T
Other Factors to consider :
 Erithrocytic morphology
 Platelet disorders
 Renal compromise
 Hepatic disorders P
 Immunologic disorders R
 Genetic disorders E
S
The Causal Factors induce: E
 Thrombocytopenia N
 Microangiopathic Hemolytic Anemia T
 Periportal necrosis and distension of the A
liver´s Glisson´s capsule. T
I
DIAGNOSIS O
Clinical N
9. 3min To determine the 1. Right upper quadrant or epigastric pain. Student teacher Determine
diagnosis of HELLP 2. Nausea & vomiting. will be able to the diagnosis
syndrome. 3. Headache. determine the of HELLP
 4. Right upper quadrant tenderness diagnosis of P syndrome?
5. Diastolic BP>110 mmhg. HELLP O
6. Proteinuria:2+ syndrome. W
7. Demonstrable oedema. E
Laboratory R
1. Hemolysis: Microangiopathic harmolytic
anaemia characterized by burr cells,
schistocytes and polychromasia on
peripheral smear.
2. Elevated liver enzymes: P
 Increased bilirubin > 1.2 mg/dl mostly O
indirect. I
 Increased lactic dihydrogenase (LDH) >600 N
IU/L T
 Increased SGOT > 72 IU/L.
3.Low platelets
 Mild(class 111)platelets:100-150000/mm3
 Moderate(class 11)platelets:50-1000000/mm
 Severe(class 1) platelets:<50000/mm3
3. Two important tests
P
 Platelets:<100000/mm3
R
 LDH:>600IU/L(>1400:highest risk) E
10. 5min To explain the MANAGEMENT S
management of 1. Anticipate the diagnosis. Student teacher E Explain the
2. Evaluate the maternal condition:Class of
HELLP syndrome. will be able N management
HELLP mild , moderate or severe depending
explain the T of HELLP
on platelet count and LDH.
management of A syndrome.
3. Evaluate the fetal condition :
HELLP T
 Assess fetal gestational age and well- syndrome. I
being(NST/BPP). O
 Inj.Dexamethsone 10 mg IV every 12 hours N
for lung maturation and arrest of maternal
disease.
 4.Prevent seizures, Control the hypertension.
5. Transfusion therapy. P
 Packed RBC:if haematocrit<22% O
 Platelets 6-10 units preoperative if W
<40000/mm3 E
6. Water and electrolitic balance . R
7. Hemotherapy.
8. Management of labor and delivery:
 Vaginal
 CaesereanSection :Vasicouterine peritoneum
P
notclosed
O
9.Postpartpartum period.
I
10.24-48 hours till platelets starts increasing.
N
11.Watch for hepatic,renal and respiratory T
failure for future pregnancy.
 Risk of recurrence
 Aspirin from 6 to 36 weeks.
12Be alert for multiple organ failure.
13.Advise on future pregnancy. P
R
Complications: E
- Subcapsular Hematoma Student teacher S
10. To describe the - Subcapsular hepatica hemorrhage will be able to E Describe the
2min complication of - Hepatic Rupture. describe the N complication
HELLP syndrome  Therapeutic solutions: complication of T of HELLP
- Conservative Procedures HELLP A syndrome?
- Surgery. syndrome T
Advising on future pregnancies. I
 The risk of recurrence of preeclampsia - O
eclampsia is 42-43% and for the HELLP
syndrome: 19-27%.
 The risk of recurrence of preterm
delivery is high, about 61%.1
SUMMARY:

Hemolysis,elevated liver enzymes,low platelet count(HELLP) syndrome is a life-threatening complication of pre-eclampsia

during pregnancy or postpartum.Serious complications occur in 12.5-65% of cases of HELLP syndrome and are associated with
a maternal motality between 1.1 and 3.4%.

CONCLUSIONS

HELLP Syndrome and its management still poses a problem in modern obstetrics .Precise diagnosis and early treatment with
non-mineral corticosteroides such as Dexamethasone may help achieve favorable maternal and perinatal results.

RECAPITULATION

 Defined the topic about HELLP syndrome.

 Discuss about the incidence of HELLP syndrome.
 Describe the etiology of HELLP syndrome.
 Enumerate the clinical features of HELLP syndrome.
 Classify the HELLP syndrome.
 Describe the complication of HELLP syndrome.

BIBLIOGRAPHY

 http://www.webmd.com
 http://emedicine.medscape.com
 Dutta.D.C (2011). Textbook of Obestetrics. 7th ed. Delhi, Kolkata; New central book agency Ltd.
 Magann E.F., Martín J.N. – Twelve Steps to Optimal Management of HELLP Syndrome. Clinical Obstetrics and
Gynecology. Lippincott Williams & Wilkins, Philadelphia, 6th ed Delhi; New central book agency Ltd.