Topic: Preeclampsia and Toxaemias of pregnancy
Question: Write briefly on a)deep transverse arrest b)HELLP syndrome.
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notes on deep transverse arrest and HELLP syndrome:
A) Deep Transverse Arrest
– Definition: Complete cessation of descent of the fetal head during the second stage of labor due to impaction at the pelvic inlet.
– Causes: Cephalopelvic disproportion, malpresentation like face or brow presentation, fetal macrosomia.
– Diagnosis: On vaginal examination during labor, fetal head is high up, cervix fully dilated, absence of further descent despite good uterine contractions. Ultrasound confirms arrest of fetal descent.
– Management:
1) Correct any cephalic or brow malpresentation
2) Attempt forceps/vacuum assisted delivery if head engaged
3) Caesarean section if instrumental delivery fails or not feasible.
B) HELLP Syndrome
– Definition: A life-threatening obstetric complication involving Hemolysis, Elevated Liver enzymes and Low Platelets. Variant of preeclampsia.
– Pathogenesis: Exact cause unknown. Thought to be related to abnormal placental vasculature. Maternal endothelial dysfunction leads to microangiopathic hemolytic anemia, hepatic ischemia and thrombocytopenia.
– Clinical features: Right upper quadrant or epigastric pain, nausea, vomiting, headache, visual changes. Hypertension may be absent.
– Diagnosis: Hemolysis on peripheral smear, elevated bilirubin, LDH. AST/ALT>70IU/L. Platelet count <100,000/microliter.
– Management:
1) Delivery of the fetus is the definitive treatment
2) Corticosteroids to accelerate fetal lung maturity if preterm
3) Antihypertensives for severe hypertension
4) Blood products like packed red cells, platelet transfusion as needed
5) Close monitoring in ICU for complications like DIC, liver hemorrhage, renal failure.
Early recognition of HELLP syndrome and prompt delivery can improve maternal and fetal outcomes
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