General Anesthesia Versus Spinal Anesthesia in Patients of HELLP Syndrome
General Anesthesia Versus Spinal Anesthesia in Patients of HELLP Syndrome
Anesthesia for caesarian section in patients with HELLP syndrome is a challenge. Measures
 should be taken during caesarian delivery to guard against the maternal and fetal
 complications associated with HELLP syndrome.
The choice of anesthesia for caesarian section in parturient with HELLP syndrome is a debate.
 The low platelet count, associated with HELLP syndrome, has often favored the choice of
 general anesthesia for the caesarian delivery of these parturient. However, general
 anesthesia in such cases; is not a risk-free approach. General anesthesia is associated with
 increased risk of difficult airways, stress response to intubation and aspiration. It is also
 thought to have an effect on the fetus with the potential placental transfer of inhalational
 anesthetics prior to delivery.

 Regional anesthesia is widely regarded as a means of providing analgesia for cesarean
 section.it also avoids the above-mentioned risks associated with general anesthesia. Regional
 anesthesia for caesarian section in patients with HELLP syndrome has been used by some
 researchers in many centers with encouraging results.

 The lowest platelet count at which one can safely administer neuraxial anesthesia for labour
 and delivery is controversial. Published studies are few and sample sizes small.

 Criteria developed at the University of Mississippi, as of 2006: "For a patient to merit a
 diagnosis of HELLP syndrome, class 1 requires severe thrombocytopenia (platelets ≤50,000/μl),
 evidence of hepatic dysfunction (AST and/or ALT ≥70 IU/l), and evidence suggestive of
 hemolysis (total serum LDH ≥600 IU/l); class 2 requires similar criteria except
 thrombocytopenia is moderate (>50,000 to ≤100,000/μl); and class 3 includes patients with
 mild thrombocytopenia (platelets >100,000 but ≤150,000/μl), mild hepatic dysfunction (AST
 and/or ALT ≥40 IU/l), and hemolysis (total serum LDH ≥600 IU/L).

 The researchers chose to investigate class 2 HELLP syndrome as class 3 proved to be safe with
 regional anesthesia while class 1 seemed to be high risk and un-ethical to do spinal
 anesthesia with very low platelets count with lack of any evidence to its safety.
Inclusion Criteria:

 Patients with class (II) (12) HELLP syndrome scheduled for elective caesarian section:

 Diagnosis of HELLP syndrome was based on the clinical diagnosis of preeclampsia and the
 following laboratory abnormalities (13):

 1. Hemolysis: characteristic peripheral blood smear, serum lactic dehydrogenase (LDH) ≥
 600 U/ l, total bilirubin ≥ 1.2 mg /dl, decreased hemoglobin and hematocrit.

 2. Elevated liver enzymes, defined as aspartate aminotransferase (AST). ≥ 70 U/ l, alanin
 aminotransferase (ALT) ≥ 50 U/ l and lactate dehydrogenase (LDH) ≥ 600 U/ l.

 3. Low platelet count: class 2 HELLP having a platelet nadir between > 50000 and 100000
 mm-3.

 Exclusion Criteria:

 1. Emergency cases

 2. Placenta praevia

 3. Cardiovascular or cerebrovascular disease.

 4. Morbid obesity with a BMI ≥40

 5. Gestational age <36 or >41 weeks

 6. Platelet counts less than 50000 mm-3; class 1 HELLP and class 3 HELLP having platelet
 count more than 100 000 mm-3