Cuidados de enfermagem a mulheres com síndrome HELLP: scoping review Atención de enfermería a mujeres con síndrome HELLP: revisión del alcance

Arduini, Pâmela Silva; de Resende, Cynthya Viana; da Silva, Jéssica Aparecida; Ruiz, Mariana Torreglosa

Pâmela Silva Arduini

Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.

https://orcid.org/0009-0002-3566-0634

Cynthya Viana de Resende

Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.

https://orcid.org/0000-0003-1203-2504

Jéssica Aparecida da Silva

Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.

https://orcid.org/0000-0002-4308-5978

Mariana Torreglosa Ruiz

Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Atenção à Saúde, Uberaba, MG, Brazil.

https://orcid.org/0000-0002-5199-7328

Corresponding author: Mariana Torreglosa Ruiz, Praça Manoel Terra, 330, Centro, 38025-015 – Uberaba, MG, Brazil, mariana.ruiz@uftm.edu.br

ASSOCIATE EDITOR

Rebeca Nunes Guedes de Oliveira

Database	Search strategy	n
PubMed	(((“HELLP Syndrome” [Mesh] OR Syndrome, HELLP OR Hemolysis, Elevated Liver Enzymes, Lowered Platelets) AND (“Nursing Care”[Mesh] OR Care, Nursing OR Management, Nursing Care OR Nursing Care Management OR “Obstetric Nursing” [Mesh] OR Nursing, Obstetric OR Nursings, Obstetric OR Obstetric Nursings OR Nursing, Obstetrical OR Nursings, Obstetrical OR Obstetrical Nursings OR Obstetrical Nursing)	25
EMBASE	(‘HELLP Syndrome’/exp OR ‘HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome’ OR ‘hemolysis, elevated liver enzymes, and low platelet count syndrome’ OR ‘hemolysis, elevated liver enzymes, and low platelets syndrome’ OR ‘hemolysis, elevated liver enzymes, low platelet count syndrome’ OR ‘syndrome HELLP’ OR ‘HELLP syndrome’) AND (‘Obstetrical nursing’/exp OR ‘obstetric nursing’ OR ‘obstetrics nursing’ OR ‘obstetrical nursing’ OR ‘Nursing’/exp OR ‘hospital nursing service’ OR ‘nursing service’ OR ‘nursing service, hospital’ OR ‘nursing services’ OR ‘nursing support’ OR ‘nursing, private duty’ OR ‘nursing, supervisory’ OR ‘office nursing’ OR ‘private duty nursing’ OR ‘supervisory nursing’ OR ‘nursing’) AND [embase]/lim NOT ([embase]/lim AND [medline]/lim)	28
Scopus	ALL (“HELLP Syndrome”) AND TITLE-ABS-KEY (nursing AND care OR obstetric AND nursing )	54
WoS	(ALL=(HELLP syndrome)) AND ALL=(Nursing care) AND (ALL=(HELLP syndrome)) AND ALL=(obstetric nursing)	27
LILACS	(tw:(“Síndrome HELLP” OR “HELLP Syndrome” OR “HELLP syndrome” OR C12.050.703.395.186 )) AND (tw:(“Cuidados de Enfermagem” OR “Nursing Care” OR “Atención de Enfermería” OR “Soins infirmiers” OR “Assistência de Enfermagem” OR “Atendimento de Enfermagem” OR “Cuidado de Enfermagem” OR “Gestão da Assistência de Enfermagem” OR “Sistematização da Assistência de Enfermagem” OR “E02.760.611” “OR N02.421.533” OR “Enfermagem Obstétrica” OR “Obstetric Nursing” OR “Enfermería Obstétrica” OR “Soins infirmiers em obstétrique” OR “H02.478.676.570” OR “N02.421.533.571”)) AND (db:(LILACS))	-
CAPES	Síndrome HELLP	88
Cochrane	HELLP syndrome	07

ID^* * ID – identification, article A followed by sequential number.	Author (s)	Year of publication	Country	Objectives	Population and sample size	Methodology	Results	Main findings
A1(²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... )	Adorno M, Maher-Griffiths C, Abadie HRG	2022	USA	Describe care in cases of HELLP syndrome.	NA	Descriptive study	Proposal for 11 specific nursing care measures to assist women with HELLP syndrome.	The study proposes a care plan for women with HELLP syndrome.
A2(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... )	Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF &dos Santos WA	2022	Brazil	Identify the main nursing diagnoses and nursing interventions for women with HELLP syndrome.	NA	Descriptive study based on a literature review and based on NANDA/NIC taxonomy	Eleven nursing diagnoses were described, eight of which were risk diagnoses and three were real. The diagnoses generated 55 possible nursing interventions.	The interventions are aimed at critical and intensive care for women, but also include care for the fetus/neonate and covering the emotional aspects of women and their families.
A3(²¹21. Bhatia R, Bhatia R, Pathak V, Mor S, Gupta S. Safe motherhood after cardiopulmonary resuscitation in a term pregnancy with eclampsia: a maternal near miss. J Clin Diagn Res. 2020;14(11):6–7. doi: http://doi.org/10.7860/JCDR/2020/45297.14210. https://doi.org/10.7860/JCDR/2020/45297.... )	Bhatia R, Pathak V, Mor S & Gupta S	2020	India	Describe a case of a first-time pregnant woman diagnosed with eclampsia and HELLP syndrome.	01	Case study description	First-time pregnant woman, 26 years old, 38 weeks and four days of gestation, with a history of seizures for 48 hours. Upon admission, she was oliguric (100 ml diuresis/12 hours), with blood pressure of 200 x 110, fetal heart rate of 70 bpm and heart rate of 124 bpm. It abruptly progressed to cardiorespiratory arrest. She was immediately intubated and underwent cardiopulmonary resuscitation. Due to the persistence of cardiorespiratory arrest, an emergency cesarean section was performed. The newborn was born weighing 2,500 grams, asphyxiated, with Apgar scores 6/7. She received neonatal intensive care, including respiratory support with continuous positive airway pressure, monitoring of blood parameters, and administration of antibiotics to prevent infection. After the cesarean section, the patient was transferred to the Intensive Care Unit and received ventilatory support. Treatment included adequate antibiotic coverage, control of hypertension and monitoring of laboratory parameters such as platelet count and renal function. After 24 hours, the woman in labor was weaned from the ventilator. Dyas was discharged, without neurological sequel and in good condition.	The study points to the need for a multidisciplinary care team that is qualified to work in cardiopulmonary resuscitation. Timely cesarean section is also highlighted, in more serious cases, to guarantee better outcomes.
A4(²⁰20. Cervantes R, Favre M, Carson-Romero C. Epigastric pain as a potencial indicator of hemolysis-elevated liver enzimes-low plaquets count (HELLP) syndrome in pregnant women. J Obstet Gynecol Neonatal Nurs. 2019;48(Supl 3):S167. doi: http://doi.org/10.1016/j.jogn.2019.04.276. https://doi.org/10.1016/j.jogn.2019.04.2... )	Cervantes R, Favre M& Carson-Romero C	2019	USA	Describe a case of second-time pregnant woman with epigastric pain.	01	Case study description	Second-time pregnant woman, with a previous miscarriage at screening, had intense epigastric pain and uterine contractions for three hours. Her cervix was closed and the fetus was tachycardic (fetal heart rate at 170 bpm). Intravenous therapy was started and a laboratory panel for pre-eclampsia was collected. Laboratory tests were highly suggestive of HELLP. An ultrasound was performed, which showed a large subcapsular hematoma in the liver. After an emergency cesarean section was indicated, a viable newborn was born without complications. During surgery, liver trauma was identified, which required suturing, which progressed to shock and disseminated intravascular coagulation. She required multiple transfusions, frequent visits to the surgical suite for reoperation and intubation for five days. She was discharged 12 days after giving birth.	Every complaint of epigastric pain must be carefully assessed and investigated, as it indicates the severity of the disease. It should be noted that pain precedes the laboratory test that indicates HELLP by several hours; therefore, in the complaint, a differential diagnosis must be carried out.
A5(²⁵25. De Oliveira RS, De Matos IC, Da Silva TBP, Azevedo NM, Andrade M, Do Espirito Santo FH. Síndrome HELLP: estudo de revisão para o cuidado de enfermagem. Enfermería Global. 2012 [cited 2023 Dec 04];28:346. Available from: https://scielo.isciii.es/pdf/eg/v11n28/pt_revision2.pdf. https://scielo.isciii.es/pdf/eg/v11n28/p... )	De Oliveira, RS, De Matos, IC, Da Silva, TBP, De Azevedo, NM, Andrade, M, &Do Espirito Santo, FH	2012	Brazil	Deepen understanding of HELLP syndrome and its evolution.	NA	Descriptive study based on narrative review	Eight studies made up the sample, five case studies, two reviews and one clinical trial. Predominantly laboratory diagnosis and the importance of investigating the syndrome in cases of hypertensive syndrome during pregnancy during prenatal care were observed. The importance of nursing consultation in screening and investigating symptoms is highlighted.	The importance of nursing consultation and in-depth investigation of symptoms is reinforced, especially for women with hypertensive syndrome during pregnancy.
A6(¹⁹19. Desmuk A, Tarale S, Tembhre V, Pathade A. Case report on HELLP syndrome with severe anemia. J Pharm Negat Results. 2022;1102–1105:1102–5. doi: http://doi.org/10.47750/pnr.2022.13.S07.153. https://doi.org/10.47750/pnr.2022.13.S07... )	DeshmukhA, Tarale S, Tembhre V & Pathade A	2022	India	Describe a case of a second-time pregnant woman with HELLP syndrome and severe anemia.	01	Case study description	Second-time pregnant woman, 24 years old, 37 weeks of gestation, complained of edema of the lower limbs bilaterally for a month, chest and abdominal pain, especially on the upper right side, vaginal bleeding, changes in vision, intolerance to heat, especially at night, but with cold palm, insomnia, weight loss due to nausea and vomiting, excessive sweating, dizziness, tremor, increased appetite and headache. Upon vaginal examination, the cervix was closed. Laboratory tests showed low hemoglobin values, a low platelet count and serum bilirubin within normal limits. Ultrasonography revealed a fetus with an age compatible with 31 weeks and altered cardiac flow. A cesarean section was performed under spinal anesthesia, however, during the procedure, the woman in labor developed a seizure and was immediately treated with magnesium sulfate, intravenous fluids and other medications, including oxytocin, vitamin K, tramadol and antibiotics. The newborn was born and cried immediately, indicating good vitality. However, due to low birth weight, the baby was transferred to the Neonatal Intensive Care Unit and received additional care, including continuous positive airway pressure, esophageal feedings every two hours, and administration of antibiotics.	The importance of investigating symptoms and considering the possibility of HELLP syndrome is highlighted, in addition to childbirth for better outcomes and care by a qualified multidisciplinary team.
A7(¹⁸18. Geake J, Dabscheck E, Reid D. Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome in a 26-year-old woman with cystic fibrosis: a case report. J Med Case Reports. 2012;6(1):134. doi: http://doi.org/10.1186/1752-1947-6-134. PubMed PMID: 22620288. https://doi.org/10.1186/1752-1947-6-134... )	Geake J, Dabscheck E &Reid D	2012	Australia	Describe a case of a second-time pregnant woman with cystic fibrosis who presented HELLP syndrome in the third trimester of pregnancy.	01	Case study description	Second-time pregnant woman, 26 years old, had cystic fibrosis as a comorbidity. Two weeks earlier, she experienced nausea and worsening respiratory function. After a week, she continued to experience nausea and worsening respiratory function. She opted for hospitalization, with blood pressure 153 x 89 mmHg, platelets at 101 thousand, alanine aminotransferase at 179 (3 x higher) and lactate dehydrogenase at 279 (<240). An ultrasound was performed with a suspected diagnosis of pre-eclampsia or HELLP. Two doses of corticosteroid therapy were applied within 12 hours, administering antihypertensive drugs. There was stability of the parameters, however, on the fifth day, she developed thrombocytopenia at 62 thousand, alanine aminotransferase at 118 and hemoglobin at 8.8 g/dl, with schistocytes in the blood. A diagnosis of HELLP syndrome was made. The cesarean section was performed ten hours after the result, and did not use magnesium sulfate. The newborn was born healthy, with Apgar scores 9/9. All parameters normalized postpartum.	The need for multidisciplinary teamwork, rigorous observation of symptoms and suspicion of HELLP syndrome, the importance of laboratory diagnosis, and urgent childbirth as definitive treatment were highlighted.
A8(²⁷27. Kidner MC, Flanders-Stepans MB. A model for the HELLP syndrome: the maternal experience. J Obstet Gynecol Neonatal Nurs. 2004;33(1):44–53. doi: http://doi.org/10.1177/0884217503261131. PubMed PMID: 14971552. https://doi.org/10.1177/0884217503261131... )	Kidner MC, Flanders-Stepans MB	2004	USA	Describe theory about the maternal experience of HELLP.	09	Qualitative study based on Grounded Theory, with nine HELLP survivors who had platelet counts below 100 thousand	HELLP‘S traumatic experiences are similar to those of a whirlwind. Even after recovering, the experience continues to be part of women’s emotional and physical aspects, described as common emotions: fear of death, frustration, anger and guilt, a universal feeling of loss of control and lack of information. In the speeches, the following categories emerged: Premonition; Symptoms; Feeling betrayed; The whirlwind; The losses; and No information and no control.	The study points to the need for empathetic care, involving everything from physical care to emotional care for women and their families.
A9(²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... )	Moraes MTS, Sousa RFO, Marcolino KMT, Davim RMB, CarvalhoCFS, Galvão CMB& Oliveira SX	2011	Brazil	Develop a proposal for a care plan for women with HELLP syndrome, taking into account the Nursing Process stages based on the main nursing diagnoses according to NANDA taxonomy.	NA	Descriptive study based on the search for diagnoses in NANDA taxonomy	Six risk diagnoses and four real diagnoses and 46 nursing interventions aimed at women with HELLP syndrome were identified.	The importance of systematizing nursing care in care planning as a guide for care for the team, women and family members is highlighted.
A10(²²22. White A. Emergency care for patients with HELLP Syndrome. Adv Emerg Nurs J. 2006;28(4):338–45. doi: http://doi.org/10.1097/01261775-200610000-00010. doi: http://doi.org/10.1097/01261775-200... )	White A	2006	USA	Describe a case of a first-time pregnant woman diagnosed with HELLP syndrome.	01	Case study description	First-time pregnant woman, 28 years old, 32 weeks of gestation, who complained of extreme weakness. She requested emergency care due to severe pain in the upper quadrant of the abdomen and shoulders and edema of the lower limbs. When emergency services arrived, she was lying supine, pale, cold, and sweating profusely. She had blood pressure at 120x85 mmHg, heart rate at 140 bpm and respiratory rate at 28 bpm. Oxygen therapy 4l/minute and serum therapy were installed during transport. Upon admission, proteinuria was identified, indicating an emergency cesarean section. During the cesarean section, the obstetrician observed active hepatic hemorrhage. A ruptured hepatic hematoma and laceration involving the right lobe of the liver were found. Based on these findings, the diagnosis was expanded to HELLP syndrome. She received multiple transfusions and remained hospitalized in the CCU and on mechanical ventilation. She was discharged after 20 days of hospitalization. The newborn, who was born healthy, was discharged after ten days of life.	The study points to the need for physical care and emotional support for women and their families. Due to the severity of illnesses and possible losses, psychological aspects must be valued.

Nursing care for women with HELLP syndrome
Prenatal care
1. Carefully assess signs and symptoms of HELLP syndrome in women with hypertensive syndromes during prenatal care(²⁵25. De Oliveira RS, De Matos IC, Da Silva TBP, Azevedo NM, Andrade M, Do Espirito Santo FH. Síndrome HELLP: estudo de revisão para o cuidado de enfermagem. Enfermería Global. 2012 [cited 2023 Dec 04];28:346. Available from: https://scielo.isciii.es/pdf/eg/v11n28/pt_revision2.pdf. https://scielo.isciii.es/pdf/eg/v11n28/p... ) 2. Pay attention to the symptoms of HELLP syndrome and the need for investigation based on nursing consultation during prenatal care(²⁵25. De Oliveira RS, De Matos IC, Da Silva TBP, Azevedo NM, Andrade M, Do Espirito Santo FH. Síndrome HELLP: estudo de revisão para o cuidado de enfermagem. Enfermería Global. 2012 [cited 2023 Dec 04];28:346. Available from: https://scielo.isciii.es/pdf/eg/v11n28/pt_revision2.pdf. https://scielo.isciii.es/pdf/eg/v11n28/p... ) 3. Carefully assess and investigate complaints of epigastric and/or right hypochondrium pain in all pregnant women with complaints(²⁰20. Cervantes R, Favre M, Carson-Romero C. Epigastric pain as a potencial indicator of hemolysis-elevated liver enzimes-low plaquets count (HELLP) syndrome in pregnant women. J Obstet Gynecol Neonatal Nurs. 2019;48(Supl 3):S167. doi: http://doi.org/10.1016/j.jogn.2019.04.276. https://doi.org/10.1016/j.jogn.2019.04.2... ) 4. Differentiate signs and symptoms of HELLP syndrome from common signs of pregnancy(²⁷27. Kidner MC, Flanders-Stepans MB. A model for the HELLP syndrome: the maternal experience. J Obstet Gynecol Neonatal Nurs. 2004;33(1):44–53. doi: http://doi.org/10.1177/0884217503261131. PubMed PMID: 14971552. https://doi.org/10.1177/0884217503261131... ) 5. Value clinical history and physical examination as important diagnostic tools(²⁷27. Kidner MC, Flanders-Stepans MB. A model for the HELLP syndrome: the maternal experience. J Obstet Gynecol Neonatal Nurs. 2004;33(1):44–53. doi: http://doi.org/10.1177/0884217503261131. PubMed PMID: 14971552. https://doi.org/10.1177/0884217503261131... )
In the presence of symptoms/diagnosis
1. Promote emergency transportation/care(²²22. White A. Emergency care for patients with HELLP Syndrome. Adv Emerg Nurs J. 2006;28(4):338–45. doi: http://doi.org/10.1097/01261775-200610000-00010. doi: http://doi.org/10.1097/01261775-200... ) 2. Provide maternal hospitalization, preferably in a CCU(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ) 3. During maternal hospitalization, request a place in the neonatal CCU(²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ) 4. Continuously monitor mother and fetus(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ,²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ), paying attention to vital signs. 5. Strictly control blood pressure, paying attention to systolic values above 160 mmHg and diastolic values above 110 mmHg(²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ) 6. Puncture and maintain patent large-caliber venous access(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 7. Perform blood gas analysis for acid-base control according to medical prescription(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 8. Perform a rigorous water balance(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 9. Administer oxygen therapy(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 10. Provide ventilatory care, if necessary(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 11. Supervise mechanical ventilation, if necessary(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 12. Maintain strict monitoring of the level of consciousness by applying the Glasgow Coma Scale(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 13. Prevent seizures with the use of magnesium sulfate, if necessary(²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ), as well as aspiration and possible injuries in case of seizures(²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 14. Perform a detailed physical examination, including palpation of the right hypochondrium, inspection of the skin for signs of jaundice and/or pallor, observation of skin hydration, and presence of edema(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 15. If an emergency or immediate delivery is necessary, depending on gestational age, assess with the team the need and possibility of performing corticosteroid therapy(²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ) 16. Plan the cesarean section in a timely manner(¹⁸18. Geake J, Dabscheck E, Reid D. Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome in a 26-year-old woman with cystic fibrosis: a case report. J Med Case Reports. 2012;6(1):134. doi: http://doi.org/10.1186/1752-1947-6-134. PubMed PMID: 22620288. https://doi.org/10.1186/1752-1947-6-134... ,¹⁹19. Desmuk A, Tarale S, Tembhre V, Pathade A. Case report on HELLP syndrome with severe anemia. J Pharm Negat Results. 2022;1102–1105:1102–5. doi: http://doi.org/10.47750/pnr.2022.13.S07.153. https://doi.org/10.47750/pnr.2022.13.S07... ,²¹21. Bhatia R, Bhatia R, Pathak V, Mor S, Gupta S. Safe motherhood after cardiopulmonary resuscitation in a term pregnancy with eclampsia: a maternal near miss. J Clin Diagn Res. 2020;14(11):6–7. doi: http://doi.org/10.7860/JCDR/2020/45297.14210. https://doi.org/10.7860/JCDR/2020/45297.... ,²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ) 17. Use communication skills during care: reassure women; welcome with empathetic and work on active listening; always maintain eye contact during communication; and, if they are aware, inform them about the situation and allow them to make decisions(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ,²⁷27. Kidner MC, Flanders-Stepans MB. A model for the HELLP syndrome: the maternal experience. J Obstet Gynecol Neonatal Nurs. 2004;33(1):44–53. doi: http://doi.org/10.1177/0884217503261131. PubMed PMID: 14971552. https://doi.org/10.1177/0884217503261131... ) 18. Promote care with a trained multidisciplinary team(²¹21. Bhatia R, Bhatia R, Pathak V, Mor S, Gupta S. Safe motherhood after cardiopulmonary resuscitation in a term pregnancy with eclampsia: a maternal near miss. J Clin Diagn Res. 2020;14(11):6–7. doi: http://doi.org/10.7860/JCDR/2020/45297.14210. https://doi.org/10.7860/JCDR/2020/45297.... ), including training in cases of cardiorespiratory arrest(¹⁸18. Geake J, Dabscheck E, Reid D. Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome in a 26-year-old woman with cystic fibrosis: a case report. J Med Case Reports. 2012;6(1):134. doi: http://doi.org/10.1186/1752-1947-6-134. PubMed PMID: 22620288. https://doi.org/10.1186/1752-1947-6-134... ,²¹21. Bhatia R, Bhatia R, Pathak V, Mor S, Gupta S. Safe motherhood after cardiopulmonary resuscitation in a term pregnancy with eclampsia: a maternal near miss. J Clin Diagn Res. 2020;14(11):6–7. doi: http://doi.org/10.7860/JCDR/2020/45297.14210. https://doi.org/10.7860/JCDR/2020/45297.... )
Immediate and immediate postpartum period
1. Strictly assess/monitor lochiation every 15 minutes(²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ) due to increased risk of bleeding 2. After maternal stabilization, promote bonding with newborn(²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ) 3. As soon as the postpartum woman is stable, encourage breastfeeding or perform mechanical milking, if necessary(²⁶26. Adorno M, Maher-Griffiths C, Abadie HRG. HELLP syndrom. Critic Care Nurs N Am. 2022;34(3):277–88. doi: http://doi.org/10.1016/j.cnc.2022.04.009. PubMed PMID: 36049847. https://doi.org/10.1016/j.cnc.2022.04.00... ) 4. Observe the surgical incision for phlogistic signs and bleeding(²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 5. Promote aseptic care when handling probes, drains and catheters(²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 6. Promote skin hydration care and change position periodically, if necessary(²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... ) 7. Assess maternal conditions and advise on newborn care(²⁴24. Moraes MTS, Sousa FRO, Marcolino KMT, Davim RMB, Carvalho CFS, Galvão MCB, et al. Síndrome HELLP: proposta de um plano assistencial. Saúde Coletiva. 2011 [citado 2023 dez 04];8(54):244–8. Available from: http://www.redalyc.org/articulo.oa?id=84221108005. http://www.redalyc.org/articulo.oa?id=84... )
Family care
1. Assure the family that the woman and fetus are receiving the best care possible(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ) 2. Respect the privacy of each family member(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ) 3. Actively listen to family members’ concerns, questions and feelings(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ) 4. Provide information about the nursing care provided(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ) 5. Promote family involvement in decisions and care(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... ) 6. Offer necessary support/support(²³23. Beltrão HB, Brito CGR, Sousa DC, da Silva MEF, Brandão PF, dos Santos WA. Main nursing diagnoses and interventions for Hellp Syndrome. Salud Cienc. Tecnol. 2022;2:106. doi: http://doi.org/10.56294/saludcyt2022106. https://doi.org/10.56294/saludcyt2022106... )
Care at hospital discharge or during hospital stay
1. Promote continuous emotional support in the postpartum period(²⁷27. Kidner MC, Flanders-Stepans MB. A model for the HELLP syndrome: the maternal experience. J Obstet Gynecol Neonatal Nurs. 2004;33(1):44–53. doi: http://doi.org/10.1177/0884217503261131. PubMed PMID: 14971552. https://doi.org/10.1177/0884217503261131... ) 2. Promote emotional/psychological care for postpartum women and their families in cases of fetal/neonatal loss(²²22. White A. Emergency care for patients with HELLP Syndrome. Adv Emerg Nurs J. 2006;28(4):338–45. doi: http://doi.org/10.1097/01261775-200610000-00010. doi: http://doi.org/10.1097/01261775-200... ,²⁷27. Kidner MC, Flanders-Stepans MB. A model for the HELLP syndrome: the maternal experience. J Obstet Gynecol Neonatal Nurs. 2004;33(1):44–53. doi: http://doi.org/10.1177/0884217503261131. PubMed PMID: 14971552. https://doi.org/10.1177/0884217503261131... ) 3. Refer at discharge to a support group to share and talk about their experience and be able to give it a new meaning(²⁷27. Kidner MC, Flanders-Stepans MB. A model for the HELLP syndrome: the maternal experience. J Obstet Gynecol Neonatal Nurs. 2004;33(1):44–53. doi: http://doi.org/10.1177/0884217503261131. PubMed PMID: 14971552. https://doi.org/10.1177/0884217503261131... )

[1] Corresponding author: Mariana Torreglosa Ruiz, Praça Manoel Terra, 330, Centro, 38025-015 – Uberaba, MG, Brazil, mariana.ruiz@uftm.edu.br

Brasil

Brasil

Cuidados de enfermagem a mulheres com síndrome HELLP: scoping review Atención de enfermería a mujeres con síndrome HELLP: revisión del alcance

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