Intravascular hemolysis, elevated liver function tests and low platelets counts (thrombocytopenia) also known as HELLP syndrome has been recognized as a complication of severe preeclampsia and eclampsia for many decades. The purpose of this document is to describe the pathogenesis, diagnosis and management of this syndrome. The presence of this syndrome is associated with increased risk of adverse outcome for both mother and fetus. This review will explain the controversies surrounding the diagnosis and management of this syndrome. Recommendations for the counseling of these women are also provided based on the results of recent studies.Read More

When any fetal group factor inherited from the father is not possessed by the mother, antepartum or intrapartum fetal-maternal bleeding may stimulate an immune reaction by the mother. The term hemolytic disease of the fetus/newborn, for instance has replaced hemolytic disease of the newborn because modern diagnostic techniques now allows us to detect the disorder much earlier. To prevent the disease, routine postpartum use of Rhesus immune globulin (Rh I G) in Rh-negative patients was introduced in the United States over 40 years ago. A subsequent recommendation for routine antenatal use at 28 weeks' gestation was introduced 20 years later. Despite these efforts, a recent review of the 2001 birth certificates in the US by the Centers for Disease Control and Prevention indicates that Rh sensitization still affects 6.7 out of every 1,000 live births. Maternal immune reactions can also occur from blood product transfusion.Read More