HELLP Syndrome

What is HELLP syndrome?

HELLP syndrome is a life-threatening disease associated with preeclampsia that usually occurs in 5 to 8 percent of pregnancies, usually after the 20th week of pregnancy. Preeclampsia can also occur early in pregnancy or, rarely, postpartum.

HELLP syndrome is a liver and blood disorder that can be fatal if left untreated. The symptoms of HELLP syndrome are diverse and vague, and it can be difficult to diagnose initially. The name HELLP syndrome is an abbreviation for the three main abnormalities seen in the initial laboratory analysis. These include:

  • H emolysis
  • HAND : elevated liver enzymes
  • LP : Low platelet count

hemolysis refers to the breakdown of red blood cells. In patients with hemolysis, red blood cells break down too soon and too quickly. This can cause low red blood cell levels and eventually lead to anemia, a condition in which the blood does not carry enough oxygen to the rest of your body.

elevated liver enzymes indicates that your liver is not working properly. Inflamed or injured liver cells flush large amounts of certain chemicals, including enzymes, into your blood.

platelets of your blood components that help coagulation. When platelet levels are low, the risk of excessive bleeding increases.

HELLP syndrome is a rare disorder that affects less than 1 percent of all pregnancies. However, this is a major health concern and can be life-threatening for both the mother and the unborn baby. Immediate treatment and delivery of the baby is usually required for best results.

HELLP syndrome usually develops in the last trimester of pregnancy, but can occur early or even postpartum. The cause of the symptoms is unknown. Some experts believe that HELLP syndrome is a severe form of preeclampsia, a pregnancy complication that causes high blood pressure. About 10-20 percent of women who develop preeclampsia also develop HELLP syndrome.

There are also some factors that can increase your risk of developing HELLP syndrome if you have pre-existing high blood pressure or diabetes, advanced maternal age, having multiples such as twins, and a previous history of preeclampsia.

What are the symptoms of HELLP syndrome?

HELLP syndrome symptoms are the same as stomach flu. The symptoms may seem like “normal” signs of pregnancy. However, it’s important to see your doctor right away if you experience flu-like symptoms during pregnancy. Only your doctor can be sure that your symptoms do not indicate serious health problems.

Symptoms of HELLP syndrome can vary from person to person, but the most common are:

  • feeling generally uncomfortable or tired
  • stomach pain, especially in the upper abdomen
  • nausea
  • vomiting
  • headache

You may also experience:

  • swelling, especially in the hands or face
  • excessive and sudden weight gain
  • blurred vision, loss of vision, or other changes in vision
  • headache
  • shoulder pain
  • pain when taking deep breaths

In rare cases, you may also have confusion and seizures. These signs and symptoms usually indicate advanced HELLP syndrome and should be promptly evaluated by your doctor.

What are the risk factors for HELLP syndrome?

The cause of HELLP syndrome is unknown, but there are some factors that can increase your risk of developing it.

preeclampsia is the biggest risk factor. This condition is marked by high blood pressure and usually occurs in the last trimester of pregnancy. However, it can occur during pregnancy or early postpartum (in rare cases). Not all pregnant women with preeclampsia develop HELLP syndrome.

Other risk factors for HELLP include:

  • be over 35 years old
  • being African-American
  • be obese
  • have previous pregnancies
  • having diabetes or kidney disease
  • hypertension
  • a history of preeclampsia

You’re also at a higher risk for HELLP syndrome if you’ve had the condition during a previous pregnancy. A study found that the risk of recurrence for hypertensive disorders, including preeclampsia and HELLP, in future pregnancies showed that about 18 percent .

How is HELLP syndrome diagnosed?

If HELLP syndrome is suspected, your doctor will perform a physical exam and order various tests. During the exam, your doctor may feel abdominal tenderness, an enlarged liver, and excessive swelling. These could be signs of a liver problem. Your doctor may also check your blood pressure.

Some tests can help your doctor make a diagnosis. Your doctor may also order:

  • blood tests to evaluate platelet levels, liver enzymes, and red blood cell count
  • urine test to check for abnormal proteins
  • MRI to determine if there is bleeding in the liver

How is HELLP syndrome treated?

Once a diagnosis of HELLP syndrome is confirmed, delivery of the baby is the best way to prevent complications, as this should stop the progression of the disease. In most cases, the baby is born prematurely.

However, your treatment may vary depending on the severity of your symptoms and how close you are to your due date. If your HELLP syndrome symptoms are mild or your baby is less than 34 weeks, your doctor may recommend:

  • blood transfusions to treat anemia and low platelet levels
  • magnesium sulfate to prevent seizures
  • antihypertensive drugs to control blood pressure
  • corticosteroid medication to help your baby’s lungs mature when premature birth is needed

During treatment, your doctor monitors your red blood cell, platelets, and liver enzyme levels. Your baby’s health will also be closely monitored. Your doctor may recommend certain prenatal tests that evaluate movement, heart rate, stress, and blood flow. You will be admitted to the hospital for close monitoring.

If your doctor determines that your condition warrants immediate delivery to your baby, you may be given medications to aid in labor. In some cases, a cesarean delivery is necessary. However, if there are blood clotting problems related to low platelet levels, this can cause complications.

What is the long-term outlook for women with HELLP syndrome?

Most women with HELLP syndrome recover completely if the condition is treated early. Symptoms also improve markedly after the baby is born. Most of the symptoms and side effects go away within a few weeks after giving birth. It is important to follow up with your doctor after delivery to assess the resolution of the disease.

Perhaps the biggest concern is the impact of HELLP syndrome on the baby. Most babies are born prematurely when mothers develop HELLP syndrome, so they have a greater risk of complications from premature birth. Babies born before 37 weeks are carefully monitored in the hospital before going home.

Possible complications of HELLP syndrome

Complications associated with HELLP syndrome include:

  • liver rupture
  • kidney failure
  • acute respiratory failure
  • fluid in the lungs (pulmonary edema)
  • excessive bleeding during childbirth
  • placental abruption, which occurs when the placenta separates from the uterus before the baby is born
  • stroke
  • death

Early treatment is the key to preventing these complications. However, even with treatment, there can be some complications. The symptoms of HELLP syndrome can also affect you and your baby after birth.

Preventing HELLP syndrome

HELLP syndrome is not preventable in most pregnant women because the cause of the condition is unknown. However, people can lower their risk of HELLP syndrome by maintaining a healthy lifestyle to prevent pre-existing conditions that can increase the risk, such as diabetes or high blood pressure. This includes exercising regularly and eating a heart-healthy diet consisting of whole grains, vegetables, fruits, and lean protein.

If you have these or other risk factors, regular routine prenatal care is important so your doctor can evaluate you right away if you start developing preeclampsia or HELLP. Some doctors may recommend taking low-dose aspirin during a subsequent pregnancy for prevention, based on your personal care.

It is also important to contact your doctor immediately if you experience symptoms of HELLP syndrome. Early diagnosis and treatment can help reduce the risk of complications.

Resources:

HELLP syndrome. (2013).

HELLP syndrome. (2015).

HELLP syndrome. (2015).

Hypertension in pregnancy. (2013).

van Oostwaard MF, et al. (2015) Relapse of hypertensive disorders of pregnancy: meta-analysis of individual patient data DOI:

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