HELLP Syndrome

"HELLP" stands for the three major elements of the syndrome: (H) hemolysis, (EL) elevated liver enzymes, and a (LP) low platelet count. Hemolysis involves the destruction of red blood cells.

HELLP is a rare, but life-threatening medical condition that occurs in 0.2% to 0.6% of pregnancies. Though the cause of HELLP is not yet fully understood, it can lead to lung and heart failure, permanent liver and kidney damage, internal bleeding, stroke, and other serious complications in the mother. It can also cause early placental detachment from the uterine wall (placenta abruptio), which can lead to fetal death. Other serious complications for the fetus include intrauterine growth restriction and respiratory distress syndrome.

Approximately 1% of women with HELLP syndrome and 7 to 20% of their babies die as a result of HELLP.

Although any pregnant woman can get HELLP syndrome, some are at higher risk, including those who:

• Are at the extreme ends of the age group (over age 35 or under age 20).
• Never gave birth before.
• Have blood pressure problems such as high blood pressure, preeclampsia, or eclampsia.
• Experienced problems with HELLP, preeclampsia, or eclampsia in past pregnancies.

Most affected women develop HELLP in their third trimester, though the condition sometimes develops in the second trimester or in the week after delivery.

HELLP can make mothers very, very sick. In one study of women with HELLP, more than half needed a blood transfusion. Complications may require invasive treatments such as dialysis, for kidney failure, and intubation, for severe swelling of the lungs.

How Do I Know I Have It?
The symptoms include fatigue, general malaise, pain in the upper right part of the abdomen, nausea, vomiting, headache, blurry vision, and water retention accompanied by excessive weight gain. Some women also have convulsions. Because most of these symptoms are common in a normal pregnancy or mimic other ailments like the flu, HELLP syndrome is difficult to diagnose. Report any seizures, abdominal pain, or flu-like symptoms to your doctor right away.

If your doctor suspects the syndrome, she will order a complete blood count to look for signs of hemolytic anemia and a platelet count. She will also order liver function tests that detect specific enzymes which signal liver damage, and she may order blood-clotting studies.

A number of other diseases that involve blood vessel and clotting abnormalities can be confused with HELLP. These include: systemic lupus erythematosus (SLE); acute fatty liver of pregnancy (AFL); thrombotic thrombocytopenic purpura (TTP); and other collagen vascular diseases.

How Can I Treat It?
The first-line treatment is delivering the baby as soon as possible if you are close to term. Your doctor may induce labor (with or without the use of cervical ripening agents) or schedule an early cesarean section.

If you are fewer than 32 weeks pregnant and your symptoms are not severe, your doctor may choose a conservative approach: bed rest, fluids, and close monitoring. This is controversial, because studies have not shown that delaying delivery improves survival for babies. Moreover, mothers with HELLP sometimes become sicker, making it difficult to safely prolong pregnancy.

Your doctor may give you medications to control or prevent complications such as high blood pressure or seizure. If the anemia or bleeding problems are severe, your doctor may give you a blood transfusion. She may also give you corticosteroids to help your baby's lungs develop faster in preparation for early delivery.

How Can I Prevent It?
HELLP is not preventable, but early detection increases the chances of your and your baby's survival. That's why you should report any seizures, persistent headaches, blurry vision, or abdominal pain to your doctor right away.

Frequently Asked Questions

Q: How will HELLP affect my baby?

A: Your baby may experience complications related to prematurity, such as respiratory distress syndrome. He may need to stay in a neonatal intensive care unit, where he can be monitored very carefully as he continues to develop. HELLP is less likely to harm your fetus if you are near 37 weeks and your lab results are close to normal. If abruptio placenta occurs there is a lack of blood flow to the baby and your baby could suffer serious injury.

Review Date: 10/22/2008
Reviewed By: Peter J. Chen, MD, Department of Obstetrics & Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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