Definition

HELLP syndrome is a rare complication of pregnancy, typically occurring in the third trimester. It is a type of hypertension in pregnancy often associated with preeclampsia, usually manifesting after the 20th week of pregnancy.

This syndrome can also occur after the birth of the placenta, but it can emerge any time after 20 weeks of pregnancy and, in special cases, even before 20 weeks. HELLP syndrome is a disorder of the liver and blood that can be fatal if not treated.

HELLP syndrome can cause problems with blood, liver function, and blood pressure. If not addressed, these issues can affect both the mother and fetus. HELLP syndrome is rare, affecting less than 1% of all births.

What HELLP Stands For

HELLP is an acronym for:

• H: Hemolysis, the breakdown or destruction of red blood cells. Red blood cells carry oxygen from the lungs to the rest of the body. In some people with hemolysis, red blood cells break down too early and too quickly, leading to anemia. Anemia results in the blood not carrying enough oxygen throughout the body.
• EL: Elevated Liver Enzymes, which are enzymes that speed up body reactions like protein breakdown. Elevated liver enzymes indicate that the liver is not functioning properly. Swelling or injury to liver cells will show increased levels of these enzymes in the blood. Some of these enzymes include SGOT and SGPT.
• LP: Low Platelet Count, where platelets (thrombocytes) are responsible for blood clotting. Low platelet levels increase the risk of bleeding.

Causes

The exact cause of HELLP syndrome is unknown. Some experts suggest that HELLP syndrome is a severe form of preeclampsia (a pregnancy complication causing high blood pressure). Approximately 10-20% of pregnant women with preeclampsia may also develop HELLP syndrome.

Risk Factor

Several factors can increase the risk of HELLP syndrome, including:

• Chronic conditions: having pre-existing chronic diseases such as high blood pressure or diabetes.
• Age: Being older than 25 years during pregnancy.
• Previous experiences: preeclampsia and/or HELLP syndrome in previous pregnancies.
• Multiple pregnancies: being pregnant with twins or more.
• Obesity
• Race: White women have a higher risk of developing HELLP syndrome

Symptoms

The symptoms of HELLP syndrome resemble digestive disorders. Some symptoms appear common and may be mistaken for usual pregnancy symptoms. Therefore, regular check-ups and consultation with a doctor are crucial if a pregnant woman experiences flu-like symptoms.

Some women recognize HELLP syndrome while they are pregnant or shortly after giving birth. Symptoms of HELLP syndrome include:

• Most common symptom: upper right abdominal pain or pain around the upper abdomen
• Blurred vision or blindness
• Fatigue
• Swelling (edema) due to fluid accumulation
• Rapid weight gain
• Nausea and vomiting
• Shoulder pain
• Headaches
• Fainting or loss of consciousness
• Nosebleeds
• Seizures

Diagnosis

Doctors will ask several questions to diagnose HELLP syndrome, such as abdominal pain, especially in the upper right, blood pressure, and leg swelling.

Laboratory Tests

Doctors will recommend several tests, such as blood tests, to check:

• The number and health of blood cells (to see if there are any damaged cells).
• Liver function.
• Kidney function.
• Urine tests to check for protein in the urine (proteinuria).

Imaging Examinations

In severe cases, doctors may recommend an abdominal ultrasound or CT scan to check for liver swelling or bleeding. Fetal health assessments, such as fetal ultrasound and Doppler to check fetal heart rate (FHR), are also necessary.

Management

Doctors will advise bed rest and provide medication to lower blood pressure and prevent seizures (e.g., magnesium sulfate). They may also administer corticosteroids to help fetal lung development if the pregnancy is not yet 37 weeks.

Several women may require blood transfusions to address anemia and low platelet counts. During treatment, doctors will monitor red blood cell levels, platelet counts, and liver enzyme levels. Fetal health monitoring, including fetal movements, FHR, blood flow, and signs of fetal distress, will also be conducted.

Delivery

The primary treatment for HELLP syndrome is early delivery. This means the baby may be delivered before 37 weeks of pregnancy. If the mother wishes to continue the pregnancy, it poses risks to both her and the fetus. Doctors will induce labor or perform a cesarean section to deliver the baby.

Complications

Complications from HELLP syndrome include:

• Blood clotting disorders
• Severe bleeding
• Liver bleeding or even liver failure
• Kidney failure
• Placental abruption
• Fluid accumulation in the lungs
• Seizures
• Stroke
• Complications for the fetus, including intrauterine growth restriction (IUGR)
• Death

Generally, HELLP syndrome resolves after the placenta is delivered.

Prevention

There is no known way to prevent HELLP syndrome. Regular pregnancy check-ups are essential so that doctors can monitor blood pressure and other vital signs to detect any issues early. Doctors may prescribe low-dose aspirin in the first trimester if the mother is at high risk of developing HELLP syndrome.

Tips to Avoid HELLP Syndrome Risk Factors

Several ways to reduce the risk factors for HELLP syndrome include:

• Maintaining a healthy lifestyle.
• Eating a healthy diet, including adequate protein, low-fat foods, vegetables, and fruits.
• Exercise regularly as advised by the doctor.
• Getting enough sleep—at least 8 hours per night.
• Regular pregnancy check-ups.
• Consulting the doctor about potential health risks.
• Informing the doctor if the mother has previously experienced HELLP syndrome, preeclampsia, or other blood pressure issues.

When to See a Doctor?

Immediately take the mother to the hospital emergency room, if the mother suddenly experiences bleeding from the vagina, blurred vision, blindness, seizures, looking confused, or even fainting while pregnant. Untreated HELLP syndrome can cause severe health complications.

Looking for more information about other diseases? Click here!