HELLP syndrome: Everything you need to know

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HELLP syndrome is a rare but life-threatening pregnancy complication. It causes issues with blood, liver, and blood pressure.

Dr. Louis Weinstein named the condition in 1982 based on the problems it causes. The name stands for:

• H — hemolysis, which is the breakdown of red blood cells
• EL — elevated liver enzymes
• LP — low platelet count

HELLP syndrome typically occurs during the later stages of pregnancy or shortly after childbirth.

According to older research, approximately 70% of cases develop before delivery, mostly between weeks 27 and 37 of pregnancy. The remaining cases occur within 48 hours of delivery.

It can be difficult for doctors to diagnose HELLP syndrome because its symptoms resemble those of many other conditions.

The syndrome can cause complications for both the pregnant woman and the developing fetus. Without treatment, it can be fatal.

There is a link between HELLP syndrome and preeclampsia. Preeclampsia is another pregnancy complication that often results in high blood pressure and damage to organs, often the liver and kidneys.

Preeclampsia typically occurs after 20 weeks of pregnancy. As with HELLP syndrome, preeclampsia can cause life-threatening complications if left untreated.

Some experts believe that HELLP syndrome is a severe form of preeclampsia.

The symptoms of HELLP syndrome can resemble those of many other conditions, including preeclampsia.

Symptoms include:

• changes in vision
• fatigue
• headache
• indigestion
• malaise
• nausea and vomiting
• pain when breathing deeply
• shoulder pain
• sudden weight gain
• swelling of the hands, legs, or face
• tenderness or pain in the upper right stomach

Rarely, people with HELLP syndrome may experience confusion and seizures.

Signs a doctor will check for to indicate HELLP syndrome include:

• high blood pressure
• protein in the urine

The exact cause of HELLP syndrome is unknown. However, certain factors increase a person’s likelihood of developing the condition. These risk factors include:

• having preeclampsia
• having a history of preeclampsia or HELLP syndrome
• being older than 25
• being Caucasian
• having obesity
• having given birth two or more times previously
• having diabetes, kidney disease, or high blood pressure

A doctor can diagnose HELLP syndrome based on a physical examination and blood and urine tests.

The doctor will look for signs of:

• high blood pressure
• an enlarged liver
• swelling in the face, hands, or legs
• abnormal liver function
• abnormal blood platelet count

The doctor may also order an imaging scan to look for bleeding in the liver.

Sometimes, doctors find it challenging to diagnose HELLP syndrome. This is especially true when there are no signs of high blood pressure or protein in the urine.

A doctor may mistake the symptoms for gastritis, gallbladder disease, or the flu.

Where a doctor does diagnose HELLP syndrome, they may class it as:

• class I: severe thrombocytopenia (platelets under 50,000 cubic millimeters (mm3))
• class II: moderate thrombocytopenia (platelets between 50,000 and 100,000/mm3)
• class III: mild thrombocytopenia (platelets between 100,000 and 150,000/mm3)

The most common and effective treatment for people with HELLP syndrome is delivering the baby.

Often, early delivery of the baby is less risky than continuing a pregnancy with HELLP syndrome.

Doctors will usually recommend delivering the baby if severe preeclampsia or HELLP syndrome occurs after week 34 of the pregnancy.

Before this, a doctor may deliver the baby if the health of the fetus or mother deteriorates.

Other treatments that may be necessary include:

• a blood transfusion to increase low platelet count
• corticosteroids to help the baby’s lungs mature
• medication for high blood pressure or seizure prevention

HELLP syndrome can cause significant complications for both mother and baby, including:

• liver rupture
• placental abruption
• seizures
• stroke

Placental abruption occurs when the placenta separates from the uterine wall. It occurs before the baby is born and may lead to premature birth or stillbirth.

Although severe complications are relatively common, the long-term outlook for women with HELLP syndrome is good.

The outlook for the fetus or newborn depends on the age and birth weight at delivery. The overall risk of death for the fetus or newborn is 7–20%.

Babies who are born early may also experience complications. The Preeclampsia Foundation indicate that babies weighing at least 2 pounds (lb) have the same survival rate and outlook as non-HELLP babies of the same size.

If the baby weighs less than 2 lb at delivery, they are more likely to require longer periods of hospitalization and ventilator care.

Having a history of HELLP syndrome increases the risk of preeclampsia or HELLP syndrome in future pregnancies.

One study indicates that the risk of these disorders in future pregnancies is approximately 18%.

While it is not possible to prevent HELLP syndrome, a person can reduce the likelihood of developing serious complications during pregnancy by:

• losing weight before getting pregnant, if overweight
• attending all prenatal appointments during pregnancy
• understanding the signs and symptoms of HELLP syndrome and preeclampsia
• providing healthcare professionals with a full medical history, including previous pregnancy complications and a family history of pregnancy complications
• seeking help immediately if symptoms develop

HELLP syndrome is a rare but serious complication of pregnancy. With treatment, most women with the condition will recover.

Without treatment, HELLP syndrome can lead to severe and life-threatening complications.

Treatment for HELLP syndrome typically involves delivering the baby, particularly if the condition develops after the 34th week of pregnancy, or if the health of the mother or fetus declines.

People who have concerns about preeclampsia, HELLP syndrome, or other pregnancy complications should speak to their doctor. Those who are showing signs and symptoms of HELLP syndrome should seek immediate medical attention.