HELLP Syndrome

What is HELLP syndrome?

HELLP syndrome is a serious complication of severe gestational hypertension (high blood pressure problems of pregnancy). The actual incidence is not known, but it appears to develop in 1 to 2 out of 1,000 pregnancies, and in 10 to 20 percent of pregnant women with severe preeclampsia or eclampsia. It usually develops before delivery but may occur postpartum (after delivery) as well. HELLP syndrome consists of the following problems:

• Hemolysis--red blood cells break down.

• Elevated liver enzymes--damage to liver cells cause changes in liver function lab tests.

• Low platelets--cells found in the blood that are needed to help the blood to clot in order to control bleeding.

What causes HELLP syndrome?

The cause of HELLP syndrome is unknown. Some conditions may increase the risk of developing HELLP syndrome, including the following:

• Preeclampsia during pregnancy

• Previous pregnancy with HELLP syndrome

Why is HELLP syndrome a concern?

In addition to the risks of high blood pressure during pregnancy, which include poor blood flow to organs and possible seizures, HELLP syndrome can cause other problems. The breakdown of red blood cells may cause anemia, and blood clotting problems may occur.

A serious blood clotting complication called disseminated intravascular coagulation (DIC) may lead to severe bleeding or hemorrhage. Placental abruption (early detachment of the placenta) may also occur. Pulmonary edema (fluid buildup in the lungs) is also a serious complication.

Severe disease may place the mother and fetus in danger and it may be necessary to deliver the baby early to prevent further complications. Recovery from HELLP syndrome may take several days after delivery. HELLP syndrome is a serious disease and can be life threatening for both mother and her baby.

What are the symptoms of HELLP syndrome?

The following are the most common symptoms of HELLP syndrome. However, each woman may exhibit experience symptoms differently. Symptoms may include:

• Right-sided upper abdominal pain or pain around the stomach

• Nausea, vomiting

• Headache

• Increased blood pressure

• Protein in the urine

• Edema (swelling)

The symptoms of HELLP syndrome may resemble other medical conditions, including pregnancy-induced hypertension. Always consult your doctor for a diagnosis.

How is HELLP syndrome diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for HELLP syndrome may include:

• Blood pressure measurement

• Red blood cell count

• Bilirubin level--a substance produced by the breakdown of red blood cells.

• Liver function tests

• Platelet count--cells found in the blood that are needed to help the blood clot to control bleeding.

• Urine tests for protein

Treatment for HELLP syndrome

Specific treatment for HELLP syndrome will be determined by your doctor based on:

• Your pregnancy, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment may include:

• Bedrest (either at home or in the hospital may be recommended)

• Hospitalization (as specialized personnel and equipment may be necessary)

• Blood transfusions (for severe anemia and low platelets)

• Magnesium sulfate (to prevent seizures)

• Antihypertensive medications (to reduce blood pressure)

• Fetal monitoring (to check the health of the fetus) may include:

  • Fetal movement counting--keeping track of fetal kicks and movements. A change in the number or frequency may mean the fetus is under stress.

  • Nonstress testing--a test that measures the fetal heart rate in response to the fetus' movements.

  • Biophysical profile--a test that combines nonstress test with ultrasound to observe the fetus.

  • Doppler flow studies--a type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel.  

• Laboratory testing of liver, urine, and blood (for changes that may signal worsening of HELLP syndrome)

• Medications, called corticosteroids, that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies)

• Delivery (if HELLP syndrome worsens and endangers the well-being of the mother or fetus, then an early delivery may be necessary)

Prevention of HELLP syndrome

Early identification of women at risk for HELLP syndrome may help prevent some complications of the disease. Education about the warning signs is also important because early recognition may help women receive treatment and prevent worsening of the disease.