What is HELLP syndrome?

HELLP syndrome is a rare but serious complication of pregnancy that typically occurs in the third trimester. It is usually considered a complication of preeclampsia, and is estimated to affect one to two pregnancies out of every 1000, and up to 10% of pregnant women with severe preeclampsia. [1]

The condition name, HELLP, is an acronym:

  • H is for haemolysis, which is the breakdown of red blood cells. In HELLP syndrome, the red blood cells are broken down earlier than normal, which can lead to anaemia;
  • EL is for Elevated Liver enzymes, which indicates abnormal liver function, and;
  • LP is for a Low Platelet count. Platelets are important in blood clotting, so a low platelet count is associated with an increased risk of excessive bleeding.

HELLP syndrome typically arises in the third trimester of pregnancy, but in some cases it may occur in the first week after the baby is born.

Preeclampsia and HELLP syndrome are typically characterised by high blood pressure, which may lead to stroke, seizures, or multiple organ failure if it is left untreated.

Women with HELLP syndrome may experience severe abdominal pain below their ribs, not unlike heartburn, except antacids will not relieve their pain. Other symptoms of HELLP syndrome can be easily confused with gall bladder disease or viral illnesses.

 

Anaemia

A deficiency in red blood cells or haemoglobin in the body.

Gall bladder

A small organ attached to the liver that stores bile until it is released into the small intestine, to aid the digestion of food.

Platelet

Small blood cells found in the blood that are essential for clotting to occur.

Red blood cells

Cells in the blood that transport oxygen from the lungs throughout the body and carbon dioxide from the body to the lungs.

Seizures

A sudden, involuntary contraction of muscle groups caused by abnormal electrical activity in the brain.

Trimester

One third of a period of time. Often used to describe the three stages of pregnancy, in which each trimester is about three months long.

Viral

Pertaining to an illness caused by a virus.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Clotting

The process by which blood changes from a liquid to a semi-solid state, usually to seal off any sites of bleeding. This is also known as coagulation.

Liver enzymes

Proteins that help to speed up chemical reactions in the liver. Elevated levels of liver enzymes may be an indication of liver damage or inflammation.

1. HELLP Syndrome: MedlinePlus Medical Encyclopedia. Accessed November 11, 2014.

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Causes

It is still not clear what causes some pregnant women to develop HELLP syndrome.

1. HELLP Syndrome: MedlinePlus Medical Encyclopedia. Accessed November 11, 2014.

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Risk factors

Risk factors for developing HELLP syndrome include:

  • A history of HELLP syndrome in a previous pregnancy;
  • Preeclampsia;
  • A poor diet;
  • Being over the age of 25;
  • Being Caucasian;
  • Being inactive, and;
  • Diabetes mellitus.

Diabetes

A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterised by high blood sugar levels. Also known as diabetes mellitus.

1. HELLP Syndrome: MedlinePlus Medical Encyclopedia. Accessed November 11, 2014.

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Signs and symptoms

The symptoms of HELLP syndrome are often vague and can be easily confused with other medical conditions. Most cases of HELLP syndrome occur before the 37th week of pregnancy, but some cases may develop in the week after the baby is born.

Some of the signs and symptoms associated with HELLP syndrome can include:

  • Nausea/vomiting/indigestion after eating;
  • Pain in the upper abdomen, felt below the ribs;
  • Shoulder pain when taking a deep breath;
  • Swelling of the legs;
  • Fatigue;
  • Blurry vision;
  • Headache;
  • High blood pressure, and;
  • Protein in the urine.

Fatigue

A state of exhaustion and weakness.

Headache

Pain across the face, eye, ears and other head or neck areas. Can be a dull ache, stabbing or throbbing pain.

1. HELLP Syndrome: MedlinePlus Medical Encyclopedia. Accessed November 11, 2014.

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Methods for diagnosis

Because HELLP syndrome is a serious complication, prompt medical diagnosis is important.

If your doctor suspects HELLP syndrome, they will perform a complete physical examination and order laboratory tests. Blood tests will measure liver enzymes, red blood cells and platelets. A urine test will measure protein levels.

The severity of HELLP syndrome is classified according to the blood platelet count as follows:

  • Class I - severe thrombocytopenia, with platelets under 50,000 mm;
  • Class II - moderate thrombocytopenia, with platelets between 50,000 and 100,000/mm, and;
  • Class III - mild thrombocytopenia, with platelets between 100,000 and 150,000/mm.

Blood tests

During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analysed to help diagnose and monitor a wide range of health conditions.

Platelets

Small blood cells found in the blood that are essential for clotting to occur.

Red blood cells

Cells in the blood that transport oxygen from the lungs throughout the body and carbon dioxide from the body to the lungs.

Urine test

A routine examination of the urine for cells, microbes, or chemicals that can indicate a range of different illnesses.

Liver enzymes

Proteins that help to speed up chemical reactions in the liver. Elevated levels of liver enzymes may be an indication of liver damage or inflammation.

Types of treatment

If the pregnancy is more than 34 weeks, definitive treatment for HELLP syndrome is delivery of the baby. Most symptoms and side effects associated with HELLP syndrome will go away two or three days after the baby is born.

If the pregnancy is less than 34 weeks, treatment may vary, depending on the severity of the condition, but some of the treatment options may include:

Anaemia

A deficiency in red blood cells or haemoglobin in the body.

Corticosteroids

A medication that resembles the cortisol hormone produced in the brain. It is used as an anti-inflammatory medication.

Platelet

Small blood cells found in the blood that are essential for clotting to occur.

Seizures

A sudden, involuntary contraction of muscle groups caused by abnormal electrical activity in the brain.

Blood transfusions

The process of receiving blood or blood components from an external source directly into the bloodstream.

Potential complications

Babies born to mothers with HELLP syndrome may be more affected by the condition than their mother.

Complications associated with HELLP syndrome may include:

  • Placental abruption, where the placenta prematurely separates from the uterus;
  • Placental failure, where the placenta is not able to supply the fetus with enough oxygen and nutrients;
  • Extremely preterm birth;
  • Kidney failure;
  • Fluid in the lungs;
  • Blood clots, stroke;
  • Liver rupture, and;
  • Death of the mother and/or the baby.

Fetus

An unborn human, from the ninth week of pregnancy until birth.

Kidney

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

Placenta

The organ that forms within the uterus of a pregnant woman to provide the fetus with nourishment from the blood supply of the mother.

Uterus

The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.

Preterm

A baby that is born before 37 weeks' gestation.

Prognosis

When treated early, women with HELLP syndrome can usually make a full recovery, with most of their symptoms and side effects resolving within a few days after delivery.

The outcome for the baby tends to be more variable. Babies with a smaller birth weight are at greater risk. They may need longer hospital stays and support with breathing.

Prevention

There is no known way to prevent HELLP syndrome, but the likelihood of developing it can be reduced by:

  • Maintaining good health and fitness before becoming pregnant;
  • Receiving good prenatal care, and;
  • Telling your healthcare practitioner if you have a family history of HELLP syndrome, preeclampsia or high blood pressure.

Prenatal

Before the birth of a baby.