HELLP stands for:

H – Hemolysis (breakdown of red blood cells)

EL – Elevated Liver enzymes (showing signs of liver damage)

LP – Low Platelet count (number of cells responsible for coagulation are low)

 

HELLP Syndrome is a life-threatening form of preeclampsia that usually develops in the later stages of pregnancy or even after childbirth. This condition can be particullary difficult to diagnose since even though it is considered a variant of preeclampsia, women will not always have high blood pressure and protein in the urine with HELLP Syndrome like they would with preeclampsia. Also, while a history of preeclampsia can increase a mother’s risk of developing HELLP, it is not necessary for HELLP to develop. The global mortality rate for HELLP has been reported to be as high as 25%, so it is critical for mothers to know the signs and risks associated with this condition [1].

       

 

The physical symptoms of HELLP can be confused with preeclampsia, so it is important for pregnant woman to check in with their doctor if they experience any of the following [1]:

  • Headache
  • Nausea, vomiting, or indigestion with pain after eating
  • Abdominal or chest tenderness and upper right upper side pain (from liver distention)
  • Shoulder pain or pain when breathing deeply
  • Bleeding
  • Changes in vision
  • Swelling

Serious Complications [2]:

  • Disseminated intravascular coagulation (DIC): formation of blood clots in small blood vessels throughout the body
  • Placental abruption (separation of placenta from uterine wall)
  • Adult respiratory distress syndrome
  • Hepatorenal failure (kidney failure that develops from liver disease)
  • Pulmonary edema (excess fluid in the lungs)
  • Subcapsular hematoma 
  • Liver rupture

Classification:

HELLP syndrome can be classified in two ways. The first is by how many of the three abnormalities are present. If only one or two out of the three are present (ex. only hemolysis), then it is considered partial HELLP syndrome. If all three of the abnormalities are present, it is considered full HELLP syndrome. The other method of classification is based on platelet count. The lower the platelet count, the more severe the condition is. Class I HELLP is when platelet count is very low, and the risk of maternal mortality is highest. Class II is intermediate, and Class III is the least severe with the highest platelet count [3].

 

Treatments [4]:

  • Since HELLP is life-threatening for both the mother and baby, the best treatment is to deliver the baby as soon as possible–even if the baby is premature. A C-section is usually performed instead of a vaginal delivery to avoid complications.
  • Some ways to manage the condition during pregnancy are with antihypertensive agents, blood transfusion (if bleeding becomes severe), bed rest, and corticosteroid therapy.

The prognosis for women with HELLP syndrome is usually good if caught early on. If not caught early on, up to 25% of women develop complications. This is why attending regular prenatal checkups is essential [4].

 

Sources:

  1. HELLP syndrome. Preeclampsia Foundation Web site. https://www.preeclampsia.org/health-information/hellp-syndrome. Updated March 24, 2015. Accessed July, 2017.
  2. HELLP syndrome. University of Maryland Medical Center Web site. http://www.umm.edu/health/medical/ency/articles/hellp-syndrome. Accessed July, 2017.
  3. Padden M. HELLP Syndrome: Recognition and Perinatal Management. Am Fam Physician. 1999;60(3):829-836. http://www.aafp.org/afp/1999/0901/p829.html.
  4. HELLP syndrome. NIH: Medline Plus Web site. https://medlineplus.gov/ency/article/000890.htm. Accessed August, 2017.