What Is HELLP Syndrome?

What Is HELLP Syndrome?

HELLP syndrome, which can be a life-threatening complication of pregnancy, is often considered to be a variant of preeclampsia. While exact statistics aren’t known, HELLP syndrome is thought to occur in one to two out of every 1,000 pregnancies, and in 10% to 20% of pregnancies where the mother has a diagnosis of severe preeclampsia.

HELLP syndrome typically occurs in the last trimester of pregnancy, but can also occur after childbirth. The name is an acronym of the three characteristics of the condition:

  • Hemolysis (breaking down of red blood cells)
  • EL: elevated liver enzymes (which can indicate liver problems)
  • LP: low platelet count (which can lead to bleeding)
Helpful HELLP syndrome treatments
Verywell / Jessica Olah.

Symptoms

It’s important to be aware of and recognize the symptoms so you can get diagnosed and treated as quickly as possible.

Symptoms of HELLP can be general and tricky to recognize at first, especially because they can mimic occurrences that are common in late pregnancy, including:

  • Blurry vision
  • Excessive weight gain
  • Fatigue
  • Fluid retention
  • Headaches
  • High blood pressure
  • Nausea or vomiting
  • Pain in upper right or middle of the abdomen
  • Protein in urine
  • Swelling of face and/or hands

If you notice any symptoms that seem unusual or are concerning to you, tell your provider immediately.

Diagnosis

Your doctor will check your blood pressure and order the following tests if they suspect HELLP syndrome:

  • Blood tests to check for hemolysis, elevated liver enzymes, and low platelets
  • A urine sample to check for proteins in the urine
  • An MRI to detect bleeding in the liver

If there are no signs of high blood pressure or protein in the urine, HELLP can be difficult to diagnose and can be mistaken for the following conditions:

  • Acute hepatitis
  • Flu
  • Gall bladder disease
  • Gastritis

Causes and Risk Factors

The exact cause of HELLP is unknown, although there are certain factors that might increase your risk.

Having a diagnosis of preeclampsia or pregnancy-induced hypertension is perhaps the biggest risk factor. However, you can develop HELLP without having preeclampsia first.

Other risk factors for HELLP include:

  • Being over the age of 25 years old
  • Being White
  • Having a sister or mother with HELLP syndrome
  • Having given birth at least twice before
  • Having HELLP syndrome with a previous pregnancy
  • LCHAD (long-chain 3-hydroxyacyl-CoA dehydrogenase) deficiency in the baby

If you have any of these risk factors, this does not necessarily mean you’ll develop HELLP syndrome. Remember, HELLP syndrome is rare. However, you may want to talk to your doctor about what symptoms you should watch for.

There is no way to prevent HELLP, but regular prenatal visits are important and can help catch any concerning signs as soon as possible.

Types

HELLP syndrome is divided into three categories, according to a system called "the Mississippi classification” and based largely on the blood platelet count of the mother:

  • Class I (severe thrombocytopenia): platelets under 50,000/uL
  • Class II (moderate thrombocytopenia): platelets between 50,000 and 100,000/uL
  • Class III (mild thrombocytopenia): platelets between 100,000 and 150,000/uL

The likelihood of severe illness and complications is highest for class I.

Treatment

Giving birth to the baby is the only definitive cure for HELLP syndrome. Ideally, this would be done in the first 24 to 48 hours after diagnosis if the baby is at least 34 weeks of gestation. The baby would also be delivered immediately if the mother or baby were in distress, even if the baby is born preterm.

Before 34 weeks, there are things that can be done to help treat HELLP while the fetus matures, including:

  • Bedrest, either at home or in the hospital
  • Blood pressure medications
  • Blood transfusions to treat the anemia and low platelet counts
  • Continuous fetal monitoring while in the hospital, including non-stress testing, biophysical profile testing, and doppler flow studies
  • Corticosteroids to help the lungs of the fetus develop in preparation for delivery
  • Magnesium sulfate to prevent seizures
  • Regular laboratory testing to monitor the progression of HELLP syndrome

Prognosis

The prognosis for HELLP syndrome can vary, depending on whether it was found in time and treated. Left untreated, it can be fatal.

With appropriate treatment, outcomes are generally good for mom and baby. Typically, once the baby is born, symptoms in the mom generally start to improve within 48 hours.

For pregnant women, the risk of complications is generally increased depending on the severity of laboratory results, and may include:

  • Acute respiratory failure
  • Anemia
  • Early delivery
  • Excessive bleeding during delivery
  • Kidney failure
  • Placental abruptions
  • Pulmonary edema (fluid in the lungs)
  • Stroke

For the baby, prognosis generally depends on the gestational age of the baby at the time of delivery, as well as its birth weight. If babies are delivered preterm, the risk of complications from premature delivery is greater.

This is why doctors will try to treat HELLP syndrome when possible, instead of simply delivering the baby, especially if the woman is not close to being full-term.

A Word From Verywell

If you’re pregnant and have risk factors for HELLP syndrome, talk with your doctor about your risk factors and concerns. They can let you know specific symptoms to watch out for and can help put you at ease about your pregnancy.

If you notice any symptoms out of the ordinary, or signs that might be related to high blood pressure or HELLP, call your doctor immediately. The sooner HELLP is identified, the sooner treatment can start.

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Article Sources
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  2. Preeclampsia Foundation. HELLP syndrome. Updated January 17, 2020.

  3. National Institutes of Health: Genetic and Rare Diseases Information Center. HELLP syndrome. 2018.

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