HELLP syndrome

Definition

HELLP syndrome is a group of symptoms that occur in pregnant women who have:

• H -- hemolysis
• EL -- elevated liver enzymes
• LP -- low platelet count

Causes, incidence, and risk factors

HELLP syndrome occurs in approximately 10% of pregnant women with preeclampsia or eclampsia. HELLP syndrome is associated with more serious cases.

Many women have high blood pressure and are diagnosed with preeclampsia before they develop HELLP syndrome. However, in some cases, HELLP symptoms are the first warning of preeclampsia and the condition is misdiagnosed as hepatitis, gallbladder disease, idiopathic thrombocytopenic purpura, or thrombotic thrombocytopenic purpura.

Symptoms

• Headache
• Nausea and vomiting that continues to get worse
• Upper abdominal pain
• Vision problems

Signs and tests

During a physical examination, the doctor may discover upper abdominal tenderness, especially in the right upper side. The liver may be enlarged.

Liver function tests (liver enzymes) may be elevated. Red blood cell and platelet counts may be low.

Treatment

The main treatment is to deliver the baby as soon as possible, even if premature, since liver function in the mother gets worse very quickly. Problems with the liver can be harmful to both mother and child.

Expectations (prognosis)

When the disease is not treated early, up to 25% of women develop serious complications. Without treatment, a small number of women die. The death rate among babies born to mothers with HELLP syndrome varies and depends on birth weight and the development of the baby's organs, especially the lungs. (See also: Prematurity)

Complications

The mother's liver may bleed (hemorrhage). Permanent liver damage may occur if delivery is delayed. Such damage can lead to death.

Calling your health care provider

See your obstetrician immediately, call the local emergency number (such as 911), or get to the emergency room if the symptoms above occur during pregnancy.

Although there is no known way to prevent HELLP syndrome, it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as HELLP syndrome early.

References

Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 33.

Martin JN, Rose CH, Briery CM. Understanding and managing HELLP syndrome: The integral role of aggressive glucocorticoids for mother and child. American Journal of Obstetrics and Gynecology. 2006; 195(914-34).