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HELLP Syndrome

What is HELLP syndrome?

HELLP syndrome is a potentially life-threatening disorder in pregnancy that is usually associated with preeclampsia, a condition that occurs in 5-8 percent of pregnancies, most often after the 20th week of pregnancy. HELLP syndrome is a disorder of the liver and blood that can be fatal if left untreated. The symptoms of HELLP syndrome are wide-ranging and vague, and can often be difficult to initially diagnose. The name HELLP syndrome is an acronym of three major abnormalities seen on the initial lab analysis. These include:

  • Hemolysis
  • EL: elevated liver enzymes
  • LP: a low platelet count

Hemolysis refers to a breakdown of red blood cells. In people with hemolysis, the red blood cells get broken down too soon and too rapidly. This may result in low red blood cell levels and can eventually lead to anemia, a condition in which the blood doesn’t carry enough oxygen to the rest of your body.

Elevated liver enzymes indicate that your liver isn’t functioning properly. Inflamed or injured liver cells leak high amounts of certain chemicals, including enzymes, into your blood.

Platelets are cell fragments in your bloodstream that help with blood clotting. When platelet levels are low, you develop an increased risk of excessive bleeding.

HELLP syndrome is a rare disorder, affecting less than 1 percent of all pregnancies. However, it is a major health concern and can be life-threatening to both the mother and the unborn baby. Prompt treatment and delivery of the baby are generally required for the best outcome.

HELLP syndrome usually develops in the last trimester of pregnancy, before the 37th week. The cause of symptoms is unknown. Some experts believe HELLP syndrome is related to preeclampsia, a pregnancy complication that causes high blood pressure. Approximately 10-20 percent of women who develop preeclampsia will also develop HELLP syndrome. There are also certain factors that can increase your risk of developing HELLP syndrome, such as poorly controlled blood pressure, advanced maternal age, and previous history of preeclampsia.

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Symptoms

What are the symptoms of HELLP syndrome?

HELLP syndrome symptoms are very similar to those of the flu. The symptoms may seem to be “normal” symptoms of pregnancy. However, it’s important see your doctor right away if you’re experiencing any flu-like symptoms during pregnancy. Only your doctor can ensure that your symptoms aren’t indicative of serious health issues.

The symptoms of HELLP syndrome may vary from person-to-person, but the most common ones include:

  • feeling generally unwell or fatigued
  • stomach pain
  • nausea
  • vomiting
  • headache

You may also experience:

  • swelling, especially in the hands, legs, or face
  • abdominal pain
  • excessive and sudden weight gain
  • excessive or unexplained bleeding
  • blurry vision or changes in vision
  • heartburn or indigestion
  • shoulder pain
  • pain when breathing deeply

In rare cases, you may also have headaches, confusion, and seizures. These signs and symptoms usually indicate advanced HELLP syndrome and should prompt immediate evaluation by your doctor.

Risk factors

What are the risk factors for HELLP syndrome?

The cause of HELLP syndrome is unknown, but there are certain factors that may increase your risk of developing it.

Preeclampsia is the greatest risk factor. This condition is marked by high blood pressure and swelling, and it typically occurs during the last trimester of pregnancy. However, not all pregnant women with preeclampsia will develop HELLP syndrome.

Other risk factors include:

  • being over age 30
  • being Caucasian
  • being very overweight
  • having previous pregnancies
  • having a poor diet
  • having diabetes
  • history of preeclampsia

You’re also at a higher risk for HELLP syndrome if you had the condition during a previous pregnancy. In fact, your risk can increase by 19 to 27 percent in each future pregnancy.

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Diagnosis

How is HELLP syndrome diagnosed?

Your doctor will perform a physical exam and order various tests if HELLP syndrome is suspected. During the exam, your doctor may feel for abdominal tenderness, an enlarged liver, and any excess swelling. These can be signs of a liver problem. Your doctor may also check your blood pressure.

Certain tests can also help your doctor make a diagnosis. Your doctor may also order a:

  • blood test to evaluate platelet levels and red blood cell count
  • urine test to check for elevated liver enzymes and abnormal proteins
  • MRI to determine whether there’s bleeding in the liver

Treatment

How is HELLP syndrome treated?

Once a HELLP syndrome diagnosis is confirmed, delivery of the baby is the best way to prevent complications. In many cases, the baby is born prematurely.

However, your treatment may vary depending on the severity of your symptoms and how close you are to your due date. If your HELLP syndrome symptoms are mild or if your baby is less than 34 weeks old, your doctor may recommend:

  • bedrest, either at home or in the hospital
  • blood transfusions to treat anemia and low platelet levels
  • magnesium sulfate to prevent seizures
  • antihypertensive medication to control blood pressure
  • corticosteroid medication to help your baby’s lungs mature in case an early delivery is needed

During treatment, your doctor will monitor your red blood cell, platelet, and liver enzyme levels. Your baby’s health will also be watched closely. Your doctor may recommend certain prenatal tests that evaluate movement, heart rate, stress, and blood flow.

You may be given medications to help induce labor, if your doctor determines that your condition requires immediate delivery of your baby. In some cases, a cesarean delivery is necessary. However, this can cause complications if you have blood-clotting issues related to low platelet levels.

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Outlook

What is the long-term outlook for women with HELLP syndrome?

Most women with HELLP syndrome will recover completely if the condition is treated early. Symptoms also improve significantly after the baby is delivered. Most symptoms and side effects will go away within two to three days after delivery.

Perhaps the biggest concern is the impact HELLP syndrome can have on the baby. Most babies are delivered early when the mothers develop HELLP syndrome, so there’s often a greater risk of complications from premature delivery. Babies who are born before 37 weeks are carefully monitored in the hospital before they are able to go home.

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Complications

Possible complications of HELLP syndrome

Complications associated with HELLP syndrome include:

  • blood clots
  • liver rupture
  • kidney failure
  • acute respiratory failure
  • fluid in the lungs (pulmonary edema)
  • excessive bleeding during delivery
  • placental abruption, which occurs when the placenta detaches from the uterus before the baby is born
  • stroke
  • death

Early treatment is the key to preventing these complications. However, some complications may occur during treatment. Symptoms of HELLP syndrome can also affect you and your baby after delivery.

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Prevention

Preventing HELLP syndrome

HELLP syndrome isn’t preventable in most pregnant women, because the cause of the condition isn’t known. However, people with preeclampsia can lower their risk for HELLP syndrome by maintaining a healthy lifestyle. This includes exercising regularly and eating a heart-healthy diet that consists of whole grains, vegetables, fruits, and lean protein. It’s also important to contact your doctor immediately if you’re experiencing symptoms of HELLP syndrome. Early detection and treatment can help lower the risk of complications.

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