HELLP syndrome is a potentially life-threatening disorder that’s usually associated with preeclampsia, a condition that occurs in 5–8 percent of pregnancies — most often after the 20th week of pregnancy. Preeclampsia can also occur earlier in pregnancy or, rarely, postpartum.
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:
- EL: elevated liver enzymes
- LP: 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 components of your blood that help with 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, but may occur earlier, or even present postpartum. The cause of symptoms is unknown. Some experts believe HELLP syndrome is a severe form of 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 preexisting high blood pressure or diabetes, advanced maternal age, carrying multiples, such as twins, and having a previous history of preeclampsia.
HELLP syndrome symptoms are very similar to those of the stomach flu. The symptoms may seem to be “normal” symptoms of pregnancy. However, it’s important to 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, especially in your upper abdomen
You may also experience:
- swelling, especially in the hands or face
- excessive and sudden weight gain
- blurry vision, loss of vision, or other changes in vision
- shoulder pain
- pain when breathing deeply
In rare cases, you may also have confusion and seizures. These signs and symptoms usually indicate advanced HELLP syndrome and should prompt immediate evaluation by your doctor.
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 it typically occurs during the last trimester of pregnancy. However, it may present earlier in the pregnancy or postpartum (in rare cases). Not all pregnant women with preeclampsia will develop HELLP syndrome.
Other risk factors for HELLP include:
- being over age 35
- being African-American
- being obese
- having previous pregnancies
- having diabetes or kidney disease
- having high blood pressure
- history of preeclampsia
You’re also at a higher risk for HELLP syndrome if you had the condition during a previous pregnancy. One study showed that the risk of recurrence for hypertensive disorders, including preeclampsia and HELLP, in future pregnancies is .
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:
Once a HELLP syndrome diagnosis is confirmed, delivery of the baby is the best way to prevent complications, as this should stop progression of the disease. 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:
- 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 will be hospitalized for close monitoring.
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.
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 days to weeks after delivery. It is important to follow up with your doctor after to delivery to evaluate for resolution of the disease.
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.
Complications associated with HELLP syndrome include:
- 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
Early treatment is the key to preventing these complications. However, some complications may occur even with treatment. Symptoms of HELLP syndrome can also affect you and your baby after delivery.
HELLP syndrome isn’t preventable in most pregnant women, because the cause of the condition isn’t known. However, people can lower their risk for HELLP syndrome by maintaining a healthy lifestyle to prevent preexisting conditions that may increase the risk, such as diabetes or high blood pressure. This includes exercising regularly and eating a heart-healthy diet that consists of whole grains, vegetables, fruits, and lean protein.
If you have these or other risk factors, regular routine prenatal care is important so that your doctor can evaluate you promptly if you begin to develop preeclampsia or HELLP. Some doctors may recommend taking a low-dose aspirin during a subsequent pregnancy for prevention, based on your individual care.
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.