HELLP Syndrome

HELLP syndrome stands for Hemolysis with a microangiopathic blood smear, Elevated Liver enzymes, and Low Platelet count. It is common in pregnant and postpartum patients as complications.

Last Updated: February 25, 2024

0.5% to 0.9% of women have HELLP syndrome. 70% of instances occur in the third trimester and 30% within 48 hours following delivery. HELLP syndrome causes 0 to 24% maternal mortality and up to 37% perinatal mortality. 

Although its cause has yet to be pinpointed, HELLP syndrome is believed to be a complement-mediated (enhanced activity of our immune cells to destroy pathogens) inflammatory illness that manifests itself systemically. It is thought that there may be a similar pathogenesis between HELLP syndrome and preeclampsia with poor placentation. However, for unknown reasons, this can cause the complement system to be activated too much and cause more inflammation in the liver in people with HELLP syndrome. A subtype of HELLP syndrome is characterized by complement dysregulation linked with thrombotic microangiopathy and can manifest with pregnancy-related hemolytic uremic syndrome (HUS).

Women may have signs of HELLP syndrome during pregnancy or soon after giving birth. Some of them are the following:

  • The most common sign is pain in the right upper quadrant or in the mid-epigastric area
  • Blurry vision
  • Malaise or fatigue
  • Swelling (edema) and gaining weight quickly
  • Nausea and vomiting
  • Less often, headaches or blurred vision.

In rare cases, women may also experience:

  • Nosebleeds that do not stop
  • Seizures or shaking that cannot be stopped

The following laboratory tests are required to establish the diagnosis of HELLP syndrome in a pregnant patient in the third trimester of pregnancy or immediate postpartum 7 days after birth who presents with the above symptoms, including new-onset hypertension or proteinuria:

  • Complete blood count
  • Peripheral smear
  • Liver panel test: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, and 
  • Creatinine levels

Treatment

Drugs that reduce blood pressure and prevent seizures may be part of the treatment plan for HELLP syndrome. A transfusion is necessary for some pregnant women. Donated whole blood or blood plasma is used in this therapy.

HELLP syndrome is ultimately treated through delivery. Preterm delivery is a possible outcome if you have HELLP syndrome. The doctor may prescribe corticosteroids to aid with your infant's lung maturation.

Your doctor may prescribe medication to help bring on labor. Another option is having a cesarean section to accomplish the birth (C-section).

Preventing HELLP syndrome is currently impossible. Ensure that you are receiving routine prenatal care. If you are at a high risk for HELLP syndrome, your doctor may recommend that you begin taking low-dose aspirin after the first trimester.

The likelihood of a healthy pregnancy can be improved by:

  • Whole grains, lean protein, fruits, and vegetables make up a nutrient-dense diet.
  • Participating in a moderate exercise program, or one prescribed by your doctor.
  • Prenatal care involves setting up a regular schedule of doctor's appointments.
  • Consistently getting eight hours of sleep nightly.
  • Discussing any concerns you may have with your doctor.

References

Khalid F, Mahendraker N, Tonismae T. HELLP Syndrome. [Updated 2022 Jun 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560615/

Cleveland Clinic (2022). HELLP Stndrome. Retrieved November 25, 2022, from https://my.clevelandclinic.org/health/diseases/21637-hellp-syndrome

Last Updated: February 25, 2024