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HELLP Syndrome

What is HELLP Syndrome?

HELLP syndrome is a serious and potentially life-threatening condition that can occur during pregnancy, typically in the third trimester or shortly after delivery. The name HELLP stands for:

  • Hemolysis (breakdown of red blood cells)
  • Elevated Liver enzymes
  • Low Platelet count

It is considered a variant of preeclampsia, although it can sometimes occur without high blood pressure or protein in the urine.

What Causes HELLP Syndrome?

The exact cause of HELLP syndrome is not fully understood. However, it is believed to be related to problems with the placenta and abnormal immune response. It shares features with preeclampsia, a pregnancy complication involving high blood pressure and damage to organs like the liver and kidneys.

Risk factors may include:

  • History of preeclampsia or HELLP syndrome
  • High blood pressure during pregnancy
  • Being over 25 years old
  • Multiple pregnancies (e.g., twins or triplets)
  • Previous pregnancy complications

What Are the Symptoms?

Symptoms of HELLP syndrome can develop suddenly and may be confused with other pregnancy-related conditions. Common signs and symptoms include:

  • Upper right abdominal pain or tenderness (near the liver)
  • Nausea or vomiting
  • Headache
  • Fatigue or malaise
  • Swelling (especially in hands and face)
  • Blurred vision
  • High blood pressure (may or may not be present)
  • Easy bruising or bleeding

If you are pregnant and experience any of these symptoms, it’s important to seek immediate medical attention.

How Is It Diagnosed?

HELLP syndrome is diagnosed through blood tests and clinical evaluation. Key diagnostic criteria include:

  • Hemolysis: Broken red blood cells detected on a blood smear or elevated bilirubin
  • Elevated liver enzymes: AST and ALT levels are significantly higher than normal
  • Low platelet count: Less than 100,000 per microliter

Additional tests may include:

  • Urinalysis to check for protein
  • Ultrasound to assess liver size or bleeding
  • Fetal monitoring to evaluate the baby’s health

What Is the Treatment?

Immediate delivery of the baby is the most effective treatment, especially if the pregnancy is beyond 34 weeks or the condition is worsening. The goal is to prevent complications in both the mother and baby.

Treatment may include:

  • Hospitalization and close monitoring
  • Steroid medications to help mature the baby’s lungs (if delivery is expected before 34 weeks)
  • Blood pressure control medications
  • Magnesium sulfate to prevent seizures
  • Blood transfusions if platelets or red blood cells are very low

After delivery, symptoms often improve within a few days, but continued monitoring is necessary.

Are There Any Complications?

HELLP syndrome can cause serious complications for both the mother and baby if not treated promptly. These may include:

For the mother:

  • Liver rupture or bleeding
  • Kidney failure
  • Stroke
  • Disseminated intravascular coagulation (DIC) – a severe clotting disorder
  • Placental abruption – early separation of the placenta
  • Death (rare with proper care)

For the baby:

  • Premature birth
  • Low birth weight
  • Fetal distress or stillbirth

Early recognition and proper treatment significantly reduce the risk of complications.

What Is the Outlook?

With early diagnosis and proper treatment, most women recover well from HELLP syndrome. However, future pregnancies require careful monitoring, as there is a risk of recurrence in some women.

Most women go on to have healthy pregnancies afterward, especially if closely supervised by an obstetrician or maternal-fetal medicine specialist.