HELLP syndrome

Overview

HELLP syndrome is a severe and life-threatening complication of pregnancy, typically occurring in the third trimester or shortly after childbirth. The name HELLP is an acronym that stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count - the three key laboratory findings that define the condition. It is considered a variant of preeclampsia and affects approximately 0.5% to 0.9% of all pregnancies. Early recognition and prompt treatment are essential to prevent serious complications for both the mother and the baby.

Causes

The exact cause of HELLP syndrome is not fully understood, but it is believed to be related to abnormal placental development and maternal vascular dysfunction, similar to preeclampsia. Risk factors include:

• History of preeclampsia or HELLP syndrome in a previous pregnancy

• Chronic hypertension

• Multiple gestation (e.g., twins)

• Maternal age over 35

• Obesity

• Autoimmune disorders

HELLP may develop without the classic signs of preeclampsia (high blood pressure and proteinuria), making diagnosis more challenging in some cases.

Symptoms

Symptoms of HELLP syndrome can be vague and often mimic other conditions, leading to delayed diagnosis. Common symptoms include:

• Right upper abdominal pain or epigastric pain (liver area)

• Nausea and vomiting

• Headache

• Visual disturbances

• Fatigue or malaise

• Swelling (edema)

• High blood pressure (may or may not be present)

• Bleeding or bruising easily (due to low platelets)

In some cases, symptoms can escalate rapidly, leading to serious maternal or fetal complications if not promptly addressed.

Diagnosis

Diagnosis of HELLP syndrome is based on clinical evaluation and laboratory findings. The key diagnostic criteria include:

• Hemolysis: Abnormal blood smear, elevated lactate dehydrogenase (LDH), and low haptoglobin

• Elevated liver enzymes: Increased aspartate transaminase (AST) and alanine transaminase (ALT)

• Low platelet count: Platelets below 100,000/µL

Additional tests may include complete blood count, coagulation profile, kidney function tests, and fetal monitoring. Imaging may be used to assess liver complications, such as hematomas or rupture.

Treatment

The definitive treatment for HELLP syndrome is delivery of the baby, especially if the pregnancy is beyond 34 weeks or if there are signs of maternal or fetal distress. Management includes:

• Hospitalization: For close monitoring and supportive care

• Blood pressure control: Using antihypertensive medications if necessary

• Magnesium sulfate: To prevent seizures (eclampsia)

• Corticosteroids: To accelerate fetal lung maturity and possibly stabilize maternal condition

• Blood transfusions: For anemia or low platelet counts

• Prompt delivery: Vaginal or cesarean delivery depending on maternal and fetal status

In cases diagnosed before 34 weeks of gestation, doctors may attempt to delay delivery briefly to allow for fetal lung development, provided the mother and baby remain stable.

Prognosis

With early diagnosis and appropriate management, the prognosis for HELLP syndrome has improved significantly. However, it still carries substantial risks, including:

• Placental abruption

• Liver rupture or bleeding

• Kidney failure

• Disseminated intravascular coagulation (DIC)

• Preterm delivery and complications for the baby

Maternal mortality is estimated at 1–3%, and perinatal mortality may range from 10–60% depending on gestational age and complications. Long-term, most women recover fully, but some may be at increased risk of hypertensive disorders in future pregnancies. Regular postpartum follow-up is essential.