HELLP Syndrome

HELLP syndrome is a serious liver disorder. It develops during the latter stages of pregnancy (third trimester) or just after birth.

The causes of HELLP syndrome are unknown.

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• What Is HELLP Syndrome? 
• What Are the Symptoms of HELLP Syndrome? 
• How Do You Diagnose HELLP Syndrome?
• How Do You Treat HELLP Syndrome? 

What Is HELLP Syndrome? 

HELLP stands for hemolysis, elevated liver enzymes, and low platelet syndrome. It is a serious disorder that can develop during pregnancy. HELLP syndrome disrupts blood clotting and damages the liver. It can cause excessive bleeding.

HELLP is linked to preeclampsia. Preeclampsia is high blood pressure in pregnancy, along with signs of organ dysfunction like protein in the urine. Some experts see HELLP as a symptom or precursor to preeclampsia. Others think of it as a variant of preeclampsia.

HELLP syndrome develops during the third trimester or right after childbirth. HELLP syndrome is a severe condition. It can be deadly for you and your baby.

However, the symptoms of HELLP syndrome can be hard to recognize. It's important to note that while the two seem to be related, not all people with HELLP syndrome exhibit the classic signs of preeclampsia, such as high blood pressure and protein in the urine.

How common is HELLP syndrome?

HELLP syndrome is relatively uncommon. It develops in between 0.5% and 0.9% of births, according to BMC Pregnancy Childbirth. Almost 70% of cases of HELLP syndrome occur in the third trimester, with the other 30% developing within 48 hours of childbirth.

What Causes HELLP Syndrome?

HELLP syndrome is still not fully understood. Experts think that it is due to inflammation in the body.

Risk factors and complications of HELLP syndrome

HELLP syndrome risk factors 

Risk factors for HELLP syndrome include:

• Age – Risk increases with age.
• COVID-19 – The exact link is unknown.
• Family history — A family history of preeclampsia, HELLP syndrome, certain autoimmune conditions, or clotting disorders.
• Mulitparity – Having had multiple children. HELLP syndrome is more common in second or later pregnancies.

Complications of HELLP syndrome

The bleeding caused by HELLP syndrome can be deadly for the pregnant person or their child.

HELLP syndrome is related to preeclampsia, but the link isn't clear. Preeclampsia can cause seizures in a pregnant person. Complications of HELLP and preeclampsia can pose a serious threat to you and the viability of your pregnancy.

The most common reasons for pregnant people to become critically ill or die from HELLP syndrome are liver rupture or stroke. Prompt treatment can prevent these complications if HELLP is caught in time.

According to BMC Pregnancy Childbirth, the maternal mortality rate of HELLP syndrome is between 1% and 24%, making it a very serious condition. Between 7% and 34% of HELLP babies die, too. Those born before 32 weeks are less likely to survive.

What happens to the baby in HELLP syndrome?

Babies born to pregnant people who develop HELLP syndrome may die. These deaths are often due to stillbirth before delivery or complications with the placenta due to bleeding.

The impact of HELLP syndrome on your baby depends on how far along you are in your pregnancy, your baby's weight at birth, and any issues from early delivery.

These may include:

• Placental abruption — The placenta separates from the uterus too early.
• Placental failure — The baby doesn't get enough oxygen.
• Extreme prematurity — If the baby needs to be delivered before it's ready.

Babies who weigh more than 1000 grams (about 2 pounds) at birth have similar survival rates and hospital stays to other babies of the same size, with few long-term problems.

However, the outlook is not as positive if the baby weighs 1000 grams or less (less than 2 pounds). They often need more extended hospital stays and more ventilator support.

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What Are the Signs and Symptoms of HELLP Syndrome?

The symptoms of HELLP syndrome can include:

• Abdominal, chest, or shoulder pain, especially on the right side.
• Bleeding.
• Fatigue.
• Headache.
• Indigestion, nausea, or vomiting.
• Itching.
• Red pinpoint rash.
• Shortness of breath or breathing difficulty.
• Swelling of face or hands.
• Vision problems.
• Yellowing of the skin and the whites of the eyes (jaundice).

When should I see a doctor about my HELLP syndrome symptoms?

HELLP syndrome is very serious for both you and your baby. If you are pregnant and experience any of these symptoms, especially in the third trimester, call your doctor and seek immediate emergency medical treatment.

What can I do to prevent HELLP syndrome?

There's no way to prevent HELLP syndrome. The best thing you can do is develop healthy habits before you get pregnant.

During pregnancy:

• Attend regular prenatal visits.
• Ask your doctor about taking aspirin, which lowers the risk of preeclampsia. It may also reduce the risk of HELLP syndrome.
• Learn the warning signs and promptly report them to your ob-gyn. Trust your instincts if something feels off.
• Tell your ob-gyn if you've had any high-risk pregnancies before or if there's a family history of HELLP syndrome, preeclampsia, or other blood pressure issues.

Can you get HELLP syndrome again?

Yes. Having HELLP syndrome in a prior pregnancy puts you at higher risk of all forms of preeclampsia in later pregnancies. The rate ranges from 16% to 52%, according to the Preeclampsia Foundation. You are also at a higher risk of HELLP syndrome starting earlier – even in the second trimester.

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How Do Doctors Diagnose HELLP Syndrome?

HELLP syndrome can be difficult to diagnose. Because the complications are so severe, it is essential to get medical help immediately if you think something's wrong.

The following blood tests can help doctors diagnose HELLP syndrome:

• Creatinine levels.
• Complete blood count.
• Liver function tests.
• Peripheral smear.

High liver enzymes, low platelets, and the presence of hemolysis (the destruction of red blood cells) are signs of HELLP syndrome.

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How Do You Treat HELLP Syndrome? 

HELLP syndrome can lead to complications in childbirth, so the goals of treatment are to regulate the body and minimize the chance of problems with your pregnancy.

In some cases, HELLP syndrome will require a premature delivery or cesarean section. Delivery can help ensure the best chances of a healthy baby and to keep the pregnant person safe.

Most of the time, HELLP syndrome goes away after delivery.

In other cases, doctors can treat the symptoms of HELLP syndrome with medicines such as:

• Blood transfusions to treat anemia and a low platelet count.
• Corticosteroids to help prepare your baby's lungs for birth if the pregnancy is less than 34 weeks.
• Magnesium sulfate to prevent seizures (eclampsia).
• Medicines to control severe high blood pressure.

In severe cases of HELLP syndrome, the pregnant or postpartum person may have seizures. The person may need ventilation, pain medication, vasopressors, or nutritional support.

By UPMC Editorial Staff. Last reviewed on 2024-09-05.