HELLP syndrome is a very rare form of preeclampsia and is a life-threatening complication. Both conditions occur in the later stages of pregnancy and sometimes postpartum.
HELLP syndrome was named in 1982 by Dr. Louis Weinstein after the following characteristics (Preeclampsia Foundation, 2015):
H (hemolysis, which is the breakdown of red blood cells)
EL (elevated liver enzymes)
LP (low platelet count – thrombocytes)
HELLP syndrome is difficult to diagnose, especially in the absence of high blood pressure and when proteins are not present in the urine. HELLP symptoms are sometimes mistaken for gastritis, flu, acute hepatitis, gallbladder disease, and other illnesses.
Globally, the mortality rate for HELLP syndrome is approximately 25% (Preeclampsia Foundation, 2015). Therefore, it is important for pregnant women to be aware of this condition and its symptoms so that diagnosis can be made and treatment can begin more quickly.
Causes of HELLP Syndrome
We still do not know exactly what causes HELLP syndrome. Although the syndrome occurs more frequently in women who have preeclampsia or pregnancy-induced hypertension, there are still many women who develop HELLP syndrome without prior signs of preeclampsia (American Pregnancy Association, 2015).
Symptoms of HELLP Syndrome
The physical symptoms of HELLP syndrome initially resemble preeclampsia. Pregnant women with HELLP syndrome report having one or more of the following symptoms (Preeclampsia Foundation, 2015; American Pregnancy Association, 2015):
– Headache
– Nausea, vomiting (which often worsens), indigestion with pain after eating)
– Abdominal and chest tenderness (pain under the right rib cage)
– Shoulder pain and pain with deep breathing
– Bleeding
– Vision changes
– Swelling
– Fatigue
Signs to watch out for:
– High blood pressure
– Protein in the urine
The most common complications are severe liver damage or stroke (cerebral edema or cerebral hemorrhage). Both can usually be prevented if the person receives timely treatment.
Treatment of HELLP Syndrome
Most often, the definitive cure for a woman with HELLP syndrome is delivery. During pregnancy, some women with HELLP syndrome require blood transfusions (e.g., red blood cells, platelets, or plasma). Corticosteroids can be used in early pregnancy to help with fetal lung maturation.
Prevention of HELLP Syndrome
Unfortunately, there is currently no way to prevent this syndrome. The following is recommended (Preeclampsia Foundation, 2015; American Pregnancy Association, 2015):
– Ensure good physical fitness and exercise before pregnancy
– Maintain a balanced healthy diet
– Regularly visit your doctor/gynecologist and midwife during pregnancy
– Inform your doctor/gynecologist and midwife if you have had a high-risk pregnancy in the past, if you have a family history of HELLP syndrome, preeclampsia, or other high blood pressure issues
Classification of HELLP Syndrome
The severity of HELLP syndrome is measured by the mother’s blood platelet count and is divided into three categories, according to the “Mississippi Classification” (Preeclampsia Foundation, 2015):
– Class I (severe thrombocytopenia): platelets below 50,000/mm3
– Class II (moderate thrombocytopenia): platelets between 50,000 and 100,000/mm3
– Class III (AST> 40 IU/L, mild thrombocytopenia): platelets between 100,000 and 150,000/mm3
How HELLP Syndrome Affects Infants
If a newborn weighs at least 1000 grams at birth, they have the same survival rate and approximately the same health outcomes as non-HELLP infants of the same size. Infants weighing less than 1000 grams at birth have more problems. Several studies show that these infants require longer hospital stays and additional care. Currently, doctors cannot predict the extent of health problems these children will face later in life (Preeclampsia Foundation, 2015).
In developed countries, the stillbirth rate (for intrauterine fetal death after 20 weeks) is 51 infants per 1000 pregnancies. This rate is higher than for severe preeclampsia and eclampsia. The overall perinatal mortality due to HELLP syndrome (stillbirth and neonatal death) ranges from 7.7 to 60%. Most of these deaths are attributed to placental abruption – detachment of the placenta, placental failure with intrauterine asphyxia (the fetus does not receive enough oxygen), and significantly premature birth (Preeclampsia Foundation, 2015).
Risk of HELLP Syndrome in Future Pregnancies
Women with a history of HELLP syndrome are at increased risk for all forms of preeclampsia in future pregnancies. The rate of preeclampsia in future pregnancies ranges from 16 to 52% (higher rates occur when HELLP appears in the second trimester). The rate of recurrent HELLP syndrome in subsequent pregnancies ranges from 2 to 19%, depending on the patient population studied (Preeclampsia Foundation, 2015).
