HELLP Syndrome During Pregnancy

HELLP syndrome during pregnancy is a life-threatening complication of pregnancy that is usually associated with preeclampsia.

Both disorders generally occur after the 20th week of pregnancy and can also happen after birth.

HELLP is thought to be a variant of preeclampsia which occurs in around 5-8% of all pregnancies. However medical experts have discussed HELLP as a condition in its own right.

HELLP Syndrome During Pregnancy

The term HELLP syndrome was first coined by Dr. Louis Weinstein in 1982. It stands for:

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

When red blood cells break down too soon and too rapidly, the result can be low levels of red blood cells, and eventually anemia. Anemia means there isn’t sufficient oxygen available to the body.

If liver enzymes are elevated, this indicates the liver isn’t functioning properly. The liver has an important role in the body; it filters blood and removes toxins, processes nutrients from food, and regulates metabolism.

Platelets help the blood to clot. If platelet levels are low, there is an increased risk of excessive bleeding.

What Causes HELLP Syndrome?

HELLP syndrome is a rare disorder and affects less than 1% of pregnancies worldwide, HELLP is a life-threatening condition with potentially devastating consequences.

Medical experts don’t know exactly what causes the disorder. About 10-20% of women who have preeclampsia will go on to develop HELLP. But there are also women who develop HELLP without having shown any previous signs of preeclampsia.

You’re more likely to be at risk for the syndrome if:

• You’ve experienced HELLP syndrome in a previous pregnancy
• You’ve experienced preeclampsia or eclampsia in a previous pregnancy or in the current pregnancy
• You are Caucasian
• You’re over the age of 25.

Symptoms Of HELLP Syndrome

Diagnosis of HELLP syndrome can be challenging, particularly if there are no clinical signs such as high blood pressure or protein present in urine. Symptoms can be similar to those seen in gallbladder disease, flu, or acute hepatitis.

It’s important to be checked by your care provider if you’re pregnant and have the following symptoms:

• Headaches
• Nausea and vomiting which tends to increase
• Pain in the upper right abdominal area, or pain/tenderness in the chest (from liver distention)
• Fatigue or feeling generally unwell.

Other symptoms you might experience include:

• Pain when taking a deep breath
• Swelling, particularly of the face, legs, and hands
• Bleeding
• Blurry vision
• Shoulder pain
• High blood pressure
• Protein in urine
• Confusion
• Seizures.

If you experience these symptoms, or anyone you know shows evidence of them, then seek immediate emergency medical help. Women who develop HELLP syndrome can become critically ill, or even die, due to liver rupture or stroke. This can be prevented with immediate medical assistance.

Diagnosis Of HELLP Syndrome

To ensure women are giving prompt treatment for suspected HELLP syndrome, care providers will perform a physical examination and run a series of tests.

Your care provider will check for tenderness and pain in the abdominal area, which indicates an enlarged liver. You will also have your blood pressure monitored, and your urine tested for protein and elevated liver enzymes.

The most accurate way to diagnose HELLP syndrome is to have blood tests for platelet levels and red blood cell count.

Treatment Of HELLP Syndrome

If HELLP syndrome is confirmed, appropriate treatment will be determined, based on the gestation of the pregnancy and severity of symptoms.

If your symptoms are mild and your pregnancy is less than 34 weeks gestation, your care provider might recommend:

• Bed rest and admission to hospital
• Corticosteroid medication to help baby’s lungs mature quickly
• Blood transfusions to treat anemia and low platelet levels
• Magnesium sulfate to prevent seizures
• Medication to control high blood pressure
• Fetal monitoring.

If you are more than 34 weeks pregnant or your symptoms begin to worsen, your care provider will recommend the immediate birth of your baby.

It’s no longer recommended to perform a c-section as standard for HELLP syndrome. Women who are at least 34 weeks gestation are usually induced and given the opportunity to try for a vaginal birth. C-sections can cause complications, due to the higher risk of blood clotting problems with low platelet counts.

Risks And Complications Of HELLP

If HELLP syndrome is treated early, most women will recover completely. Once the baby is born, most symptoms will disappear within three days.

However, if HELLP isn’t diagnosed or treated, it can result in devastating complications for both mothers and babies. These include:

• Liver rupture
• Blood clots
• Fluid build up in lungs (pulmonary edema)
• Excessive bleeding leading to hemorrhage
• Lung failure
• Kidney failure
• Placental abruption
• Stroke
• Intrauterine growth restriction
• Infant respiratory distress syndrome
• Death

The rate of maternal death for HELLP syndrome is 1.1%. Infant mortality rates vary between 10% and 60%, depending on factors such as pregnancy gestation, the severity of symptoms, and the timing of treatment.

Babies born early are at risk for complications due to prematurity, depending on their age of gestation.

Can HELLP Be Prevented?

Because we don’t know exactly what causes HELLP syndrome, it’s difficult to know how to prevent it from occurring.

As mentioned previously, around 5-8% of women develop preeclampsia during pregnancy. Of those, 10-20% will go on to develop HELLP syndrome.

The following factors are believed to increase the risk of women developing HELLP syndrome:

• Having a previous pregnancy with HELLP syndrome (with a greater chance of recurrence in each pregnancy)
• Preeclampsia
• Pregnancy-induced hypertension (high blood pressure)
• Increased maternal age
• Caucasian heritage
• Having given birth two or more times previously.

If you’re at risk for HELLP, it’s recommended you maintain a healthy diet and exercise routine during pregnancy.

Speak to your care provider immediately if you are concerned about HELLP, or experiencing HELLP symptoms. Early recognition of symptoms and prompt treatment can prevent HELLP from becoming severe.