HELLP syndrome

HELLP syndrome is a rare but serious complication of pregnancy that typically occurs in the third trimester. It is usually considered a complication of preeclampsia, and is estimated to affect one to two pregnancies out of every 1000, and up to 10% of pregnant women with severe preeclampsia.

The condition name, HELLP, is an acronym:

• H is for haemolysis, which is the breakdown of red blood cells. In HELLP syndrome, the red blood cells are broken down earlier than normal, which can lead to anaemia;
• EL is for Elevated Liver enzymes, which indicates abnormal liver function, and;
• LP is for a Low Platelet count. Platelets are important in blood clotting, so a low platelet count is associated with an increased risk of excessive bleeding.

HELLP syndrome typically arises in the third trimester of pregnancy, but in some cases it may occur in the first week after the baby is born.

Preeclampsia and HELLP syndrome are typically characterised by high blood pressure, which may lead to stroke, seizures, or multiple organ failure if it is left untreated.

Women with HELLP syndrome may experience severe abdominal pain below their ribs, not unlike heartburn, except antacids will not relieve their pain. Other symptoms of HELLP syndrome can be easily confused with gall bladder disease or viral illnesses.

 

Causes

It is still not clear what causes some pregnant women to develop HELLP syndrome.

Signs and symptoms

The symptoms of HELLP syndrome are often vague and can be easily confused with other medical conditions. Most cases of HELLP syndrome occur before the 37^th week of pregnancy, but some cases may develop in the week after the baby is born.

Some of the signs and symptoms associated with HELLP syndrome can include:

• Nausea/vomiting/indigestion after eating;
• Pain in the upper abdomen, felt below the ribs;
• Shoulder pain when taking a deep breath;
• Swelling of the legs;
• Fatigue;
• Blurry vision;
• Headache;
• High blood pressure, and;
• Protein in the urine.

Methods for diagnosis

Because HELLP syndrome is a serious complication, prompt medical diagnosis is important.

If your doctor suspects HELLP syndrome, they will perform a complete physical examination and order laboratory tests. Blood tests will measure liver enzymes, red blood cells and platelets. A urine test will measure protein levels.

The severity of HELLP syndrome is classified according to the blood platelet count as follows:

• Class I - severe thrombocytopenia, with platelets under 50,000 mm;
• Class II - moderate thrombocytopenia, with platelets between 50,000 and 100,000/mm, and;
• Class III - mild thrombocytopenia, with platelets between 100,000 and 150,000/mm.

Types of treatment

If the pregnancy is more than 34 weeks, definitive treatment for HELLP syndrome is delivery of the baby. Most symptoms and side effects associated with HELLP syndrome will go away two or three days after the baby is born.

If the pregnancy is less than 34 weeks, treatment may vary, depending on the severity of the condition, but some of the treatment options may include:

• Bed rest and hospital admission to enable closer monitoring of your condition;
• Corticosteroids to help the baby's lungs develop more rapidly;
• Antihypertensive medication to control high blood pressure;
• Blood transfusions for anaemia and low platelet count;
• Magnesium sulphate to prevent seizures, and;
• Monitoring of the unborn baby.

Potential complications

Babies born to mothers with HELLP syndrome may be more affected by the condition than their mother.

Complications associated with HELLP syndrome may include:

• Placental abruption, where the placenta prematurely separates from the uterus;
• Placental failure, where the placenta is not able to supply the foetus with enough oxygen and nutrients;
• Extremely preterm birth;
• Kidney failure;
• Fluid in the lungs;
• Blood clots, stroke;
• Liver rupture, and;
• Death of the mother and/or the baby.

Prognosis

When treated early, women with HELLP syndrome can usually make a full recovery, with most of their symptoms and side effects resolving within a few days after delivery.

The outcome for the baby tends to be more variable. Babies with a smaller birth weight are at greater risk. They may need longer hospital stays and support with breathing.

Prevention

There is no known way to prevent HELLP syndrome, but the likelihood of developing it can be reduced by:

• Maintaining good health and fitness before becoming pregnant;
• Receiving good prenatal care, and;
• Telling your healthcare practitioner if you have a family history of HELLP syndrome, preeclampsia or high blood pressure.