HELLP Syndrome

HELLP Syndrome happens to be a gynecological disorder affecting 0.2-0.6% of pregnant women and could become life-threatening if left untreated. It is basically an obstetric issue, alleged to be a type of preeclampsia. The condition is actually a sequence of symptoms that affects a woman during her pregnancy.

What happens During HELLP Syndrome?

The condition remains idiopathic as medical scientists, healthcare experts and specialists still do not know the exact cause of the syndrome. Oftentimes, physicians and medical practitioners misdiagnose the condition because of its idiopathic nature. A large proportion of healthcare specialists and experts believe that there might be a strong correlation between the disorder and eclampsia, and preeclampsia.

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Any pregnant woman with hypertension or abnormally high blood pressure is vulnerable to preeclampsia when the kidneys and liver start malfunctioning. When preeclampsia becomes more pronounced or severe, it is known as eclampsia. A pregnant woman diagnosed with eclampsia has damaged kidneys and liver and also experiences episodes of epilepsy.

Demystifying HELLP Syndrome

The expression HELLP is an abbreviation of:

  • Hemolysis (H)
  • Elevated liver enzymes (EL)
  • Low platelets counts (LP)

The breakdown of erythrocytes or red blood cells is known as hemolysis. Elevated or high levels of enzymes produced in the liver indicate that the organ is not functioning properly. Platelets promote blood clotting. A low platelet count implies that your blood does not clot easily if and when you bleed, resulting in inordinate hemorrhage.

Pregnant women are at increased risk of contracting HELLP syndrome if they already suffer from one or more of the above abnormalities. More often than not, it is presupposed that preeclampsia and HELLP can occur concurrently. But sometimes HELLP symptoms surface even when signs of preeclampsia are not noticeable.

On the other hand, up to 12% of pregnant women already with preeclampsia have a high probability of being affected by HELLP.

HELLP Syndrome Symptoms

  • Swelling
  • Vision changes
  • Uncontrolled bleeding
  • Pain in the shoulders when inhaled or exhaled deeply
  • Tenderness in the chest or abdomen accompanied by pain in the upper right brought about by a distended liver
  • Painful vomiting following a meal
  • Nausea
  • Indigestion
  • Headache
  • Extreme fatigue which does not relieve even with resting
  • Sudden and inexplicable weight gain
  • Nosebleed
  • Epileptic seizures

Women with HELLP could also experience symptoms typical to pregnancy like:

  • Bleeding
  • Excruciating headaches
  • Edema
  • Proteinuria (presence of undue amount of protein in urine)
  • Hypertension
  • Vision problems

HELLP Syndrome Cause

Medical experts and physicians are yet in the dark about the exact causes of this syndrome. You’re most likely to get HELLP if you’re hypertensive or have been diagnosed with the condition on an earlier occasion. However you’re also prone to developing the syndrome even if your blood pressure is normal. Caucasian women aged over 25, having given birth to at least 2 babies, and planning to get pregnant again is susceptible to the condition as well.


About 5%-8% of pregnant American women go on to develop preeclampsia. Out of these, approximately 15% have an enhanced likelihood of reporting symptoms of HELLP. Numerically speaking, nearly 48,000 pregnant women in the US are exposed to the condition every year.

HELLP Syndrome Diagnosis

Physicians and diagnosticians run a battery of blood assays to confirm the condition. Since HELLP symptoms usually coincide with those of other complications and disorders, doctors recommend pregnant women in their final trimester to opt for liver function tests in order to determine enzyme levels in the organ. Very rarely do the symptoms of HELLP come to the fore before a pregnant woman is on the threshold of her 3rd or final trimester.

HELLP could outbreak within 2 days of delivery but the symptoms become pronounced only after 5-6 days of having given birth. The doctor checks the blood pressure and carries out urine tests for examining protein levels. Nevertheless, for correctly diagnosing the condition, your doctor will perform the following tests:

  • Hemolysis (checking for bilirubin level, lactate dehydrogenase, and anomalous peripheral smear)
  • Elevated levels of liver enzymes (checking for lactate dehydrogenase and serum aspartate amniotransferase levels)
  • Blood platelets count (checking for low platelet count)

You’re more likely to be found with the condition if:

  • You’re hypertensive
  • You’ve a low platelet count
  • You’ve pain in the right epigastrium
  • Your liver is enlarged or swollen
  • Your legs are inflamed
  • There is bleeding inside your liver

Differential Diagnosis

The symptoms of both HELLP and preeclampsia are so closely related that even experienced physicians often find it quite difficult to differentiate one from the other, thus causing misdiagnosis. Doctors also misinterpret HELLP symptoms confusing them as signs of other diseases like thrombocytic purpura, gallbladder disorders or hepatitis.

HELLP Syndrome Treatment

When it comes to dealing with HELLP, the most effective solution is to speed up delivery. The sooner you give birth, the less exposed you and your baby is from the disorder. It has been observed majority of the symptoms of the condition fade away 2-3 days following delivery.

Gynecologists and obstetricians in order to ensure a safe delivery normally attempt to examine the embryo’s lung function in women who’ve been pregnant for less than 34 weeks. Until the affected woman is ready to give birth, the attending physician recommends the following treatment options:

  • Corticosteroids for promoting faster development of the fetus’s lungs
  • Blood transfusion if and when platelets count falls below the normal level
  • Magnesium sulfate (for arresting and preventing seizures)
  • Biophysical tests, non-stress tests, sonograms, and fetal movement assessment for checking fetal development
  • Blood pressure medicines (if blood pressure is very high)
  • Immediate hospitalization if symptoms worsen

HELLP Syndrome Risk Factors & Complications

  • Blood transfusion
  • Infant Respiratory Distress Syndrome (lung failure)
  • IUGR (Intrauterine Growth Restriction)
  • Renal failure
  • Ruptured liver hematoma
  • Adult respiratory distress syndrome
  • Disseminated intravascular coagulation (the abnormality that impairs clotting of blood, leading to unrestrained bleeding)
  • Pulmonary edema (a condition in which fluid accumulates in lungs)
  • Placental abruption

HELLP Syndrome Prevention

HELLP Syndrome is not easily detectable as its remains idiopathic. Timely detection and treatment seems to be only way to prevent the condition from taking a serious turn.

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