HELLP syndrome and preeclampsia

HELLP syndrome is a life-threatening liver disorder thought to be a type of severe preeclampsia. It is characterized by Hemolysis (destruction of red blood cells), Elevated Liver enzymes (which indicate liver damage), and Low Platelet count.

HELLP is usually related to preeclampsia. About 10% to 20% of women who have severe preeclampsia develop HELLP.1 In most cases, this happens before 35 weeks of pregnancy, though it can also develop right after childbirth.1

HELLP syndrome often occurs without warning and can be difficult to recognize. It can occur without the signs of preeclampsia (which are usually a large increase in blood pressure and protein in the urine). Symptoms of HELLP syndrome include:

  • Headache.
  • Vision problems.
  • Pain in the upper right abdomen (liver).
  • Shoulder, neck, and other upper body pain (this pain also originates in the liver).
  • Fatigue.
  • Nausea and vomiting.
  • Seizure.

HELLP syndrome can be life-threatening for both the mother and her fetus. (Most fetal deaths that follow HELLP syndrome are actually caused by complications of premature birth before 28 weeks of pregnancy.2 A woman with symptoms of HELLP syndrome requires emergency medical treatment.

Treatment and prognosis

Delivery is the only known way to reverse HELLP syndrome. Vaginal delivery is often possible, but a cesarean is used if the mother or fetus is not medically stable. Before delivery, treatment with medicines is used to:

  • Prevent seizures, known as eclampsia (magnesium sulfate prevents seizures).
  • Control severe high blood pressure.
  • Develop the fetus's lungs if the pregnancy is less than 34 weeks along (corticosteroid injections are given to the mother).

Most women begin to recover from HELLP within 2 days after delivery. But women who have had complications of HELLP (such as placenta abruptio and a bleeding disorder called disseminated intravascular coagulation [DIC], or kidney problems) sometimes get worse for the first few days after delivery.2 Supportive treatment may be used to:

  • Control blood pressure with medicine, if necessary.
  • Replace lost blood with transfusions, if necessary.
  • Help hasten recovery. Corticosteroids have been used as an experimental treatment to try to help women recover faster. Research results are conflicting about whether this really works.

If you have had HELLP syndrome, you may be wondering whether it can cause long-term problems. Follow-up studies have shown that:2

  • After having HELLP, the risk of preeclampsia in a later pregnancy is at least 20%. The risk is higher if HELLP started in the second trimester.
  • Overall, only about 5% of women with HELLP have it again in a later pregnancy.

After having HELLP syndrome, you are considered high-risk for complications during any future pregnancies. Make sure that your doctor knows about this part of your health history—you will require close monitoring during any pregnancy and postpartum period.

Citations

  1. Habli M, Sibai BM (2008). Hypertensive disorders of pregnancy. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 257–275. Philadelphia: Lippincott Williams and Wilkins.
  2. Sibai BM (2004). Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstetrics and Gynecology, 103(5): 981–991.

Last Updated: November 14, 2008

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