HELLP Syndrome
Serious Pregnancy Complication

Signs of HELLP

HELLP Syndrome Diagnosis

HELLP Syndrome

Contents

What Is HELLP Syndrome?
What Are The Symptoms?
How Is It Diagnosed?
What Is The Treatment?
Can I Prevent It?
What Are The Risk Factors?
Babies Born To Mothers With HELLP


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Pregnancy Complication Guide

What Is HELLP Syndrome?

It is a rare but serious condition which can occur in pregnant women. Most commonly it occurs in the third trimester of pregnancy but it can occur any time after week 20. In about 8 percent of cases it happens postpartum directly after delivery and childbirth. The acronym stands for:

H: Hemolysis - Where red blood cells are destroyed too soon causing a low red cell count (what is blood?).
EL: Elevated Liver Enzymes - Indicating the liver is not processing toxins in the body efficiently.
LP: Low Platelet Count - Makes it difficult for blood clots to form.

As many women with HELLP Syndrome also have protein in their urine and high blood pressure, some doctors view it as a form or variant of preeclampsia. When HELLP develops it can put both the mother and baby's life in danger, which is why an induced premature labor is usually the only option. Women who are not diagnosed quickly enough have a 25 percent chance of developing a serious complication such as stroke or extensive liver damage.

What Are The Symptoms?

The signs of HELLP can be very vague and because some are also common symptoms of pregnancy it can be hard to recognize the condition. Like preeclampsia the condition can suddenly develop out of the blue without warning. Symptoms include:

1. Fatigue or general malaise (90 percent of cases).
2. Nausea or vomiting which continues to get worse (30 percent). However this is also a sign of hyperemesis gravidarum.
3. Headaches (30 percent).
4. Pain and tenderness in the upper right part of the abdomen, just below the ribs (65 percent). Also known as epigastric pain, a woman may confuse the pain with heartburn. However unlike heartburn, the pain of HELLP syndrome does not burn, it does not spread towards the throat and it is not cured with antacid. HELLP pain is often severe and is associated with tenderness over the liver area.
5. Blurred vision.
6. Fluid retention and excess weight gain (edema - but its absence does not exclude HELLP).
7. Rarely: Nosebleeds or bleeding gums.
8. Rarely: Seizures or convulsions.

How Is It Diagnosed?

The doctor will carry out a physical examination and a blood test. The physical exam may reveal abdominal tenderness and swelling in the hands or legs. Blood tests can reveal a low platelet count, hemolysis and elevated liver enzymes. A CAT scan may also be carried out to check for bleeding in the liver. The baby's heart and health will also be closely monitored. If HELLP is diagnosed, it will be classified into one of three severity classes, according to the mother's platelet count:

Class I: Blood platelets under 50,000/mm3. Diagnosis: Severe Thrombocytopenia.
Class II: Blood platelets between 50,000 and 100,000/mm3. Diagnosis: Moderate Thrombocytopenia.
Class III: Blood platelets between 100,000 and 150,000/mm3. Diagnosis: Mild Thrombocytopenia.

Platelets are a type of red blood cells which are responsible for blood clotting. With HELLP syndrome the body tends to use up the platelets (thrombocytes) too fast and this leads to a shortage of platelets - a condition known as thrombocytopenia. Although women appear to be more prone to this problem while pregnant, generally platelet counts return to normal after childbirth.

What Is The Treatment?

As liver function can rapidly decline in women with HELLP, the main 'treatment' is prompt delivery of the baby. This may have to be carried out before the expected due date. If bleeding is detected a blood transfusion may also be necessary. Additionally, magnesium sulfate may be administered to decrease the risk of seizures in the mother, but evidence of the success of this treatment is conflicting. If the woman's symptoms are not extremely severe the doctor may wait a few days and prescribe steroids to allow the baby's lungs and vital organs extra time to develop before delivery. This will reduce the risks of birth defects and help strengthen the mother's immune system.

In the 48 hours after delivery, it is not uncommon for the mother's symptoms to become worse or even new ones to develop. Complications which can arise include:

1. Blood clotting problems which can lead to uncontrollable bleeding.
2. Severe liver damage which can cause the liver to fail or even rupture.
3. Severe kidney problems including complete failure.
4. Breathing difficulties bad enough to require artificial ventilation.
5. Stroke (in particular, cerebral hemorrhage) with or without convulsions.

Treatment in an intensive care unit may be necessary and it will be aimed at supporting the mother's vital systems until they have recovered to cope on their own. As long as no permanent damage has occurred, the mother should experience a full recovery. This can happen within a few days or as long as three months, depending on the severity of the complications.

Can I Prevent It?

If a woman has had HELLP in a previous pregnancy, she is likely to have it again in subsequent ones. As there is nothing that can be done to prevent the condition, she will need to be monitored very closely. Fortunately the condition is usually less severe next time around.

In preparing for pregnancy, it is best to arrive in your pregnant state as fit and healthy as possible. This will help you cope with any unforeseen problems. When the pregnancy is confirmed, be sure to have regular prenatal visits. Know the warning signs of both preeclampsia and HELLP, and learn to trust your instincts. If something does not feel 'quite right', report it.

What Are The Risk Factors?

As scientists do not know what causes HELLP syndrome, they cannot predict which women will develop it. At this moment in time, it appears to be a risk for all pregnant women. Elevated blood pressure (hypertension) appears to be one precursor, although many cases of HELLP occur where blood pressure is normal. White women over the age of 25 are slightly more at risk, as are those who suffered HELLP in previous pregnancies (1 in 4 have a chance of developing it again. The rates are slightly higher for those who develop HELLP in the second trimester of pregnancy). Also about 15 percent of women who develop preeclampsia develop HELLP Syndrome symptoms - that is about 48,000 American women every year. Where preeclampsia is diagnosed early enough, HELLP Syndrome is less likely to develop.

Babies Born To Mothers With HELLP

The main danger to a baby born to a mother with HELLP, is being born prematurely (before week 37 of pregnancy). Premature babies have less time to develop, so they can find it hard to breathe on their own. They may need to stay in a neonatal intensive care unit for close supervision. If the baby weighs less than 3.5 pounds (1,500 g), they have a 1 in 6 chance of dying before their first birthday.

The most common causes of HELLP related stillbirths is placental abruption, intrauterine asphyxia (fetus did not receive enough oxygen) and extreme prematurity.

Other Pregnancy Complications

Bleeding During Pregnancy
Fever in Pregnancy
Intrauterine Fetal Death
Intrauterine Growth Restriction
Oligohydramnios

  Related Articles on HELLP Syndrome

For more about baby and mom healthcare, see the following:

Ovarian tumors during pregnancy: What are the risks?
Digestive problems in pregnancy: mouth, tummy and bowels.
Will Pregnancy Raise My Blood Pressure?

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