HELLP syndrome

Definition

HELLP syndrome is a group of symptoms that occur in pregnant women who have:

• H -- hemolysis
• EL -- elevated liver enzymes
• LP -- low platelet count

Causes, incidence, and risk factors

HELLP syndrome occurs in approximately 10% of pregnant women with pre-eclampsia or eclampsia. Pre-eclampsia may be mild or severe. Severe cases involve high blood pressure and protein in the urine and can progress to seizures (eclampsia). Severe cases are life-threatening to both mother and fetus. HELLP syndrome is associated with more serious cases.

It may occur long before a pregnancy reaches term (for example, HELLP at 30 weeks gestation). Many women have high blood pressure and are diagnosed with pre-eclampsia before they get HELLP syndrome. However, in some cases, HELLP symptoms are the first warning of pre-eclampsia and the condition is misdiagnosed as hepatitis, gallbladder disease, idiopathic thrombocytopenic purpura, or thrombotic thrombocytopenic purpura.

Symptoms

• Progressive nausea and vomiting
• Upper abdominal pain
• Headache
• Vision problems

Signs and tests

During a physical examination, the doctor may discover upper abdominal tenderness, especially in the right upper quadrant. The liver may be enlarged.

Liver function tests (liver enzyme tests) may be elevated. Red blood cell and platelet counts may be low.

Treatment

The main treatment is to deliver the baby as soon as possible, even if premature, since liver function in the mother gets worse very quickly. Problems with the liver can be harmful to both mother and child.

Expectations (prognosis)

When the disease is not treated early, up to 25% of women develop serious complications. Without treatment, a small number of women die. The death rate among babies born to mothers with HELLP syndrome varies and depends on things such as birth weight. (See also: Prematurity.)

Complications

The mother's liver may hemorrhage (bleed). Permanent liver damage, which can be fatal, may occur if delivery is delayed.

Calling your health care provider

See your obstetrician immediately, call the local emergency number (such as 911), or get to the emergency room if the symptoms above occur during pregnancy.