HELLP syndrome is an extremely dangerous condition that can develop in pregnant women. It includes:
hemolysis
EL: elevated liver enzymes
LP: a low platelet count
Hemolysis refers to a breakdown of red blood cells. Specifically, red blood cells get broken down earlier than normal. Hemolysis can lead to anemia, a condition in which your blood does not have enough oxygen to supply your body.
Elevated liver enzymes indicate that your liver is functioning poorly. When liver cells are inflamed or injured, they leak abnormally high amounts of certain chemicals, including enzymes, into your blood.
Platelets are part of the blood that helps it clot. When they are low, you are at risk for excess bleeding.
HELLP syndrome usually occurs in the last trimester of pregnancy, before the 37th week. It is a major health concern because it can be fatal to both mother and unborn baby. Prompt treatment and delivery of the baby are generally required for the best outcome. However, about a third of HELLP cases occur after the baby is born in the first week after delivery (Padden, 1999).
The syndrome’s cause is unknown. Some experts believe it is related to preeclampsia, another pregnancy complication, which causes high blood pressure. There are certain factors that can also increase your chance of developing HELLP syndrome.
According to the National Institutes of Health, HELLP syndrome affects approximately one to two out of every 1,000 pregnant women. (NIH).
Risk Factors
There is no one cause for this condition. Instead, the medical community widely recognizes various risk factors that may increase your chances of developing HELLP syndrome.
Preeclampsia is the greatest risk factor. This condition is marked by high blood pressure, and it occurs during the last trimester of pregnancy. However, not all pregnant women with preeclampsia will necessarily develop HELLP syndrome.
Other risk factors include:
being over the age of 25
being Caucasian
having given birth previously
being obese
having a poor diet
lack of exercise
having diabetes
Having had HELLP syndrome during a previous pregnancy can also increase your risk. According to the American Pregnancy Association, your risk can increase by 19 to 25 percent in future pregnancies (APA, 2009).
Symptoms
HELLP symptoms are similar to flu-like symptoms. They may also seem to be “normal” side effects of pregnancy. Sadly, many women skip medical treatment because they misdiagnose themselves. It is important that if you have any flu-like symptoms during pregnancy that you have them checked by a professional to ensure that they are not indicative of serious health issues.
Some of the most common symptoms of HELLP syndrome are:
feeling generally unwell or fatigued
abdominal pain, especially in the upper-right side of your abdomen below the ribs
nausea
vomiting
headache
You may also experience:
swelling, especially in the hands or face
excessive weight gain
blurry vision or visual disturbances
heartburn or indigestion
shoulder pain
pain when breathing deeply
In rare cases, you may have:
nosebleeds or other bleeding that is hard to control
seizures.
Diagnosis
Because HELLP has similar symptoms to the flu, a proper medical diagnosis is needed. Blood tests can determine platelet levels, as well as your red blood cell count (to check for hemolysis). A urine test can detect high liver enzymes. Your doctor may order a computed tomography (CT) scan to detect bleeding in your liver.
Patients may also exhibit marked physical signs. A doctor can feel for abdominal tenderness (which may indicate a liver problem) or an enlarged liver. Your doctor may also look for excess swelling.
Blood pressure readings are often high with HELLP syndrome. You may also have protein in your urine (proteinuria). Your doctor should test for this at each prenatal visit.
Treatment
HELLP generally strikes before the 37th week of gestation. However, the best treatment is to deliver the baby. In many cases, the baby is born prematurely. Leaving the baby in the mother during HELLP may increase the health risks for both individuals.
Your treatment will depend on the severity of your condition and how near you are to your due date. If your HELLP syndrome symptoms are mild and/or your baby is less than 34 weeks, your doctor may recommend:
bedrest (either at home or in the hospital)
admission to the hospital
blood transfusions to treat anemia and low platelets
magnesium sulfate to prevent seizures
antihypertensive medication to control blood pressure
corticosteroid medication to help your baby’s lungs mature in case an early delivery is needed
Your doctor will also closely monitor your red blood cell, platelet, and liver enzyme levels to check for signs that your condition is worsening. Your baby’s health will also be watched closely. Your doctor may recommend fetal tests that measure movement, heart rate, stress, and blood flow.
If your doctor determines that your condition requires immediate delivery of your baby, you may be given medications to help induce labor. A cesarean section may be performed, but this may cause complications if you have blood clotting problems because your platelet count is low.