HELLP vs. PE symptoms and onset?

[expert@preeclampsia.org]

I'm confused... How are HELLP Syndrome and Pre-Eclampsia related -- or are they? Can you have HELLP without Pregnancy Induced Hypertension (PIH) or Pre-Eclampsia or any other high blood pressure issues?

In my first pregnancy, I was diagnosed with PIH at 25 weeks; HELLP at 29 weeks and delivered then by emergency c-section. I guess what I want/need to know is will there be a 'warning' sign like high blood pressure before HELLP comes on? Or, can I be feeling great one minute and have HELLP the next?! (I know the warning signs of HELLP once it hits - I'm more wondering of the days/weeks leading up to it.)

Thank you.

[expert@preeclampsia.org]

Most consider HELLP syndrome a severe form of preeclampsia. There are those who consider some forms of HELLP to be an entity distinct from preeclampsia, there are forms of HELLP associated with genetic mutations of an enzyme in the fetus, and true there are cases of HELLP described with minimal or no elevations of blood pressure. In most instances of the latter there are no data of whether early pressures had been extremely low (e.g., 86/ 40 mm Hg), and the supposedly normal values represented substantial rises.

Any patient who had HELLP should have her subsequent pregnancy managed as a “high risk” one preferably by a maternal fetal medicine subspecialist. This will include more frequent blood pressure tests and perhaps monitoring of the pertinent blood tests. In most instances the blood pressure will rise, and abnormal proteinuria will be detected before any laboratory changes in liver enzymes and/or hematological changes associated with HELLP. Information on recurrence rates are hard to find. 5% sounds correct, but these data are from tertiary referral centers with voluntary reporting. Like other forms of preeclampsia it is probably correct to say there will be a 20% recurrence rate though much of this may be mild rises in proteinuria and blood pressure late in gestation.

[expert@preeclampsia.org]

Presently HELLP syndrome is considered to represent a form of severe preeclampsia. It is distinct in a number of ways, and work being done in some genetic labs around the world may better pinpoint the similarities and the differences between the two conditions.

There may be a different pathway to disease with HELLP syndrome compared to severe preeclampsia. A patient certainly can have both, or at least appear to have both. In the series of patients with HELLP syndrome from our institution published several years ago, the recurrence risk for HELLP syndrome was approximately 1:5 for HELLP and 2:5 for preeclampsia in any of its forms. At least one other group has found a similar recurrence risk for HELLP syndrome, contrasted to a third group which found a lower risk of recurrence around 1:20.

Like most disease potential, whether or not a patient gets the condition depends upon a host of factors -- in the case of HELLP syndrome it could depend upon the genetics of the fetus, the cardiovascular health of the patient, and so forth. There is no readily available test yet available to use to predict which patient is at risk to recur, but I think we will have one within 5 years.

[expert@preeclampsia.org]

I believe that HELLP is a sub-type of severe preeclampsia that is characterized by the greatest imbalance of angiogenic factors. Most patients with HELLP will have the usual features of preeclampsia such as hypertension, proteinuria, but occasionally they may present without any warning signs of preeclampsia. I believe that here is a situation where measurement of angiogenic factors in the blood would be particularly helpful to patients to know if they are at risk of developing severe forms of preeclampsia including the HELLP syndrome.