HELLP SYNDROME

What is HELLP Syndrome?

HELLP syndrome is a life-threatening pregnancy complication usually considered to be a variant of preeclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth.

HELLP syndrome was named by Dr. Louis Weinstein in 1982 after its characteristics:

H (hemolysis, which is the breaking down of red blood cells)
EL (elevated liver enzymes)
LP (low platelet count)

HELLP syndrome can be difficult to diagnose, especially when high blood pressure and protein in the urine aren't present. Its symptoms are sometimes mistaken for gastritis, flu, acute hepatitis, gall bladder disease, or other conditions.

The global mortality rate of HELLP syndrome has been reported to be as high as 25%. That's why it's critical for expecting mothers to be aware of the condition and its symptoms so they can receive early diagnosis and treatment.

Symptoms of HELLP Syndrome

The physical symptoms of HELLP Syndrome may seem at first like preeclampsia. Pregnant women developing HELLP syndrome have reported experiencing one or more of these symptoms:

• Headache
• Nausea/vomiting/indigestion with pain after eating
• Abdominal or chest tenderness and upper right upper side pain (from liver distention)
• Shoulder pain or pain when breathing deeply
• Bleeding
• Changes in vision
• Swelling

Signs to look for include:

• High blood pressure
• Protein in the urine

The most common reasons for mothers to become critically ill or die are liver rupture or stroke (cerebral edema or cerebral hemorrhage). These can usually be prevented when caught in time. If you or someone you know has any of these symptoms, please see a healthcare provider immediately.

Treatment of HELLP Syndrome

Most often, the definitive treatment for women with HELLP Syndrome is the delivery of their baby. During pregnancy, many women suffering from HELLP syndrome require a transfusion of some form of blood product (red cells, platelets, plasma). Corticosteroids can be used in early pregnancy to help the baby's lungs mature. Some healthcare providers may also use certain steroids to improve the mother's outcome, as well. 

Who's at Risk of Getting HELLP Syndrome?

Among pregnant women in the United States, 5 to 8% develop preeclampsia. It's estimated that 15% of those women will develop evidence of HELLP syndrome. This mean as many as 48,000 women per year will develop HELLP syndrome in the US.

We can help lower the cases of HELLP syndrome by properly and quickly diagnosing and treating preeclampsia.

What Can I Do to Prevent HELLP Syndrome?

Unfortunately, there's currently no way to prevent this illness. The best thing to do is:

• Get yourself in the good physical shape before getting pregnant
• Have regular prenatal visits during pregnancy
• Inform your care providers about any previous high-risk pregnancies or family history of HELLP syndrome, preeclampsia, or other hypertensive disorders
• Understand the warning signs and report them to your healthcare provider immediately
• Trust yourself when "something just doesn't feel right"

How HELLP Syndrome is Classified

The severity of HELLP syndrome is measured according to the blood platelet count of the mother and divided into three categories, according to a system called "the Mississippi classification."

• Class I (severe thrombocytopenia): platelets under 50,000/mm3
• Class II (moderate thrombocytopenia): platelets between 50,000 and 100,000/mm3
• Class III (AST > 40 IU/L, mild thrombocytopenia): platelets between 100,000 and 150,000/mm3

How HELLP Syndrome Affects Babies

If a baby weighs at least 2 pounds (over 1000 grams) at birth, he or she has the same survival rate and health outcome of non-HELLP babies of the same size.

Unfortunately, babies under 2 pounds at delivery don't fare as well. Several studies have suggested these babies will need longer hospital stays and will have a higher chance of needing ventilator care. Unfortunately, right now doctors can't predict the scope of the medical problems that these small babies will encounter at birth and later in life.

In developed countries, the stillbirth rate (in utero death of the baby after 20 weeks) is 51 out of every 1,000 pregnancies. This rate is higher than both severe preeclampsia and eclampsia.

Overall perinatal mortality from HELLP Syndrome (stillbirth plus neonatal death) ranges from 7.7 to 60%. Most of these deaths are attributed to abruption of the placenta (placenta prematurely separating from the uterus), placental failure with intrauterine asphyxia (fetus not getting enough oxygen), and extreme prematurity.

Risk of Getting HELLP in Future Pregnancies

Women with a history of HELLP syndrome are at increased risk of all forms of preeclampsia in subsequent pregnancies. The rate of preeclampsia in subsequent pregnancies ranges from 16 to 52%, with higher rates if the onset of HELLP syndrome was in the second trimester. The rate of recurrent HELLP syndrome ranges from 2 to 19% depending upon the patient population studied.