James N. Martin, Jr, MD, FACOG, FAGOS, FAHA, F(H)RCOG
HELLP syndrome is considered a severe form of pre-eclampsia (sometimes called 'atypical pre-eclampsia'). It is characterised by haemolysis which is the breakdown of blood cells (H), elevated liver enzymes (EL), and low platelets (LP).
The condition usually occurs antepartum, between 27- and 37-weeks’ gestation; 15% to 30% of cases present initially postpartum. HELLP syndrome poses significant diagnostic and therapeutic challenges because only 80% to 85% of affected people present typically with hypertension and proteinuria.
HELLP syndrome should be considered in any pregnant person presenting in the second half of pregnancy or immediately postpartum with significant new-onset epigastric/upper abdominal pain until proven otherwise.
The disease is associated with progressive and sometimes rapid maternal and fetal deterioration. Early detection and aggressive management is needed. Timely delivery of the foetus and placenta seem to be the best and safest ways to arrest disease progression and reduce adverse outcomes. Patients may require the use of intravenous medication eg magnesium sulphate and/or blood pressure medication to prevent or minimise severe hypertension and replacement of blood products.
HELLP Syndrome is a life-threatening obstetric complication considered by many to be a variant of pre-eclampsia. Approximately 10% to 20% of women who have severe pre-eclampsia will develop HELLP syndrome. Typically, it occurs in the third trimester, but can happen at any stage of pregnancy and it occurs in 0.5% to 0.9% of pregnancies.
HELLP is an abbreviation for
Haemolytic anaemia - red blood cells carry oxygen from your lungs to your body. When diagnosed with HELLP, these red blood cells get broken too soon and too fast leading to anaemia. When this happens, the blood doesn’t carry enough oxygen to the rest of your body.
Elevated Liver enzymes – this indicates that the liver is not functioning properly. Irritated or damaged liver cells leak high amounts of certain chemicals, including enzymes, into your blood.
Low Platelet count – platelets are the parts of your blood that help it to clot. When platelet levels are low, your risk of excessive bleeding increases.
The risk factors for developing HELLP are:
The symptoms of HELLP are varied and some may appear to be symptoms of Pre-eclampsia. However, it is important to get assessed if you are experiencing any of these symptoms.
The diagnosis requires:
The treatment for HELLP syndrome will depend on the severity of your symptoms and your gestation. Depending on these factors your doctor may recommend:
If you are experiencing any signs that are unusual, if you are feeling generally unwell or if you feel concerned, it is important for you to be checked out thoroughly by your doctor. Your doctor may get you to have some blood tests to check for a variety of pregnancy related issues, including checking your liver function.
After you have received a HELLP syndrome diagnosis, your doctor will take into consideration the severity of your condition as well as your gestation and may decide the best course of action is to deliver your baby, perhaps prematurely. Delivery is the most effective way of treating HELLP and the symptoms that you are experiencing will generally subside a few days after delivery. As this condition can be life threatening to you and your baby, these decisions and measures may happen quite quickly. Your doctor will discuss whether a caesarean section is necessary or whether you may be able to deliver vaginally depending on the risks.
If the chance of delivering a preterm baby is likely, you may benefit from visiting the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) to become familiar with the experience and environment.
The Woman’s Royal Hospital -Victoria
ANZJOG - The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG)
COPE – Centre for Perinatal Excellence
Panda - Perinatal Mental Health
Disclaimer: This publication by Miracle Babies Foundation is intended solely for general education and assistance and it is it is not medical advice or a healthcare recommendation. It should not be used for the purpose of medical diagnosis or treatment for any individual condition. This publication has been developed by our Parent Advisory Team (all who are parents of premature and sick babies) and has been reviewed and approved by a Clinical Advisory Team. This publication is not a substitute for professional medical advice. Miracle Babies Foundation recommends that professional medical advice and services be sought out from a qualified healthcare provider familiar with your personal circumstances. To the extent permitted by law, Miracle Babies Foundation excludes and disclaims any liability of any kind (directly or indirectly arising) to any reader of this publication who acts or does not act in reliance wholly or partly on the content of this general publication. If you would like to provide any feedback on the information please email [email protected].