HELLP Syndrome 

Evidence 

https://bestpractice.bmj.com/topics/en-gb/1000 

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.    

Education 

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: 

• HELLP in previous pregnancies 
• Pre-existing high blood pressure 
• History of pre-eclampsia 
• Advanced maternal age 
• Carrying multiples such as twins 

• Overweight 
• Diabetes 

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. 

• Severe headaches 
• Changes in vision such as blurriness or spots in vision 
• Upper right abdominal pain or tenderness 
• Oedema (swelling), especially around face and hands 
• Nausea, vomiting and generally feeling unwell 
• Fatigue 
• Bleeding  
• Excessive and sudden weight gain
• Seizures  

The diagnosis requires: 

• Measurement of your blood pressure (though will not always be elevated in HELLP) 
• Blood tests looking at your blood count levels, liver function, kidney function, clotting profile  
• Checking your urine for protein levels 

The treatment for HELLP syndrome will depend on the severity of your symptoms and your gestation. Depending on these factors your doctor may recommend: 

• Admission into a hospital for monitoring of you and your baby 
• Preterm delivery of your baby.  Depending on the gestation and other factors it might be safe to attempt a vaginal birth or a caesarean might be recommended 
• Medication to prevent seizures 
• Medication to control blood pressure 
• Corticosteroid to help mature your baby’s lungs.  A blood transfusion to treat anaemia and low platelet levels. 

Empowerment 

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. 

Useful Links 

The Woman’s Royal Hospital -Victoria 

https://www.thewomens.org.au/health-information/pregnancy-and-birth/pregnancy-problems/pregnancy-problems-in-later-pregnancy/preeclampsia

Pre-eclampsia Foundation  

https://www.preeclampsia.org/hellp-syndrome 

ANZJOG - The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG)  

https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/ajo.13318 

COPE – Centre for Perinatal Excellence  

https://www.cope.org.au/getting-help/e-cope-directory/ 

Panda - Perinatal Mental Health 

https://panda.org.au/