c



is a series of symptoms that make up a syndrome that can affect pregnant women. HELLP
syndrome is thought to be a variant of preeclampsia, but it may be an entity all on its own. There are still many
questions about the serious condition of HELLP syndrome. The cause is still unclear to many doctors and often
HELLP syndrome is misdiagnosed. It is believed that HELLP syndrome affects about 0.2 to 0.6 percent of all
pregnancies.

 c




The name c

stands for:

Y c hemolysis ( breakdown of red blood cells)

Y
 elevated liver enzymes (liver function)
Y
 low platelets counts (platelets help the blood clot)

It is often assumed that HELLP Syndrome will always occur in connection with preeclampsia, but there are times
when the symptoms of HELLP will occur without a diagnosis of preeclampsia being made. About 4-12% of women
with diagnosed preeclampsia will develop HELLP syndrome. Unfortunately since the symptoms of HELLP
syndrome may be the first sign of preeclampsia, this is what can often lead to a misdiagnoses. The symptoms of
HELLP may cause misdiagnoses of other conditions such as hepatitis, gallbladder disease, or idiopathic/thrombotic
thrombocytopenic purpura (ITP, which is a bleeding disorder.)

  

 c




The most common symptoms of HELLP syndrome include:

Y Headaches
Y £ausea and vomiting that continue to get worse (this may also feel like a serious case of the flu.)
Y Upper right abdominal pain or tenderness
Y ºatigue or malaise

A woman with HELLP may experience other symptoms that often can be attributed to other things such as normal
pregnancy concerns or other pregnancy conditions. These symptoms may include:

Y èisual disturbances
Y High blood pressure
Y Protein in urine
Y Edema (swelling)
Y Severe headaches
Y ÿleeding

c c


 

ÿecause the symptoms of HELP can mimic many other conditions or complications, it is encouraged that physicians
run a series of blood tests, including liver function, on any woman experiencing symptoms during the third trimester
of pregnancy. HELLP syndrome may occur before the third trimester but it is rare. It also may occur within 48 hours
of delivery, although symptoms may take up to 7 days to be evident.

ÿlood pressure measurements and urine tests to check for protein are often monitored when diagnosing HELLP
syndrome. ÿut the following tests and results are what help a physician to make an accurate diagnosis of HELLP
Syndrome:


c
 

Y Abnormal peripheral smear

Y Lacatate dehydrogenase >600 U/L
Y ÿilirubin > 1.2 mg/dl

 



Y Serum aspartate amniotransferase >70 U/L

Y Lacatate dehydrogenase >600 U/L



Y Platelet count

c c




The treatment of HELLP Syndrome is primarily based on the gestation of the pregnancy, but delivery of the baby is
the best way to stop this condition from causing any serious complications for mom and baby. Most symptoms and
side effects of HELLP will subside within 2-3 days of delivery.

If the pregnancy is less than 34 weeks gestation, doctors usually try to evaluate lung function of baby to see how
well delivery would be handled.

Treatment¶s that may be used to manage HELLP until baby is delivered include:

Y ÿed rest and admission into a medical facility to be monitored closely

Y Îorticosteroid ( to help babies lungs develop more rapidly)
Y Magnesium Sulfate ( to help prevent seizures)
Y ÿlood transfusion if platelet count gets too low
Y ÿlood pressure medication
Y ºetal monitoring and tests including biophysical tests, sonograms, non stress tests and fetal movement
evaluation

If pregnancy is over 34 weeks gestation or the symptoms of HELLP begin to worsen, delivery is the recommended
course of treatment.

In the past, Îesarean delivery was the most common way for delivery of babies whose moms were dealing with
HELLP syndrome. ÿut it is now recommended that women, who are at least 34 weeks gestation and have a
favorable cervix, should be given a ³trial of labor´ (TOL). HELLP syndrome does not cause reason for an automatic
cesarean and in some situations, operative surgery may cause more complications due to the possibility of blood
clotting problems related to low platelet counts. If a cesarean delivery is necessary and the platelet count is

  c





octors are still unclear on what exactly causes HELLP syndrome. Although it is more common in women who
have preeclampsia or pregnancy induced hypertension, there are still a number of women who get it without
previously showing signs of preeclampsia.

The following is a list of factors that are believed to increase the risk of a woman developing HELLP syndrome:

Y Previous pregnancy with HELLP Syndrome (19-27% chance of recurrence in each pregnancy)
 Y Preeclampsia or pregnancy induced hypertension
Y =omen over the age of 25
Y Îaucasian
Y Multiparous (given birth two or more times)

  !
"  c




If HELLP syndrome is undiagnosed or untreated, it can result in life threatening complications for both mother and
baby. The most serious complications and risks of HELLP syndrome include:

Y Placental Abruption
Y Pulmonary Edema ( fluid buildup in the lungs)
Y iseminated intravascular coagulation (IÎ blood clotting problems that result in hemorrhage)
Y Adult Respiratory distress syndrome (lung failure)
Y Ruptured liver hematoma
Y Acute renal failure
Y Intrauterine Growth restriction (IUGR)
Y Infant respiratory istress syndrome (lung failure)
Y ÿlood transfusion

The maternal mortality rate is about 1.1% with HELLP syndrome. The infant morbidity and mortality rate is
anywhere from 10-60% depending on many factors such as gestation of pregnancy, severity of symptoms and the
promptness of treatment.

c "c




ÿecause there is not a known cause for HELLP syndrome, there is also no identified way to prevent it. Early
identification and treatment is the best way to keep HELLP syndrome from getting serious.

Since HELLP syndrome is believed to be related to preeclampsia, staying vigilant about diet, exercise and a healthy
blood pressure can only help things!