HELLP Syndrome: Causes, Symptoms, Diagnosis, Treatment, and Prevention
HELLP syndrome is a rare but life-threatening pregnancy complication that affects the blood and liver. It usually occurs in the third trimester of pregnancy, but it can also develop after delivery. The name HELLP stands for:
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Hemolysis: the breakdown of red blood cells, which carry oxygen throughout the body.
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ELevated Liver enzymes: a sign of liver damage or inflammation.
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Low Platelet count: a reduced number of platelets, which help the blood clot.
Causes of HELLP Syndrome
In pregnancy, HELLP syndrome is frequently associated with preeclampsia, which causes high blood pressure and protein in the urine. The coagulation cascade, a process that forms blood clots, can be triggered by preeclampsia, which can damage the blood vessels. Those clots may cause liver damage and elevated liver enzymes when they block blood flow to the liver. Clots can also damage red blood cells, resulting in hemolysis and low platelet counts.
Some risk factors for developing HELLP syndrome include:
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Having a history of preeclampsia or HELLP syndrome in a previous pregnancy.
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Being older than 25 years old.
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Having multiple pregnancies.
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Being white.
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Having a poor diet or being overweight.
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Having diabetes or an autoimmune disease.
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Having a SARS-CoV-2 infection during pregnancy.
Symptoms of HELLP Syndrome
The symptoms of HELLP syndrome can vary from person to person, and some may not have any symptoms at all. However, some common signs and symptoms include:
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Severe pain in the upper right part of the abdomen, which may spread to the shoulder, neck, or back.
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Nausea, vomiting, or indigestion.
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Headache, blurred vision, or other visual disturbances.
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Fatigue, malaise, or weakness.
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Swelling or rapid weight gain.
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Bleeding or bruising easily.
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Seizures or loss of consciousness.
Diagnosis of HELLP Syndrome
Some of the symptoms of HELLP syndrome can be mistaken for those of other conditions, such as gallstones, hepatitis, or gastritis, making it difficult to diagnose. Therefore, if you experience any of the symptoms mentioned above, especially if you are pregnant or have recently given birth, seek medical attention right away.
Your healthcare provider will conduct a physical examination and ask about your medical history and symptoms to diagnose HELLP syndrome. A blood test will also be ordered to determine your liver function, red blood cell count, platelet count, and other indicators of hemolysis. In some cases, they may also order an ultrasound or CT scan to look for liver damage or other complications. They may perform a urine test to check for protein in the urine.
Treatment of HELLP Syndrome
The treatment of HELLP syndrome depends on the severity of the condition and the gestational age of the fetus. The main goal of treatment is to prevent further complications and deliver the baby safely.
Your healthcare provider may recommend inducing labor or performing a cesarean section (C-section) if you have mild HELLP syndrome and your baby is close to term. After delivery, your symptoms and blood tests should improve within a few days since HELLP syndrome can only be reversed by ending the pregnancy.
The healthcare provider may admit you to the hospital and monitor you closely if you have severe HELLP syndrome or your baby has not yet grown up enough to survive outside the womb. In addition to medications to lower your blood pressure, prevent seizures, and help your baby's lungs mature, they may also perform a blood transfusion to replenish the blood cells and platelets lost during delivery. If your condition worsens or if there are signs of fetal distress, they may have to deliver the baby early.
Prevention of HELLP Syndrome
There is no sure way to prevent HELLP syndrome, but you can reduce your risk by taking good care of yourself and your baby during pregnancy. Some of the preventive measures include:
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Getting regular prenatal care and following your healthcare provider’s advice.
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Taking prenatal vitamins and eating a balanced diet.
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Drinking plenty of fluids and avoiding alcohol, tobacco, and drugs.
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Monitoring your blood pressure and weight regularly.
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Reporting any unusual symptoms or changes to your healthcare provider immediately.
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Seeking emergency care if you have severe abdominal pain, bleeding, or other signs of HELLP syndrome.
Outlook and Prognosis of HELLP Syndrome
HELLP syndrome can have serious consequences for both the mother and the baby. Some of the possible complications include:
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Liver failure or rupture.
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Kidney failure or damage.
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Bleeding or hemorrhage.
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Stroke or brain damage.
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Respiratory failure or pulmonary edema.
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Placental abruption or detachment.
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Fetal growth restriction or death.
There are several factors that determine the outlook and prognosis of HELLP syndrome, including the severity of the condition, the timing of diagnosis and treatment, and the presence of other complications. Most women and babies can recover and thrive from HELLP syndrome if treated promptly and appropriately. However, some women may have long-term health problems, such as hypertension, diabetes, or liver disease. Some babies may have developmental delays, cerebral palsy, or other disabilities.
If you have had HELLP syndrome in a previous pregnancy, you have a higher chance of developing it again in a future pregnancy. During a pregnancy, it is important to consult your healthcare provider before planning another pregnancy, and to receive close monitoring and care. The recurrence rate is estimated at 5% to 27%. Preeclampsia and HELLP syndrome can also be prevented by taking aspirin or other medications.
