HELLP Syndrome in Pregnancy

The name HELLP stands for:

* H- hemolysis ( breakdown of red blood cells)
* EL- elevated liver enzymes (liver function)
* LP- low platelets counts (platelets help the blood clot)

The HELLP syndrome is a recognized complication of preeclampsia and eclampsia (toxemia) of pregnancy, occurring in 25% of these pregnancy.

Common symptoms in women with the HELLP syndrome include a general feeling of feeling unwell (malaise), nausea and/or vomiting, and pain in the upper abdomen. Increased fluid in the tissues (edema) is also frequent. Protein is measurable in the urine of most women with the HELLP syndrome. Blood pressure may be elevated. Occasionally, coma can result from seriously low blood sugar (hypoglycemia).

The first order of treatment of HELLP syndrome is management of the blood clotting issues. Urgent delivery is required if the growth of the fetus is restricted, Delivery is also required if the syndrome develops after 34 weeks' gestation, if the fetus' lungs are mature, or if the mother's health is in jeopardy.

After delivery, the mother's status is monitored closely. The HELLP syndrome can be complicated by liver rupture, anemia, bleeding, and death.

The HELLP syndrome can also develop during the early period after delivery of a baby.

Women with a history of HELLP syndrome are considered at increased risk for complications in future pregnancies.

Common Misspellings: hellp syndrone

HELLP Syndrome Symptoms

The most common symptoms of HELLP syndrome include:

1) Tiredness
2) Abdominal pain
3) Nausea
4) Vomiting
5) Blood in urine
6) Blood in stools
7) Increase in weight
8) Swelling
9) Cerebral disturbance
10) Pulmonary edema
11) Jaundice
12) Reduced urination
13) High blood pressure
14) Excess protein in urine
15) Low blood platelet level
16) Reduced prothrombin time
17) Headache
18) Blurred vision
19) Malaise
20) Increased liver enzymes
21) Seizure.

HELLP Syndrome Diagnosis

The diagnosis of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) is based upon the presence of the characteristic laboratory findings in patients of appropriate gestational age. Imaging tests, particularly CT or MRI scanning, are useful when complications such as hepatic infarction, hematoma, or rupture are suspected.

The diagnosis is established by the presence of preeclampsia and the following criteria:

1) Microangiopathic hemolytic anemia with characteristic schistocytes on blood smear

2) Platelet count <100,000 cells/µL

3) Serum lactate dehydrogenase >600 IU/L or total bilirubin >1.2 mg/dL

4) Serum aspartate aminotransferase (AST) >70 IU/L

How is HELLP Syndrome Treated ?

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:

* Bed rest and admission into a medical facility to be monitored closely
* Corticosteroid ( to help babies lungs develop more rapidly)
* Magnesium Sulfate ( to help prevent seizures)
* Blood transfusion if platelet count gets too low
* Blood pressure medication
* Fetal 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, Cesarean delivery was the most common way for delivery of babies whose moms were dealing with HELLP syndrome. But it is now recommended that women, who are at least 34 weeks gestation and have a favorable cervix, should be given a “trial 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 <75,000, general anesthesia will likely be recommended.

What Causes HELLP Syndrome ?

Doctors 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:

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

What are the Risks and Complications ?

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:

* Placental Abruption
* Pulmonary Edema ( fluid buildup in the lungs)
* Diseminated intravascular coagulation (DIC—blood clotting problems that result in hemorrhage)
* Adult Respiratory distress syndrome (lung failure)
* Ruptured liver hematoma
* Acute renal failure
* Intrauterine Growth restriction (IUGR)
* Infant respiratory Distress syndrome (lung failure)
* Blood 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.

How can HELLP Syndrome be Prevented ?