HELLP syndrome and pregnancy

HELLP syndrome is a series of symptoms that make up a syndrome that can affect pregnant women. HELLP syndrome is considered a variant of preeclampsia, but it can also be a separate disease. There are still many questions about the severity of HELLP syndrome. The cause is still unclear to many physicians, and HELLP syndrome is often misdiagnosed. HELLP syndrome is thought to affect about 0.2–0.6% of all pregnancies.

What is HELLP Syndrome?

It is often assumed that HELLP syndrome will always occur in association with preeclampsia, but there are cases where HELLP symptoms appear without a diagnosis of preeclampsia. Approximately 4-12% of women diagnosed with preeclampsia develop HELLP syndrome. Unfortunately, because the symptoms of HELLP syndrome can be the first sign of preeclampsia, this can often lead to misdiagnosis. HELLP symptoms can lead to misdiagnosis of other conditions such as hepatitis, gallbladder disease, or idiopathic/thrombotic thrombocytopenic purpura, which is a bleeding disorder.

What are the symptoms?

The most common symptoms of HELLP syndrome include:

Headaches
Nausea and vomiting that continues to get worse–(This may also feel like a serious case of the flu).
Upper right abdominal pain or tenderness
Fatigue or malaise

A woman with HELLP may experience other symptoms that can often be attributed to other things, such as normal pregnancy problems or other pregnancy conditions.

These symptoms may include:

Visual disturbances
High blood pressure
Protein in urine
Edema (swelling)
Severe headaches
Bleeding

How is it diagnosed?

Because HELLP symptoms can mimic many other conditions or complications, doctors are advised to run a series of blood tests, including a liver function test, on any woman with symptoms in the third trimester of pregnancy. HELLP syndrome may occur before the third trimester, but is rare. It can also happen within 48 hours of giving birth, although symptoms may take up to 7 days to appear.

In diagnosing HELLP syndrome, blood pressure measurements and urine protein tests are often monitored.

But the following tests and results help the doctor make an accurate diagnosis:

Hemolysis -Red blood bells
Abnormal peripheral smear
Lactate dehydrogenase >600 U/L
Bilirubin > 1.2 mg/dl
Elevated liver enzyme levels
Serum aspartate aminotransferase >70 U/L
Lactate dehydrogenase >600 U/L
Low Platelets
Platelet count

How is it treated?

Treatment for HELLP syndrome is mainly based on the gestational age, but delivery is the best way to prevent serious complications of the condition for mother and baby. Most symptoms and side effects disappear within 2 to 3 days after delivery.

If the pregnancy is less than 34 weeks, doctors usually try to evaluate the baby's lung function to see how well the delivery will go.

Treatments that can be used to manage HELLP before the baby is born 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 the gestational age exceeds 34 weeks or HELLP symptoms begin to worsen, delivery is recommended.

In the past, caesarean section was the most common mode of delivery for children whose mothers suffered from HELLP syndrome. But at present, women with a pregnancy of at least 34 weeks and a favorable cervix are recommended to undergo a "trial of childbirth." HELLP syndrome is not a reason for an automatic caesarean section, and in some situations, surgery can lead to more complications due to possible blood clotting problems associated with low platelet count.

What causes HELLP syndrome?

Doctors still don't know exactly what causes HELLP syndrome. Although it is more common in women with preeclampsia or pregnancy-induced hypertension, there are still a number of women who have not had the condition before.

Here is a list of factors that increase the risk of HELLP syndrome in women:

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 not diagnosed and treated, it can lead to life-threatening complications for both mother and baby.

The most serious complications and risks include:

Placental Abruption
Pulmonary Edema (fluid buildup in the lungs)
Disseminated intravascular coagulation (blood clotting problems that result in hemorrhage)
Adult Respiratory distress syndrome (lung failure)
Ruptured liver hematoma
Acute renal failure
Intrauterine growth restriction
Infant respiratory distress syndrome (lung failure)

Blood transfusion

The maternal mortality rate is about 1.1% in HELLP syndrome. Infant morbidity and mortality rates range from 10% to 60% depending on many factors such as gestational age, severity of symptoms, and timeliness of treatment.

How to prevent HELLP syndrome?

Because there is no known cause for HELLP syndrome, there is no way to prevent it. Early detection and treatment is the best way to prevent worsening of HELLP syndrome. Because it's thought to be related to preeclampsia, being vigilant about diet, exercise, and healthy blood pressure can only help.