HELLP syndrome

Some pregnant women with high blood pressure develop a condition called HELLP syndrome. HELLP stands for these blood and liver problems:

  • H--Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body.
  • EL--Elevated liver enzymes. High levels of these chemicals can be a sign of liver problems.
  • LP--Low platelet count. Platelets help the blood clot.

HELLP syndrome is rare but serious. It happens in about 1 to 2 of 1,000 pregnancies. About 2 in 10 pregnant women (20 percent) with preeclampsia or eclampsia have HELLP.

What are the signs and symptoms of HELLP syndrome?
Signs and symptoms can appear during pregnancy or after giving birth. Most women with HELLP have signs and symptoms before 37 weeks of pregnancy. But some women don’t have them until the week after they give birth.

Signs and symptoms include:

If you have any of these signs or symptoms, call your health care provider or go for medical care immediately.

How is HELLP syndrome diagnosed?
Your provider does a physical exam to check you for:

  • Belly pain or soreness, especially in the upper right side
  • Enlarged liver
  • High blood pressure
  • Swelling in your legs

Your provider also may use a liver function test to check your liver enzyme levels or blood tests to check your platelet count. A CAT scan can show bleeding into the liver. A CAT scan is a test that uses X-rays and computers to take pictures of your body.

Many women are diagnosed with preeclampsia before they have HELLP. Preeclampsia is a kind of high blood pressure that only pregnant women can get. Sometimes HELLP symptoms are the first sign of preeclampsia.

How is HELLP syndrome treated?
If you have HELLP, your provider may give you medicine to control your blood pressure and prevent seizures. Sometimes women also need a blood transfusion. This is when you have new blood put into your body.

Women who have HELLP syndrome almost always need to give birth as soon as possible, even if the baby is born prematurely, before 37 completed weeks of pregnancy. Early birth is necessary because HELLP complications can get worse and harm both mom and baby.

If you have HELLP syndrome, your provider may give your corticosteroid medicines to help speed your baby’s lung growth. He also may induce your labor. This means he gives you medicines to make labor begin. Some women need a cesarean section (c-section). A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.

Without early treatment, 1 out of 4 women (25 percent) with HELLP syndrome has serious complications. Without any treatment, a small number of women die.

What causes HELLP syndrome?
We don’t know what causes HELLP. But if you’ve had it before, you may have it again in 1 out of 4 future pregnancies (25 percent).

You may be able to reduce your risk of having HELLP syndrome by getting prenatal care early and throughout your pregnancy. Getting regular prenatal care allows your provider to find and treat any problems like HELLP early.

Last reviewed April 2012

See also: High blood pressure during pregnancy, Preeclampsia

Most common questions

What is mononucleosis?

Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.

You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:

  • Achy muscles
  • Belly pain
  • Fatigue (feeling tired all the time)
  • Fever
  • Sore throat
  • Swollen glands in your neck

If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.

There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

I had a miscarriage. How long should I wait to try again?

Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.

Are gallstones common during pregnancy?

Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.

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