HELLP syndrome

What is HELLP syndrome?

HELLP syndrome is a serious pregnancy complication that affects the blood and liver. 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 in your blood can be a sign of liver problems.
• LP--Low platelet count. Platelets are little pieces of blood cells that help your blood clot. A low platelet count can lead to serious bleeding.

HELLP syndrome is rare. It happens in about 1 to 2 of 1,000 pregnancies. HELLP usually develops in the third trimester of pregnancy, but it sometimes develops in the week after a baby is born. If you have HELLP syndrome, the liver may bleed, causing pain in your chest or belly. It’s is a medical emergency that needs quick treatment. Without early treatment, 1 out of 4 women (25 percent) with HELLP has serious complications. Without any treatment, a small number of women die.

If you’ve had HELLP syndrome in a past pregnancy, tell your provider. Getting early and regular prenatal care can help reduce your risk of having HELLP again. Going to all your prenatal care checkups allows your health care provider to find and treat problems like HELLP early. 

HELLP syndrome usually goes away after giving birth.

What causes HELLP syndrome?

We don’t know what causes HELLP syndrome. You’re at risk for HELLP if you have preeclampsia or eclampsia. About 1 to 2 in 10 pregnant women (10 to 20 percent) with preeclampsia or eclampsia develop HELLP. Preeclampsia is a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia). It’s when a woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Eclampsia is when preeclampsia is uncontrolled and causes seizures. Seizures are sudden, abnormal electrical activity in the brain that can cause changes in behavior, movement, feelings and consciousness.

What are signs and symptoms of HELLP syndrome?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy. Signs and symptoms of HELLP syndrome can appear during pregnancy or after giving birth. Some women develop HELLP suddenly, without having any signs or symptoms.

Signs and symptoms of HELLP syndrome include:

• Blurry vision
• Chest pain or pain in the upper right or middle part of the belly
• Headache, fatigue (feeling really tired) or feeling unwell
• Nausea (feeling sick to your stomach) or throwing up that gets worse
• Quick weight gain and swelling
• Nosebleed or other bleeding that doesn’t stop. This is rare.
• Seizures or convulsions. This is rare. Convulsions are when your body shakes quickly and without control.

If you have any signs or symptoms of HELLP syndrome, call your health care provider or emergency services (911) or go to a hospital emergency room for medical care right away.

Signs and symptoms of HELLP syndrome are the same as for other health conditions. So sometimes HELLP is misdiagnosed as:

• Flu or other illness caused by a virus
• Gallbladder disease. The gallbladder is an organ under your liver that stores bile, a fluid your liver makes to help the body break down fat.
• Hepatitis. This is inflammation (swelling) of the liver.  
• Idiopathic thrombocytopenic purpura (also called ITP). This is a bleeding disorder. If you have ITP, you may bruise easily or have a lot of bruising (also called purpura). You also may bleed easily or heavily. For example, you may have bleeding from the gums or nose or bleeding into the skin that looks like a rash of pinpoint red spots.
• Lupus flare. A lupus flare is a period of time when you have many or intense lupus symptoms. Lupus is an autoimmune disorder that can cause health problems during pregnancy. Autoimmune disorders are health conditions that happen when antibodies (cells in the body that fight off infections) attack healthy tissue by mistake. Lupus and other autoimmune disorders can cause swelling, pain and sometimes organ damage. Lupus also can affect joints, skin, kidneys, lungs and blood vessels. 
• Thrombotic thrombocytopenic purpura. This is a rare condition that causes blood clots to form in small blood vessels throughout the body. These clots can cause serious health problems if they block the flow of blood to organs, like the brain, kidneys and heart.

What health problems can HELLP cause?

HELLP syndrome can cause:

• Bleeding and blood clotting problems. Some women with HELLP develop disseminated intravascular coagulation (also called DIC). This is a blood clotting disorder than can lead to heavy bleeding (also called hemorrhage).
• Fluid buildup in the lungs (also called pulmonary edema). This can cause breathing problems.
• Kidney failure
• Liver hemorrhage or failure
• Placental abruption. This is a serious condition in which the placenta separates from the wall of the uterus before birth.

How is HELLP syndrome diagnosed?

To find out if you have HELLP syndrome, your provider does a physical exam to check you for:

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

Your provider may do blood tests to check your liver enzyme levels and your platelet count. He may do a CT scan to see if there’s bleeding in your liver. A CT scan is a test that uses X-rays and computers to take pictures of your body.

Your provider may do tests like a non-stress test or ultrasound to check your baby’s health. A non-stress test (also called NST or fetal heart rate monitoring) checks your baby’s heart rate in the womb to see how the heart rate changes when your baby moves. Your provider uses this test to make sure your baby’s getting enough oxygen. Ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.

Many women are diagnosed with preeclampsia before they have HELLP. Sometimes signs and symptoms of HELLP symptoms are the first signs 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. You may need a blood transfusion. This is when you have new blood put into your body.

If you have HELLP syndrome, you may need to give birth as soon as possible. This may mean that your baby is born prematurely, before 37 weeks of pregnancy. Early birth may be necessary because HELLP complications can get worse and harm both you your baby. If you’re giving birth early, your provider may give you medicines called antenatal corticosteroids to help speed your baby’s lung growth. Your provider can induce labor (make labor start) with medicine or other methods. Or you may have your baby by cesarean birth (also called c-section). This is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.

Last reviewed: February, 2019