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HELLP syndrome

HELLP syndrome is a group of symptoms that occur in pregnant women who have:

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Preeclampsia

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Causes

The cause of HELLP syndrome has not been found. It is considered to be a variant of preeclampsia. Sometimes the presence of HELLP syndrome is due to an underlying disease such as antiphospholipid syndrome.

HELLP syndrome occurs in about 1 to 2 out of 1,000 pregnancies. In women with preeclampsia or eclampsia, the condition develops in 10% to 20% of pregnancies.

Most often HELLP develops during the third trimester of pregnancy (between 26 to 40 weeks gestation). Sometimes it develops in the week after the baby is born.

Many women have high blood pressure and are diagnosed with preeclampsia before they develop HELLP syndrome. In some cases, HELLP symptoms are the first warning of preeclampsia. The condition is sometimes misdiagnosed as:

Symptoms

Symptoms include:

Exams and Tests

During a physical exam, the health care provider may discover:

Liver function tests (liver enzymes) may be high. Platelet counts may be low. A CT scan may show bleeding into the liver. Excessive protein may be found in the urine.

Tests of the baby's health will be done. Tests include fetal non-stress test and ultrasound, among others.

Treatment

The main treatment is to deliver the baby as soon as possible, even if the baby is premature. Problems with the liver and other complications of HELLP syndrome can quickly get worse and be harmful to both the mother and child.

Your provider may induce labor by giving you medicines to start labor, or may perform a C-section.

You may also receive:

Outlook (Prognosis)

Outcomes are most often good if the problem is diagnosed early. It is very important to have regular prenatal checkups. You should also let your provider know right away if you have symptoms of this condition.

When the condition is not treated early, up to 1 of 4 women develop serious complications. Without treatment, a small number of women die.

The death rate among babies born to mothers with HELLP syndrome depends on birth weight and the development of the baby's organs, especially the lungs. Many babies are born prematurely (born before 37 weeks of pregnancy).

HELLP syndrome may return in up to 1 out of 4 future pregnancies.

Possible Complications

There can be complications before and after the baby is delivered, including:

After the baby is born, HELLP syndrome goes away in most cases.

When to Contact a Medical Professional

If symptoms of HELLP syndrome occur during pregnancy:

There is no known way to prevent HELLP syndrome. All pregnant women should start prenatal care early and continue it through the pregnancy. This allows the provider to find and treat conditions such as HELLP syndrome right away.

Related Information

Hemolytic anemia
Platelet count
Preeclampsia
Eclampsia
Hepatitis
Immune thrombocytopenic purpura (ITP)

References

Esposti SD, Reinus JF. Gastrointestinal and hepatic disorders in the pregnant patient. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 39.

Sibai BM. Preeclampsia and hypertensive disorders. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 31.

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Review Date: 9/25/2018  

Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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