HELLP Syndrome: Symptoms, Causes, & Treatment

HELLP syndrome is a complication that can occur in pregnancy. It is characterized by the destruction of red blood cells, an increase in liver enzymes and a decrease in platelet levels. It is most common after 28 weeks of pregnancy.

This syndrome can cause symptoms such as general malaise, nausea, vomiting, headache and/or pain on the right side of the upper belly. This pain can sometimes be confused with illnesses such as gastritis, flu or acute hepatitis.

If HELLP syndrome is suspected, it is important to seek urgent obstetric assessment so that this condition is caught as early as possible. If left untreated, it can lead to further complications like premature birth and placental abruption.

Common symptoms

The main symptoms of HELLP syndrome are:

• General malaise
• Pain in the pit of the stomach or below the ribs on the right
• Headache
• Nausea and vomiting
• Fatigue
• Leg swelling
• High blood pressure
• Sudden weight gain
• Yellow skin and eyes
• Changes in vision, such as blurred, double vision or flashing lights
• Nose bleeding

Typically, symptoms of HELLP syndrome appear between 28 and 37 weeks of pregnancy or within the first 7 days after birth. These symptoms tend to worsen at night. The headache caused by this condition generally does not improve with the use of painkillers.

Symptoms of HELLP syndrome can sometimes be confused with other conditions, such as  gastritis or the flu, while cases  that present with high blood pressure can be confused with pre-eclampsia. This is why diagnosis can sometimes be tricky.

Can you get pregnant again after having HELLP syndrome?

Women diagnosed with HELLP syndrome that received adequate treatment can become pregnant again. However, there is a risk of recurrence of this syndrome in future pregnancies.

Therefore, it is recommended for pregnant women with a history of HELLP syndrome to be closely monitored throughout their pregnancy to prevent the risk of a new flare-up.

Possible causes

It is believed that HELLP syndrome occurs is related to an exaggerated activation of the immune system. It is thought that abnormalities in how the placenta develops during pregnancy triggers an inflammatory response in the body.

Some factors that may increase the risk for HELLP syndrome include:

• History of HELLP syndrome, pre-eclampsia or eclampsia in a previous pregnancy
• Being over 35 years old
• Multiple pregnancies
• Obesity
• Illnesses such as diabetes and high blood pressure

Additionally, it is believed that some women may also have a genetic predisposition that increases their risk for HELLP syndrome during pregnancy.

Confirming a diagnosis

A diagnosis of HELLP syndrome is confirmed by the obstetrician based on presenting symptoms and blood test results. The doctor will order bloodwork that specifically looks at red blood cell and platelet levels.

The doctor usually also orders tests that evaluate liver function, such as bilirubin, AST and ALT levels in the blood. These can also become altered in the presence of HELLP syndrome.  

Treatment options

Treatment for HELLP syndrome is normally carried out in the Intensive Care Unit so that the obstetrician can continuously monitor the woman and baby's health status. This will help to indicate the most optimal time and type of birth.

Typically, treatment depends on how far along the pregnancy is. After the 34th week of pregnancy, the OB will often opt to induce labor if the woman is stable. A c-section may be indicated to prevent complications for the woman or the baby.

When the pregnant woman is less than 34 weeks, corticosteroid injections, such as betamethasone, can be given to accelerate the development of the baby's lungs. However, this treatment may not be effective for pregnancies at less than 24 weeks, at which point, it may be necessary to terminate the pregnancy.

Possible complications

HELLP syndrome that is left untreated can lead to several complications that pose a risk to the pregnancy, such as:

• Eclampsia
• Placental abruption
• Disseminated intravascular coagulation 
• Thrombosis
• Liver rupture
• Cerebral hemorrhage
• Pulmonary or cerebral edema
• Acute kidney injury
• Reduced intrauterine growth
• Premature birth
• Neonatal respiratory distress syndrome

It is important to seek immediate medical attention as soon as you notice any symptoms of HELLP syndrome to prevent life-threatening complications.

Does HELLP syndrome cause chronic effects?

HELLP syndrome usually does not typically lead to any chronic or lifelong effects, especially if it is identified and treated early.

Prevention measures

There is no way to prevent the development of HELLP syndrome. Therefore, it is important to follow your OB's recommendations, and to attend all prenatal consultations. Be sure to seek medical help immediately if any syndrome is suspected. 

It is important to maintain healthy habits during pregnancies, like exercising as approved by your OB, maintaining and balanced diet, and managing any other conditions, like diabetes or high blood pressure.