What Causes HELLP Syndrome In Pregnancy?

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HELLP Syndrome includes a series of symptoms that can affect pregnant women. Though HELLP syndrome is considered to be a variant of preeclampsia, it do have an entity of its own. Studies show that HELLP syndrome may affects about 0.2 to 0.6 percent of all pregnancies.

What is HELLP Syndrome?

The name HELLP stands for:

  • H stands for ┬áhemolysis ( breakdown of red blood cells)
  • EL stands for elevated liver enzymes (liver function)
  • LP stands for low platelets counts (platelets help the blood to clot)

Studies reveal that about 4-12% of women with diagnosed preeclampsia are suspected to develop HELLP syndrome and since the symptoms of HELLP syndrome may be the first sign of preeclampsia it can often lead to a misdiagnosis. The symptoms of HELLP may result in the misdiagnosis for other conditions like hepatitis, idiopathic/thrombotic thrombocytopenic purpura (ITP) or gallbladder disease or, which is a bleeding disorder.

What are the Symptoms of HELLP Syndrome?

The common symptoms of HELLP syndrome include:

  • Headaches
  • Nausea and vomiting that continue to get worse
  • Upper right abdominal pain or tenderness
  • Fatigue or malaise

These symptoms may include:

  • High blood pressure
  • Visual disturbances
  • Protein in urine
  • Edema or swelling
  • Severe headaches
  • Bleeding


How is HELLP Syndrome Diagnosed?

Because the symptoms of HELP can mimic many other conditions, it is always encouraged to run a series of blood tests, including liver function, on any woman experiencing symptoms during the third trimester of pregnancy. HELLP syndrome may rarely occur before the third trimester, may also occur within 48 hours of delivery, even though symptoms may take up to 7 days to be evident. Blood pressure measurements and urine tests are often monitored while diagnosing HELLP syndrome to check for protein.

The following tests and results help a physician to make an accurate diagnosis of HELLP Syndrome:

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 HELLP Syndrome Treated?

The treatment of HELLP Syndrome is based on the gestation of the pregnancy, but delivery of the baby is the best way to avoid any serious complications for both mother and baby. Most symptoms and side effects of HELLP will get reduced within 2-3 days of delivery. If the pregnancy is less than 34 weeks gestation, doctors usually try to evaluate the lung function of the baby to see how well delivery would be handled.

Treatments used to manage HELLP until baby is delivered include:

  • Bed rest and admission into a medical facility to be monitored closely
  • Corticosteroid used to help babies lungs develop more rapidly
  • Magnesium Sulfate used to help prevent seizures
  • Blood transfusion if platelet count gets too low
  • Blood pressure medication
  • Fetal monitoring and tests including sonograms,biophysical tests, non-stress tests and fetal movement evaluation

If the pregnancy is more than 34 weeks gestation or if the symptoms of HELLP become severe, delivery is the recommended as the course of treatment.

Cesarean delivery was considered as the course of treatment for those dealing with HELLP syndrome. But now trial of labor (TOL) is recommended as the treatment for HELLP syndrome suitable for those who are at least 34 weeks gestation. HELLP syndrome is not always the reason for automatic cesarean, but in some cases, operative surgery may cause additional complications due to the possibility of blood clotting problems related to low platelet counts.

What Causes HELLP Syndrome?

The causes of HELLP syndrome are still remain unknown. Although it is more common in women who have preeclampsia or pregnancy induced hypertension, there are still a number of women who get it without previously showing signs of preeclampsia.

The following is a list of factors that are believed to increase the risk of a woman developing HELLP syndrome:

  • A previous pregnancy history with HELLP Syndrome
  • 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 of HELLP Syndrome?

If HELLP syndrome is left undiagnosed or untreated, it can result in life threatening complications for both mother and baby.

The complications and risks of HELLP syndrome include:

  • Placental Abruption
  • Pulmonary Edema
  • Disseminated intravascular coagulation
  • Adult Respiratory distress syndrome (lung failure)
  • Ruptured liver hematoma
  • Intrauterine Growth restriction (IUGR)
  • Acute renal failure
  • Infant respiratory Distress syndrome (lung failure)
  • Blood transfusion

The maternal mortality rate was found to be 1.1% with HELLP syndrome. The infant morbidity and mortality rate can be anywhere from 10-60% depending on many factors such as gestation of pregnancy, severity of symptoms, and the promptness of treatment.

How can HELLP Syndrome be Prevented?

Since the actual cause for HELLP syndrome is unknown, there is no identified way to prevent it either. Early identification and treatment is the best way to manage HELLP syndrome and to avoid additional complications. Since HELLP syndrome is believed to be related to preeclampsia, staying active through regular exercise, remaining vigilant about diet, maintaining a healthy blood pressure can only help.