HELLP syndrome is characterized by a group of symptoms occurring in pregnant women. HELLP syndrome typically occurs during the third trimester of a pregnancy. However, it has occurred as early as 23 weeks of pregnancy. HELLP syndrome can also occur shortly after the baby is born. HELLP syndrome is potentially fatal and requires immediate medical attention.
What Is HELLP Syndrome?
HELLP stands for:
- H—hemolysis, or the breakdown of red blood cells
- EL—elevated liver enzymes
- LP—low blood platelet count
HELLP syndrome is typically associated with preeclampsia or eclampsia. Preeclampsia is also known as pregnancy-induced hypertension or toxemia. It is characterized in a pregnant woman by high blood pressure and protein in the urine, or proteinuria. It typically occurs in the late second or third trimester. If left untreated, preeclampsia can develop into eclampsia. Eclampsia can lead to seizures.
Symptoms of HELLP Syndrome
Symptoms of HELLP syndrome include:
- Fluid retention
- Excess weight gain
- Nausea or vomiting
- Blurry vision
- High blood pressure
- Leg swelling
- Malaise, or discomfort and uneasiness
- Upper right abdominal pain or tenderness
- Nosebleed or other bleeding
Diagnosis and Treatment
If a pregnant woman experiences symptoms of HELLP syndrome, the medical practitioner should begin testing immediately. It is recommended to perform blood testing, including liver function testing. This testing includes blood count, liver enzymes, a coagulation panel, electrolytes, and renal function. A CT scan may reveal bleeding into the liver.
Once symptoms are confirmed, the patient should be admitted into a medical facility and monitored closely. Magnesium sulfate can be administered to help prevent seizures. High blood pressure is often treated with blood pressure medications. If the blood platelet count becomes too low, a blood transfusion may be performed.
Typically, treatment of HELLP syndrome involves prompt delivery of the baby if it is 34 weeks or older. In this case, corticosteroids may be administered to help expedite fetal lung development. It is important that the fetus is consistently monitored to prevent complications. Sonograms, biophysical tests, non-stress tests and sonograms should be conducted for fetal movement and well-being.
Misdiagnosis of HELLP Syndrome
The symptoms of HELLP syndrome can be misdiagnosed as:
- Gallbladder disease
- Flu or other viruses
- Lupus flare
- Thrombotic thrombocytopenic purpura (TTP), or a blood disorder that causes small vessel blood clot formation, leading to a low platelet count
- Idiopathic thrombocytopenic purpura (ITP), or a blood disorder that is characterized by a decrease in blood platelets
Risks and Complications
HELLP syndrome is life-threatening if undiagnosed, untreated, or improperly treated. Roughly 25% of women experience complications and resulting injury. The infant morbidity rate ranges from 10% to 60% depending on several factors. These factors include gestation of pregnancy, severity of HELLP syndrome symptoms, and promptness of treatment.
Potential complications of HELLP syndrome include:
- Placental abruption
- Acute renal failure
- Retinal detachment
- Ruptured liver hematoma
- Permanent liver damage
- Intrauterine growth restriction (IGR)
- Pulmonary edema, or fluid buildup in the lungs
- Adult respiratory distress syndrome and subsequent lung failure
- Infant respiratory distress syndrome and subsequent lung failure
- Disseminated intravascular coagulation, or blood clotting