HELLP syndrome
HELLP syndrome is a complication of pregnancy; the acronym stands for hemolysis, elevated liver enzymes, and low platelet count. It usually begins during the last three months of pregnancy or shortly after childbirth. Symptoms may include feeling tired, retaining fluid, headache, nausea, upper right abdominal pain, blurry vision, nosebleeds, and seizures. Complications may include disseminated intravascular coagulation, placental abruption, and kidney failure.
| HELLP syndrome | |
|---|---|
| Specialty | Obstetrics |
| Symptoms | Feeling tired, retaining fluid, headache, nausea, upper abdominal pain, blurry vision, seizures |
| Complications | Disseminated intravascular coagulation (DIC), placental abruption, kidney failure, pulmonary edema |
| Usual onset | Last 3 months of pregnancy or shortly after childbirth |
| Types | Complete, incomplete |
| Causes | Unknown |
| Risk factors | Preeclampsia, eclampsia, previously having HELLP, mother older than 25 years |
| Diagnostic method | Blood tests |
| Differential diagnosis | Viral hepatitis, thrombotic thrombocytopenic purpura, cholangitis, hemolytic uremic syndrome |
| Treatment | Delivery of the baby as soon as possible, management of blood pressure |
| Prognosis | <1% risk of death (mother); 7.3% to 11.9% risk of death (child) |
| Frequency | ~0.7% of pregnancies |
The cause is unknown. The condition occurs in association with pre-eclampsia or eclampsia. Other risk factors include previously having the syndrome and a mother older than 25 years. The underlying mechanism may involve abnormal placental development. Diagnosis is generally based on blood tests finding signs of red blood cell breakdown (lactate dehydrogenase greater than 600 U/L), an aspartate transaminase greater than 70 U/L, and platelets less than 100×109/l. If not all the criteria are present, the condition is incomplete.
Treatment generally involves delivery of the baby as soon as possible. This is particularly true if the pregnancy is beyond 34 weeks of gestation. Medications may be used to decrease blood pressure and blood transfusions may be required.
HELLP syndrome occurs in about 0.7% of pregnancies and affects about 15% of women with eclampsia or severe pre-eclampsia. Death of the mother is uncommon (< 1%). Outcomes in the babies are generally related to how premature they are at birth. The syndrome was first named in 1982 by American gynaecologist Louis Weinstein.