HELLP Syndrome: Symptoms, Causes and Prevention

HELLP Syndrome can be defined & characterized as hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP) leading to a well known complication called pre-eclampsia during pregnancy. Dr. Louis Weinstein first described the syndrome in 1982. HELLP Syndrome is often thought to be a variant of preeclampsia and its remains unclear. The name HELLP Syndrome is derived from three abnormalities namely: H - Hemolysis (break down of red blood cells), EL- Elevated liver enzymes (liver function) and LP- Low platelets count (platelet helps the blood to clot). HELLP Syndrome affects nearly 0.2 to 0.6 percent of pregnant women all over the world and can cause serious complication to a mother and baby if left untreated. It has been found that around 4-12 percent of pregnant woman who are diagnosed with preeclampsia are at a greater risk of developing HELLP Syndrome. Sometimes HELLP syndrome is misdiagnosed with other similar conditions like idiopathic/thrombotic thrombocytopenic purpura (ITP), hepatitis and gallbladder disease all of which are associated with bleeding disorder. A pregnant woman can experience these complications during the third trimester of pregnancy or within 48 hours of delivery.

Preeclampsia & the Symptoms

We should first have some knowledge about pre-eclampsia as a pregnancy complication, which can be characterized by high blood pressure and symptoms of organ damage, mainly, liver and kidneys. Pre-eclampsia can be fatal to both mother and fetus and usually begins after 20 weeks of pregnancy in a woman whose blood pressure has been normal. The doctor and mother can face many challenges during the pregnancy if pre-eclampsia is diagnosed at a very early stage of pregnancy. In this case, a baby needs more time to mature but there is always a risk of serious complications that need to be avoided.

To prevent unawareness about the condition, one needs to monitor blood pressure of the expecting mother on a regular basis. Excessive protein in the urine, severe headaches, nausea vomiting, upper abdominal pain, decreased urine outputs and decreased platelet count, impaired liver functions and shortness of breath are all considered as other symptoms of pre-eclampsia that should be taken care of.

Symptoms of HELLP Syndrome

The symptoms of HELLP syndrome can be similar to pre-eclampsia, it can include the following symptoms:

• Epigastria or abdominal pain accompanied by nausea
• Vomiting, anemia, and backache
• Some women can also suffer headache and visual/vision problems
• Fatigue or malaise
• Edema or swelling
• Bleeding accompanied by severe headaches
• Stroke and seizures
• Hypertension (low blood pressure)

These symptoms may vary for different patients depending upon the severity of the condition. They are commonly mistaken as normal pregnancy symptoms, especially when they are not severe. These symptoms can be severe during nighttime and as the condition starts getting worse, a spontaneous hematoma (localized collection of blood outside the blood vessels) appears leading to the rupture of the liver capsule, which occurs, most frequently in the right lobe. The existence of any combinations of these symptoms, especially, sub capsular liver hematoma warns for an immediate check-up due to high morbidity & mortality rates of this condition.

Causes of HELLP Syndrome

What is the main cause of HELLP Syndrome is still unknown. This syndrome usually occurs in association with pre-eclampsia or eclampsia. Individuals who have had this syndrome earlier are at a greater risk of having it again. Most women who have high blood pressure usually get this syndrome however; one can also get this syndrome with normal blood pressure. Your odds may be higher in the following cases:

• If a mother is older than 25 years, and being white
• When a pregnant woman has high blood pressure 
• When a woman has given birth two or more times before
• Are Caucasian

Risk Factors associated with HELLP

The HELLP syndrome can be genetic and is more likely to occur in females in their subsequentpregnancies. Elevated BMI and metabolic disorders also increase the risk of HELLP syndrome in female patients. Other risk factors include the females who are over the age of 30 years, Caucasian, and are overweight, women who have had previous pregnancies, who have a poor diet or diabetes and the females having the history of pre-eclampsia.

Diagnosis of HELLP Syndrome

The symptoms of HELLP Syndrome can encourage many other complications during pregnancy, so it is encouraged that doctors run a series of tests on a woman having complications during the third trimester of pregnancy. The following tests can be useful to diagnose HELLP Syndrome:

• A series of blood tests, including liver function
• Hemolysis
• Blood pressure measurements
• Urine tests to check for protein
• Abnormal peripheral smear
• Lactatedehydrogenase
• Bilirubin level
• Elevated liver Enzyme levels
• Serum aspartate amniotransferase

Treatment’s to manage HELLP until delivery include the following:

• Complete bed rest and admission into a medical facility to be monitored closely
• Corticosteroid (to help babies lungs develop more rapidly)
• Magnesium Sulfate (to help prevent seizures)
• Blood transfusion if the platelet count gets too lower than the normal blood count

• Medications to control blood pressure
• Tests including biophysical tests, sonograms, non stress tests, fetal movement evaluation
• Fetal monitoring

In case the pregnancy is more than 34 weeks gestation or if the symptoms of HELLP have worsened, delivery is the recommended course of treatment.

Preventing HELLP syndrome

There is no specific solution to prevent HELLP Syndrome in pregnant women. The best way to treat HELLP Syndrome is the delivery of baby to prevent serious complications for baby and mother. Most of the side effects and symptoms of HELLP syndrome subside within the first 2-3 days of delivery.

Early diagnosis and treatment is the only way to cure complications as followed by the HELLP Syndrome. However, people can lower the risk by following certain measures:

• Maintaining a healthy lifestyle in order to prevent pre-existing conditions such as diabetes and high blood pressure
• Being observant about proper diet which means eating foods healthy for heart that consists of whole grains, vegetables, fruits, and lean protein
• Exercising regularly

The above mentioned are the only crucial ways to prevent HELLP Syndrome. HELLP syndrome does not require an expectant mother to go for an automatic cesarean, even though some situations like operative surgery may cause more complications due to blood clotting or excessive bleeding problems related to low platelet counts.

If you experience any of the symptoms or other associated risks, following a regular routine prenatal care is important so that the doctor can evaluate you promptly if you develop pre-eclampsia or HELLP syndrome. 
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