HELLP Syndrome

What is HELLP syndrome?

HELLP syndrome is a rare pregnancy complication that mainly affects your blood and liver. It usually occurs during the third trimester of pregnancy (between 28 to 40 weeks) but can occur anytime in the second half of pregnancy (from 20 weeks onwards). HELLP syndrome can also develop in the seven days after childbirth.

The name HELLP syndrome stands for the three signs of the disease:

• H: Hemolysis, breaking down of red blood cells (cells that carry oxygen from your lungs to the rest of your body).
• EL: Elevated liver enzymes (chemicals that speed up body reactions, like breaking down proteins).
• LP: Low platelet count (parts of your blood that help with clotting).

Is preeclampsia the same as HELLP?

HELLP is usually considered a severe form of preeclampsia, but some experts consider it a different disease.

Preeclampsia leads to high blood pressure (hypertension) and proteinuria (high levels of protein in your pee). HELLP syndrome typically occurs with preeclampsia, but you can also have preeclampsia without HELLP. About 1 in 5 cases of HELLP syndrome occur without elevated blood pressure or protein in your urine.

About 8% of all pregnant people in the U.S. will develop preeclampsia, and up to 20% of those people will develop HELLP syndrome.

How common is HELLP syndrome?

HELLP syndrome is very rare and occurs in 0.1% to 0.6% of all pregnancies.

What are the symptoms of HELLP syndrome?

HELLP syndrome and preeclampsia may have similar symptoms. You may notice symptoms of HELLP syndrome during pregnancy or shortly after childbirth. Symptoms of preeclampsia include:

• Abdominal pain, usually in the right upper side (specific to HELLP syndrome).
• Headache.
• Blurred vision.
• Nausea and vomiting.
• Fatigue.
• Edema (swelling) and quick weight gain.
• Pain when taking deep breaths.

In rare cases, you may also experience:

• Uncontrolled nosebleeds.
• Seizures or uncontrollable body shakes.

Symptoms of HELLP syndrome are sometimes mistaken for other, more common health conditions. If you believe you have symptoms of HELLP syndrome, talk to your pregnancy care provider to see if it could be the cause of your symptoms.

What causes HELLP syndrome?

There’s no known cause of HELLP syndrome. It sometimes gets misdiagnosed because it causes symptoms that are similar to other, more common conditions.

What are the risk factors for HELLP syndrome?

People with preeclampsia or eclampsia have a higher risk of HELLP syndrome. Up to 1 in 5 people who have these two conditions will develop HELLP syndrome.

Other risk factors for HELLP syndrome include:

• History of HELLP syndrome in a previous pregnancy.
• Being older than 35.
• Having given birth at least once before.
• Being white (reported in some studies).
• History of kidney disease, diabetes or high blood pressure.

What are complications of HELLP syndrome?

HELLP syndrome can cause serious complications in both the fetus and the birthing person.

Complications for the birthing person could include:

• Bleeding and blood clotting problems. Some people develop disseminated intravascular coagulation (also called DIC). This could lead to postpartum hemorrhage (severe bleeding after childbirth).
• Kidney failure.
• Liver hemorrhage (bleeding) or liver failure.
• Pulmonary edema, which can lead to breathing problems.
• Eclampsia.
• Placental abruption.

Complications for the fetus include:

• Preterm birth.
• Intrauterine growth restriction (IUGR).
• Born with low platelet count, anemia or other blood disorders.
• Respiratory distress.

How is HELLP syndrome diagnosed?

To diagnose HELLP syndrome, your healthcare provider will do a physical exam and check for:

• Belly pain, especially on your upper right side.
• Leg swelling.

Often, your blood pressure will be high and/or you’ll have protein in your pee. Your provider will order the following blood tests:

• Complete blood count (CBC).
• Liver function test.
• Kidney function test.

In severe cases, your healthcare provider may use an ultrasound or CT scan (computed tomography scan) to check for an enlarged liver or bleeding in your liver.

Classifying HELLP syndrome

Some healthcare providers further classify HELLP syndrome based on the severity of your blood test’s platelet results. The lower the class, the more serious the condition is. The class levels are:

• Class I (severe).
• Class II (moderate).
• Class III (mild).

How is HELLP syndrome treated?

If you’re 34 weeks or more in pregnancy, or if your symptoms are severe, your healthcare provider typically recommends delivery as soon as possible. Delivery is the only solution to treat the condition completely. This may mean the fetus is born prematurely. After your baby is born, HELLP syndrome usually goes away within a few days.

Other things your healthcare provider can do to treat HELLP syndrome until the fetus matures include:

• Medication to lower your blood pressure.
• A blood transfusion to treat low platelet levels.
• Magnesium sulfate to prevent seizures.
• Corticosteroids to help the lungs of the fetus develop.
• Blood tests to monitor your liver function and platelet count.

Your provider will monitor the fetus with tests like a biophysical profile, nonstress test and ultrasound.

Can I prevent HELLP syndrome?

There’s no known way to prevent HELLP syndrome. Getting regular prenatal care is the best thing you can do to reduce your risk of most pregnancy complications. Your provider will keep an eye on your blood pressure and other vital signs to catch problems like HELLP early. Your healthcare provider may recommend that you take a low-dose aspirin after the first trimester (beginning around 12 weeks) if you’re at a higher risk for HELLP syndrome.

You can increase your chances of having a healthy pregnancy by:

• Eating a nutrient-dense diet of whole grains, lean protein, fruits and vegetables.
• Getting regular physical activity.
• Attending your prenatal care visits.
• Sleeping at least eight hours per night.
• Speaking with your healthcare provider about potential health risks during pregnancy.

What can I expect if I have HELLP syndrome?

HELLP syndrome is a serious but treatable condition. You’ll work closely with your pregnancy care provider to manage HELLP syndrome. They’ll monitor you and the fetus closely and recommend delivery if that’s the safest route.

Is HELLP syndrome life-threatening?

HELLP syndrome is rarely life-threatening to the birthing person. But it can be when the condition isn’t treated.

What is the outlook for people with HELLP syndrome?

The outlook is generally good, especially when HELLP syndrome is found early. Going to your prenatal appointments is the best way for your provider to detect pregnancy complications. Your chances of developing a serious complication are less than 25% when your provider treats HELLP syndrome early. Without treatment, HELLP syndrome can be very serious for both you and the fetus. Often, an early delivery is the safest option. HELLP syndrome usually goes away within three days of giving birth.

What happens to the baby in HELLP syndrome?

In general, the longer the pregnancy continues, the better the outcome for the newborn. If a newborn weighs at least 2 pounds, the health risks and survival rates are similar to those of a non-HELLP baby of the same size.

Prematurity may lead to other health complications, like breathing and vision problems or developmental delays.

What is the survival rate for HELLP syndrome?

The survival rate for the fetus depends on several factors, like gestational age, the severity of your condition and if you receive treatment. The survival rate for a fetus ranges between 40% and 90% — the gestational age is the most important factor in determining the survival of the fetus.

The survival rate for people with HELLP syndrome is about 99%. Early detection is the best way to keep HELLP syndrome from becoming serious.

Can you get HELLP syndrome again?

If you have HELLP syndrome once, your risk increases for having it again. Up to 1 in 5 people who have HELLP syndrome experience it a second time.

When should I see my healthcare provider?

Contact your pregnancy care provider if you have symptoms of HELLP syndrome (especially if you have preeclampsia or high blood pressure). Things to watch for are:

• Abdominal pain, especially on the right side.
• Nausea and vomiting.
• Headaches or blurred vision.

When should I go to the ER?

HELLP syndrome can lead to severe health complications if left untreated. If you have any symptoms, please contact your provider. If you have severe symptoms like heavy bleeding or seizures, call 911 (or your local emergency services number) or go to your nearest emergency department.

A note from Cleveland Clinic

HELLP syndrome is a rare pregnancy complication that typically occurs in your last trimester. If you experience any symptoms of HELLP syndrome, get care right away. Your pregnancy care provider will need to monitor you and your baby closely to watch for signs of a problem. The chances of your baby being seriously ill at birth are lower when HELLP is caught early. Your provider may recommend an early delivery to prevent serious complications.

As difficult as it may feel, trust that your healthcare team is doing everything possible to make sure your baby is born safely. Most people make a full recovery from HELLP syndrome.