An Overall Guide to Hellp Syndrome

HELLP Syndromeoccurs in approximately 1-2 pregnancies out of a 1,000 and is thus considered an uncommon but serious condition. Around 20% of pregnant women with eclampsia or preeclampsia suffer from HELLP. Preeclampsia is a pregnancy ailment in which symptoms indicate that the liver and kidneys of the pregnant woman are not functioning properly and she is suffering from high blood pressure. It can develop right after pregnancy or after the 20^th week of pregnancy.

What Is HELLP Syndrome?

HELLP syndromeis believed to be a variation of preeclampsia and is a very dangerous complication that can occur during pregnancy. Pregnant women are most likely to develop both these pregnancy complications during the pregnancy’s final stage or even after giving birth.

Because of its characteristic symptoms, Dr. Louis Weinstein named this pregnancy complication HELLP syndromein 1982:

• H(hemolysis, breakdown of red blood cells)
• EL(elevated liver enzymes)
• LP(low platelet count)

The blood platelet count of the pregnant woman is used to determine the severity of this syndrome. “The Mississippi classification” is the system used for classifying the HELLP syndrome according to its severity:

• Class I (extensive thrombocytopenia): platelet count less than 50,000/mm3
• Cass II (moderate thrombocytopenia): platelet count between 50,000 – 100,000/mm3
• Class III (AST > 40 IU/L, mild thrombocytopenia): platelet count between 100,000 – 150,000/mm3

What Are the Signs of HELLP Syndrome?

Since HELLP syndromehas a reported mortality rate of 25%, it is essential that all pregnant women know about the signs and symptoms of this complication so that it can be diagnosed and treated at an early stage.

The later stages of pregnancy or the time after childbirth may be the time for the appearance of the symptoms of HELLP syndrome. Some women might not experience the signs until a week after childbirth but most of them suffering from this syndrome usually start showing the symptoms before the 37^th week of their pregnancy. Some of the signs of this syndrome are:

• Headache
• Nosebleeds or bleeding anywhere that is difficult to stop
• Cloudy vision
• Vomiting or nausea
• Fatigue
• Swelling and sudden increase in weight
• Pain in the upper belly
• Seizures

Visit your nearest medical care center or call your doctor immediately if you experience any of these symptoms.

What Are the Causes of HELLP Syndrome?

HELLP syndrome’s root cause remains a mystery. The development of this complication is usually preceded by the diagnosis of preeclampsia in most of the pregnant women suffering from high blood pressure. Sometimes, the symptoms of HELLPare among the warning signs of preeclampsia leading to a misdiagnosis such as:

• Viral ailments or flu
• Thrombotic thrombocytopenic purpura
• Gallbladder issues
• Hepatitis
• Flare of Lupus
• Idiopathic thrombocytopenic purpura (ITP)

How Is HELLP Syndrome Diagnosed?

Diagnosing this syndrome is difficult as it is easy to confuse the symptoms of this condition with other conditions like gall bladder disease, acute hepatitis, gastritis, or flu. Diagnosis becomes even more difficult if there is no protein found in the urine and the patient does not suffer from high blood pressure.

A physical exam is usually conducted by the health care provider for checking if you have:

• High blood pressure
• Swollen legs
• Liver enlargement
• Soreness or pain in the upper right side of the belly

A blood test to measure your platelet count or a liver function test to determine the liver enzyme levels is usually conducted by the health care provider. Bleeding into the liver can be examined by a CAT scan, which is a test that makes use of computers and X-rays for taking picture of the body.

It is not uncommon for pregnant women to be diagnosed with HELLP syndrome after they have been diagnosed with preeclampsia. In some cases the symptoms of HELLP are the initial warning signs of preeclampsia.

How Is HELLP Treated?

Although there is a chance of premature birth in most cases, delivering the baby is usually the best treatment for this syndrome as the health risk for the baby and the mother might increase if the baby is left in the womb during HELLP.

The proximity of your due date and the severity of your condition will decide the treatment you get. Your doctor might recommend the following options if you have mild symptoms and the baby is not even 34 weeks old:

• Complete bedrest
• Getting admitted in hospital
• Transfusion of blood for low platelet count and anemia
• Prevention of seizures by magnesium sulfate
• Controlling blood pressure by antihypertensive drugs
• Quick maturing of baby’s lungs by corticosteroids if early delivery is required

Close monitoring of your levels of RBCs, liver enzymes and platelets and your baby’s health will continue to see if the condition is getting worse. Fetal tests for measuring blood flow, movement, stress and heart rate are recommended too.

Sometimes inducing labor becomes necessary if the doctor decides that early delivery is required. There is a risk of complications for patients with low platelet count though, if a caesarean section is being performed for delivering the baby before the due date.

How Will HELLP Syndrome Affect Babies?

Babies weighing over 1000 gram or 2 pounds at the time of birth have the same health outcome and chances of survival as non-HELLPbabies of similar size.

The situation for babies weighing less than 2 pounds at the time of birth is not so encouraging though. Many of the studies have revealed that such babies require ventilator care and have to stay in the hospital for a longer period of time. Doctors at the moment can’t tell the number of medical issues that such babies might have to face at the time of birth and in the later stages of their lives.