HELLP syndrome (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Synonyms and Keywords:

Overview
HELLP syndrome is a group of symptoms that occur in pregnant women who have:

H: hemolysis (the breakdown of red blood cells)

EL: elevated liver enzymes

LP: low platelet count

What are the symptoms of HELLP syndrome?

 * Fatigue or feeling unwell
 * Fluid retention and excess weight gain
 * Headache
 * Nausea and vomiting that continues to get worse
 * Pain in the upper right part of the abdomen
 * Blurry vision
 * Nosebleed or other bleeding that won't stop easily (rare)
 * Seizures or convulsions (rare)

What causes HELLP syndrome?

 * A cause for HELLP syndrome has not been found.


 * HELLP syndrome occurs in about 1 to 2 out of 1,000 pregnancies, and in 10-20% of pregnant women with severe preeclampsia or eclampsia.


 * Most often HELLP develops before the pregnancy is 37 weeks along. Sometimes it can develop in the week after the baby is born.


 * Many women have high blood pressure and are diagnosed with preeclampsia before they develop HELLP syndrome.


 * However, in some cases, HELLP symptoms are the first warning of preeclampsia and the condition is misdiagnosed as:
 * Flu or other viral illness
 * Gallbladder disease
 * Hepatitis
 * Idiopathic thrombocytopenic purpura (ITP)
 * Lupus flare
 * Thrombotic thrombocytopenic purpura

When to seek urgent medical care?

 * If symptoms of HELLP syndrome occur during pregnancy:
 * See your obstetrician immediately
 * Call the local emergency number (such as 911)
 * Get to the emergency room


 * Although there is no known way to prevent HELLP syndrome, it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as HELLP syndrome early.

Diagnosis

 * During a physical examination, the doctor may discover:
 * Abdominal tenderness, especially in the right upper side
 * Enlarged liver
 * High blood pressure
 * Swelling in the legs


 * Liver function tests (liver enzymes) may be high.
 * Platelet counts may be low.
 * A CT scan may show bleeding into the liver.


 * Tests of the baby's health will be done.

Treatment options

 * The main treatment is to deliver the baby as soon as possible, even if the baby is premature.


 * Problems with the liver and other complications of HELLP syndrome can quickly get worse and be harmful to both the mother and child.


 * Your doctor may induce labor by giving you drugs to start labor, or may perform a C-section.


 * You may also receive:
 * A blood transfusion if bleeding problems become severe
 * Corticosteroid medications to help the baby's lungs develop faster
 * Medications to treat high blood pressure

Where to find medical care for HELLP syndrome?
Directions to Hospitals Treating HELLP syndrome

What to expect (Outlook/Prognosis)?

 * When the disease is not treated early, up to 1 out of 4 women develop serious complications. Without treatment, a small number of women die.


 * The death rate among babies born to mothers with HELLP syndrome depends on birth weight and the development of the baby's organs, especially the lungs.


 * HELLP syndrome may return in up to 1 out of 4 future pregnancies.

Possible complications

 * There can be complications before and after the baby is delivered, including:
 * Disseminated intravascular coagulation (DIC): a clotting disorder that leads to
 * excess bleeding (hemorrhage)
 * Fluid in the lungs (pulmonary edema)
 * Kidney failure
 * Liver hemorrhage and failure
 * Separation of the placenta from the uterine wall (placental abruption)


 * After the baby is born and HELLP syndrome has time to improve, most of these complications will go away.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/000890.htm