HELLP Syndrome is a rare but severe pregnancy complication that usually develops in the third trimester or shortly after childbirth. It is closely linked to preeclampsia and poses serious risks to both the mother and baby. Without timely diagnosis and treatment, HELLP syndrome can lead to life-threatening problems such as liver damage, stroke, or kidney failure.1Sibai, B. M. (2004). Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics & Gynecology, 102(1), 181–192.
What Is HELLP Syndrome?
HELLP stands for:
- Hemolysis – the breakdown of red blood cells
- EL– Elevated liver enzymes – a sign of liver injury
- LP – Low Platelets – increasing the risk of bleeding
This condition mainly affects liver function and blood components. It usually develops between weeks 28 and 36 of pregnancy, but in some cases, it can occur after delivery.2Aldasouqi, S. A., Gossain, V. V., & Saccone, G. (2020). Postpartum HELLP syndrome. BMJ Case Reports, 13(1), e232068. Because it progresses quickly and unpredictably, HELLP syndrome requires close monitoring in high-risk pregnancies. Major complications include liver rupture, kidney failure, and premature birth, making it one of the most dangerous hypertensive disorders of pregnancy.3Barton JR, Sibai BM. Care of the woman with HELLP syndrome. UpToDate. 2004.
HELLP syndrome has been described as a “silent threat” during pregnancy. That’s because its early symptoms often mimic typical pregnancy discomforts. This makes it crucial for both healthcare providers and expectant mothers to be aware of the warning signs. Once detected, aggressive treatment can significantly reduce both maternal and fetal risk. Unfortunately, in resource-limited settings, lack of access to adequate prenatal care can result in delayed diagnosis and poor outcomes. Hence, awareness is a key factor in preventing fatal cases.
Who Is at Risk?
HELLP syndrome affects any pregnant woman, but specific conditions increase her chances of developing it.
- Any previous pregnancy complications or a family history of preeclampsia or HELLP
- Being over the age of 35
- Multiple pregnancies (twins or triplets)
- Pre-existing high blood pressure or kidney disease
- Any autoimmune disorders or diabetes
These risk factors do not guarantee the appearance of HELLP syndrome, but frequent prenatal screenings may help identify preeclampsia or early warning signs that could precede HELLP syndrome.4Martin, J. N., Rinehart, B. K., May, W. L., Magann, E. F., Terrone, D. A., & Blake, P. G. (2005). The spectrum of severe preeclampsia: Comparative analysis by HELLP syndrome classification. American Journal of Obstetrics and Gynecology, 183(5), 1053–1059. Although stress and diet influence overall health, current evidence does not directly link them to HELLP syndrome. However, maintaining a healthy lifestyle during pregnancy, including balanced nutrition, regular exercise, and stress management, is still encouraged to support overall maternal well-being.
HELLP Syndrome Symptoms
Common Symptoms:
HELLP syndrome is difficult to recognize because its symptoms usually resemble other pregnancy complications. The warning signs consist of the following symptoms (the first three are early warning signs):
- Upper right abdominal or chest pain
- Severe fatigue or malaise
- Severe nausea and vomiting in the last trimester.
- Swelling in the face or hands
- Blurred vision or other visual disturbances
- A headache that doesn’t go away
- Unexplained bruising or bleeding
The symptoms appear rapidly and shift into dangerous complications if medical treatment is delayed.5Goldenberg RL, Cliver SP, Small M, et al. The preeclampsia syndrome. Am J Obstet Gynecol. 1996;175(5):1359-1364. Most women report that the pain in the upper right abdomen is persistent and unlike anything they’ve experienced before. This symptom, in particular, is often misdiagnosed as indigestion or gallbladder issues, which delays the correct diagnosis. Additionally, the feeling of “just not being right,” a sense of overwhelming fatigue or malaise, can be dismissed by patients and providers alike as normal pregnancy fatigue.
HELLP can progress quickly, often within a few days. Early detection is key. Any unusual or persistent symptoms during pregnancy should be evaluated by a healthcare provider without delay.
Emergency Symptoms Requiring Immediate Care:
HELLP syndrome becomes dangerous in extreme cases when it leads to severe hypertension along with seizures and placental abruption. This is a medical emergency requiring immediate attention.
Seizures, in particular, are a terrifying sign that the condition has progressed to eclampsia, a full-blown medical emergency. At this point, urgent delivery is not only the best option but the only one that can potentially save both mother and baby. In many cases, the mother is admitted directly to an intensive care unit (ICU) for stabilization. Emergency intervention could involve not just delivery, but advanced liver monitoring, dialysis in case of kidney failure, or blood transfusions if the platelet count has dropped dangerously low.
Causes of HELLP Syndrome
The causes of HELLP syndrome are not fully understood. Multiple research studies have identified some factors that contribute to its occurrence. As this is a complex issue, it is believed to arise from the combination of different elements.
- Abnormal placentation
- Immunel factors
- Genetic tendency.
These elements play a role in the syndrome’s development. Research studies focus on understanding how these elements combine to produce the syndrome.6Gaugler-Senden IP, Huijssoon AG, Visser GH, et al. Maternal and perinatal outcome of pregnancy complicated by the HELLP syndrome. Eur J Obstet Gynecol Reprod Biol. 2006;128(1-2):144-148.
Abnormal placentation triggers a chain reaction in the mother’s body, including endothelial damage (damage to blood vessel linings), platelet activation, and liver stress. These all come together in a kind of “perfect storm” that produces HELLP symptoms.
Another hypothesis revolves around the maternal immune response. In this case, the mother’s body may recognize the pregnancy as a foreign body and mount an inappropriate immune response that damages internal organs. This idea explains why autoimmune conditions are often seen in women who develop HELLP.
Knowing these root causes helps in designing early warning systems and possibly, preventive interventions in the future.
HELLP Syndrome vs. Preeclampsia
HELLP syndrome is often considered a variant of severe preeclampsia and can be life-threatening if not promptly managed. These conditions share multiple overlapping risk factors and clinical manifestations.
Comparison Table: HELLP Syndrome vs. Preeclampsia
| Feature | Preeclampsia | HELLP Syndrome |
|---|---|---|
| Definition | Pregnancy complication characterized by high blood pressure and organ damage | A severe, life-threatening complication involving hemolysis, elevated liver enzymes, and low platelet count |
| Full Form | Not an acronym | H: Hemolysis EL: Elevated Liver Enzymes LP: Low Platelets |
| Occurs When | After 20 weeks of pregnancy or postpartum | Usually in the 3rd trimester or immediately after delivery |
| High Blood Pressure | Always present (≥140/90 mmHg) | Often present, but not always |
| Protein in Urine (Proteinuria) | Common diagnostic marker | May or may not be present |
| Hemolysis (RBC destruction) | Not typical | Key feature of diagnosis |
| Elevated Liver Enzymes | May be mildly elevated in severe cases | Preterm birth, placental abruption, fetal distress, or loss |
| Low Platelet Count | Usually normal | Significantly reduced (<100,000/mm³) |
| Swelling (Edema) | Stabilize the mother and prepare for immediate delivery | May occur |
| Visual Disturbances | Common (blurred vision, light sensitivity) | Also common |
| Headache | Common | Often severe and persistent |
| Nausea/Vomiting | Sometimes | Very common, especially in the third trimester |
| Right Upper Abdominal Pain | May occur | Very common and severe |
| Seizures (Eclampsia Risk) | Possible if it progresses to eclampsia | High risk due to severity and potential progression |
| Diagnosis Based On | High BP + proteinuria + lab abnormalities | Blood tests showing hemolysis, liver dysfunction, and low platelets |
| Treatment | May involve medication and monitoring until delivery is safe | Urgent delivery is often required, especially after 34 weeks |
| Fetal Risk | Restricted growth, placental insufficiency, preterm birth | Preterm birth, placental abruption, fetal distress or loss |
| Maternal Risk | Stroke, liver or kidney damage, seizures | Liver rupture, kidney failure, bleeding, stroke, and death if untreated |
| Postpartum Occurrence | Can occur after delivery | It can also occur postpartum |
| Progression Speed | Can be gradual or sudden | Often rapid and severe |
| Management Goal | Control BP, prevent seizures, monitor fetal growth | Control BP, prevent seizures, and monitor fetal growth |
HELLP Syndrome Diagnosis
The early detection of maternal complications matters a lot for treatment. Evaluation includes both medical checkups and testing in the lab.
Blood Tests:
Doctors mainly depend on blood tests to make a diagnosis that shows:
- Hemolysis indicators: High levels of lactate dehydrogenase (LDH) and abnormal blood smears indicate red blood cell breakdown.
- Liver enzymes: If the liver is inflamed or damaged, AST and ALT levels might be higher.
- Platelet count: When thrombocytopenia occurs, the count for platelets falls below 100,000 per microliter, which indicates HELLP syndrome.
- Urinalysis: A urine test may reveal protein in the urine, which is commonly found with preeclampsia.
These laboratory indicators are essential for confirming HELLP syndrome, especially in cases where high blood pressure is absent. A misdiagnosis or delay can cause further complications such as liver rupture or internal bleeding. For this reason, physicians in high-risk pregnancy wards often run these blood tests proactively when warning signs are present.
Blood Pressure Monitoring:
Having a history of high blood pressure for many years can also signal big problems. Although high blood pressure is common, HELLP can occur even in its absence. Diagnosis relies on lab findings.
Frequent blood pressure checks during the third trimester become especially important for identifying rapid spikes, which might indicate the onset of HELLP or its precursor, preeclampsia. Blood pressure trends can shift within hours, so continuous monitoring helps catch the syndrome early, even before major organ damage begins.
Imaging:
Doctors do an ultrasound to check liver health or determine if there are any complications, such as a hematoma or rupture.7Sibai BM. HELLP syndrome: risk factors and management. Am J Obstet Gynecol. 1993;169(4):1000-1006.
Other imaging techniques, like CT scans or MRIs, may be used in advanced hospitals if liver damage is suspected or the patient is experiencing right upper quadrant pain that cannot be explained by other conditions. These tools offer a more detailed look at the internal organs and help rule out other causes, such as gallstones or appendicitis.
In severe cases, imaging may also be used to check the baby’s condition, especially for signs of fetal growth restriction or placental abruption. A non-stress test (NST) and biophysical profile (BPP) can assess fetal well-being and help determine if an emergency delivery is necessary.
HELLP Syndrome Treatment
The most effective treatment for HELLP syndrome is delivery of the baby, especially if the pregnancy has reached or surpassed 34 weeks. However, the approach may vary depending on the gestational age and severity of symptoms.
Immediate Delivery:
If the pregnancy is near term or if the mother or baby is in distress, immediate delivery is the safest plan of action. In most cases, a cesarean section is performed.
This step is not just curative but life-saving. Once the baby is delivered, many symptoms of HELLP begin to subside within a few days. However, complications can persist; that is why hospital monitoring continues for up to 72 hours after birth.
In certain situations where vaginal delivery is feasible and safe, doctors may opt for induction. However, time is critical, and C-sections are preferred in most emergency cases due to the need for fast resolution.
Medications Before Delivery (If Preterm):
If the pregnancy is under 34 weeks and the mother’s condition is stable, doctors will admit her to the hospital for close monitoring. They may delay delivery for some time to administer:
- Corticosteroids: These are primarily used to accelerate fetal lung development. Some studies suggest they may support maternal liver and platelet stability, but this is not guaranteed
- Antihypertensives: To control high blood pressure and prevent stroke.
- Magnesium sulfate: To prevent seizures, especially in patients with preeclampsia or at risk for eclampsia.
These medications are crucial for the baby’s lungs to mature and for doctors to stabilize the mother. Still, this delay is very limited, usually 48 hours or less, after which delivery is prioritized regardless of fetal age.
Supportive Care:
- Blood transfusions (especially platelets) if counts are dangerously low.
- Intravenous fluids.
- Monitoring liver function and kidney status continuously.
In severe cases, patients may be transferred to intensive care units for multi-organ support. Dialysis may be necessary if kidney function begins to fail. Close monitoring of clotting times is also essential, as HELLP increases the risk of disseminated intravascular coagulation (DIC), a life-threatening bleeding disorder.
Postpartum Monitoring:
In most cases, HELLP symptoms begin to resolve within 48–72 hours after delivery. However, monitoring is essential to manage any complications, such as liver bleeding or renal issues.8Martin JN Jr, Blake PG, Perry KG Jr. The natural history of HELLP syndrome: patterns and outcomes. Obstet Gynecol. 2006;107(6):1231-1236.
Even after the baby is born, liver enzymes can remain elevated, and platelet counts can continue to drop before rebounding. Nurses and doctors check labs frequently during this critical period.
Furthermore, the emotional recovery for many women can be just as intense. They often need counseling and support, especially if their newborn requires NICU care or if their delivery experience was traumatic.
Does HELLP Syndrome Affect Brain Health?
Yes. If HELLP progresses without treatment, it can lead to eclampsia, which involves seizures and can result in brain swelling, stroke, or permanent damage. High blood pressure also increases the risk of cerebral hemorrhage. That’s why early diagnosis and control of blood pressure are critical to protect the brain.
The reduced platelet count makes the brain more vulnerable to bleeding, while elevated blood pressure increases intracranial pressure. Women may experience confusion, vision loss, or convulsions—these are signs of severe involvement that require immediate neurological intervention.
Brain imaging, such as MRI or CT scans, may be performed in cases where neurological symptoms arise. These tools help detect swelling, bleeding, or any infarctions caused by blood clots in the brain. In extreme cases, HELLP syndrome may mimic the symptoms of a stroke, causing weakness or paralysis on one side of the body.
After delivery, many women with brain complications due to HELLP require rehabilitation or physical therapy. This adds another layer of complexity to recovery. Emotional trauma is also common, as these women often face a sudden loss of health and control, which can contribute to postpartum depression or anxiety disorders.
Thus, when we talk about HELLP syndrome, we’re not just dealing with a pregnancy complication; we’re confronting a neurological crisis that demands urgent and comprehensive care.
HELLP Syndrome Survival Rate
The survival rate for HELLP syndrome mothers has significantly improved over the past few decades because of advances in maternal healthcare. Today, over 90% of mothers survive with proper and timely medical intervention. However, the condition remains dangerous, especially if you don’t know what is happening inside.
The baby’s survival depends on gestational age and overall fetal health at the time of diagnosis. In early pregnancy, HELLP syndrome leads to premature delivery, becoming a major concern. Corticosteroids may be administered to advance lung development, while delivery should be delayed only when it poses no risk to the mother. The need for neonatal intensive care becomes essential because premature infants, before 34 weeks, experience more health complications.9Martin JN, Perry KG, Files JC, et al. (1993). The natural history of HELLP syndrome: patterns and outcomes. American Journal of Obstetrics and Gynecology, 169(4), 1000–1006.
Final Thoughts
HELLP syndrome requires urgent and immediate medical response. You should reach your nearest health center immediately when warning signs appear to save your life. Any pregnant woman experiencing abdominal pain, together with headaches and vision changes, must immediately contact their healthcare provider for help.
The best protection against HELLP complications results from routine prenatal visits and blood pressure tracking, along with maintaining open communication with your doctor. Early detection of risks and warning signs through education enables healthcare providers and mothers to respond promptly, which leads to better delivery safety for both mothers and babies.10Sibai BM. (2004). Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics & Gynecology, 102(1), 181–192.
Refrences
- 1Sibai, B. M. (2004). Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics & Gynecology, 102(1), 181–192.
- 2Aldasouqi, S. A., Gossain, V. V., & Saccone, G. (2020). Postpartum HELLP syndrome. BMJ Case Reports, 13(1), e232068.
- 3Barton JR, Sibai BM. Care of the woman with HELLP syndrome. UpToDate. 2004.
- 4Martin, J. N., Rinehart, B. K., May, W. L., Magann, E. F., Terrone, D. A., & Blake, P. G. (2005). The spectrum of severe preeclampsia: Comparative analysis by HELLP syndrome classification. American Journal of Obstetrics and Gynecology, 183(5), 1053–1059.
- 5Goldenberg RL, Cliver SP, Small M, et al. The preeclampsia syndrome. Am J Obstet Gynecol. 1996;175(5):1359-1364.
- 6Gaugler-Senden IP, Huijssoon AG, Visser GH, et al. Maternal and perinatal outcome of pregnancy complicated by the HELLP syndrome. Eur J Obstet Gynecol Reprod Biol. 2006;128(1-2):144-148.
- 7Sibai BM. HELLP syndrome: risk factors and management. Am J Obstet Gynecol. 1993;169(4):1000-1006.
- 8Martin JN Jr, Blake PG, Perry KG Jr. The natural history of HELLP syndrome: patterns and outcomes. Obstet Gynecol. 2006;107(6):1231-1236.
- 9Martin JN, Perry KG, Files JC, et al. (1993). The natural history of HELLP syndrome: patterns and outcomes. American Journal of Obstetrics and Gynecology, 169(4), 1000–1006.
- 10Sibai BM. (2004). Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics & Gynecology, 102(1), 181–192.
