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HELLP Syndrome in pregnant women

What Is HELLP Syndrome?

HELLP syndrome is an extremely dangerous condition that can develop in pregnant women. It includes:

  • hemolysis
  • EL: elevated liver enzymes
  • LP: a low platelet count

Hemolysis refers to a breakdown of red blood cells. Specifically, red blood cells get broken down earlier than normal. Hemolysis can lead to anemia, a condition in which your blood does not have enough oxygen to supply your body.

Elevated liver enzymes indicate that your liver is functioning poorly. When liver cells are inflamed or injured, they leak abnormally high amounts of certain chemicals, including enzymes, into your blood.

Platelets are part of the blood that helps it clot. When they are low, you are at risk for excess bleeding.

HELLP syndrome usually occurs in the last trimester of pregnancy, before the 37th week. It is a major health concern because it can be fatal to both mother and unborn baby. Prompt treatment and delivery of the baby are generally required for the best outcome. However, about a third of HELLP cases occur after the baby is born in the first week after delivery (Padden, 1999).

The syndrome’s cause is unknown. Some experts believe it is related to preeclampsia, another pregnancy complication, which causes high blood pressure. There are certain factors that can also increase your chance of developing HELLP syndrome.

According to the National Institutes of Health, HELLP syndrome affects approximately one to two out of every 1,000 pregnant women. (NIH).

Risk Factors

There is no one cause for this condition. Instead, the medical community widely recognizes various risk factors that may increase your chances of developing HELLP syndrome.

Preeclampsia is the greatest risk factor. This condition is marked by high blood pressure, and it occurs during the last trimester of pregnancy. However, not all pregnant women with preeclampsia will necessarily develop HELLP syndrome.

Other risk factors include:

  • being over the age of 25
  • being Caucasian
  • having given birth previously
  • being obese
  • having a poor diet
  • lack of exercise
  • having diabetes

Having had HELLP syndrome during a previous pregnancy can also increase your risk. According to the American Pregnancy Association, your risk can increase by 19 to 25 percent in future pregnancies (APA, 2009).

HELLP Symptoms

HELLP symptoms are similar to flu-like symptoms. They may also seem to be “normal” side effects of pregnancy. Sadly, many women skip medical treatment because they misdiagnose themselves. It is important that if you have any flu-like symptoms during pregnancy that you have them checked by a professional to ensure that they are not indicative of serious health issues.

Some of the most common symptoms of HELLP syndrome are:

  • feeling generally unwell or fatigued
  • abdominal pain, especially in the upper-right side of your abdomen below the ribs
  • nausea
  • vomiting
  • headache

You may also experience:

  • swelling, especially in the hands or face
  • excessive weight gain
  • blurry vision or visual disturbances
  • heartburn or indigestion
  • shoulder pain
  • pain when breathing deeply

In rare cases, you may have:

  • nosebleeds or other bleeding that is hard to control
  • seizures.

Diagnosing HELLP Syndrome

Because HELLP has similar symptoms to the flu, a proper medical diagnosis is needed. Blood tests can determine platelet levels, as well as your red blood cell count (to check for hemolysis). A urine test can detect high liver enzymes. Your doctor may order a computed tomography (CT) scan to detect bleeding in your liver.

Patients may also exhibit marked physical signs. A doctor can feel for abdominal tenderness (which may indicate a liver problem) or an enlarged liver. Your doctor may also look for excess swelling.

Blood pressure readings are often high with HELLP syndrome. You may also have protein in your urine (proteinuria). Your doctor should test for this at each prenatal visit.

Treatment Options for HELLP

HELLP generally strikes before the 37th week of gestation. However, the best treatment is to deliver the baby. In many cases, the baby is born prematurely. Leaving the baby in the mother during HELLP may increase the health risks for both individuals.

Your treatment will depend on the severity of your condition and how near you are to your due date. If your HELLP syndrome symptoms are mild and/or your baby is less than 34 weeks, your doctor may recommend:

  • bedrest (either at home or in the hospital)
  • admission to the hospital
  • blood transfusions to treat anemia and low platelets
  • magnesium sulfate to prevent seizures
  • antihypertensive medication to control blood pressure
  • corticosteroid medication to help your baby’s lungs mature in case an early delivery is needed

Your doctor will also closely monitor your red blood cell, platelet, and liver enzyme levels to check for signs that your condition is worsening. Your baby’s health will also be watched closely. Your doctor may recommend fetal tests that measure movement, heart rate, stress, and blood flow.

If your doctor determines that your condition requires immediate delivery of your baby, you may be given medications to help induce labor. A cesarean section may be performed, but this may cause complications if you have blood clotting problems because your platelet count is low.

Long-Term Outlook

When treated early, most women recover from HELLP syndrome. Symptoms significantly improve post-delivery. According to the American Pregnancy Association, most symptoms and side effects have resolved two to three days after delivery (APA, 2009).

Perhaps the biggest concern is the condition’s effects on the baby. Because most babies are delivered early when mothers develop HELLP syndrome, there is a greater risk of complications from prematurity. Babies who are born before 37 weeks are carefully monitored in the hospital before being released to go home.

Possible Complications

Early medical treatment is the key to help prevent further complications. However, some complications can arise during treatment efforts. Also, some symptoms of HELLP can affect you and your baby after delivery. Complications associated with HELLP syndrome include:

  • blood clots
  • kidney failure
  • liver rupture
  • lung failure (in mother and baby)
  • fluid in the lungs
  • renal failure
  • excessive bleeding
  • placental abruption (when the placenta detaches from the uterus before the baby is born)
  • stroke
  • death

The National Institutes of Health estimate that one in every four pregnant women develops serious complications during HELLP. This is most often due to delayed treatment (NIH, 2010).

Preventing HELLP Syndrome

HELLP syndrome is not preventable in many pregnant women because there is no one specific cause of the condition. However, if you have preeclampsia, then sticking to a healthy lifestyle may help prevent HELLP syndrome from developing. It is important to contact your doctor immediately if you suspect early symptoms of this condition.

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