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HELLP syndrome is a potentially life-threatening complication of preeclampsia, with danger to both the mother and the baby. Even though only 5 to 8 percent of pregnant people present to the office of with preeclampsia and related complications, it can be fatal without management. Read on to know more about HELLP syndrome and how to manage it:

What is HELLP syndrome?

When preeclampsia progresses to involve the liver and the blood, HELLP syndrome ensues. It is an acronym for hemolysis or break down of the red blood cells, elevated liver enzymes with painful abdomen and low platelet count. The pathology of HELLP syndrome is not completely understood, but stems from same factors that cause preeclampsia.

Even though it is rare, HELLP syndrome is a medical emergency. Without early management, it can be rapidly fatal. It is important to remember that HELLP syndrome occurs between weeks 27 of gestation to postpartum. About 15 to 30 percent of cases occur immediately postpartum.

With early management, patient can be stabilized in 24 to 48 hours. The recurrence rate of HELLP syndrome is higher for subsequent pregnancies—around 2 to 27 percent. Patients are at higher risk of: pregnancy-induced hypertension, fetal growth restriction, placental abruption and preeclampsia for future pregnancies.

What are the symptoms of HELLP syndrome?

Signs and symptoms of HELLP syndrome can appear in the second trimester. In some women, HELLP syndrome can appear insidiously without any symptoms. These include:

  • Blurriness of vision
  • Nosebleeds
  • Chest pain
  • Quick weight gain, due to water retention
  • Swelling in the limbs
  • Headache
  • Fatigue
  • Seizures and convulsions in advanced stage

If not managed timely, HELLP syndrome can cause complications, including:

  • Bleeding disorders with increased clotting and hematoma formation.
  • Cardiovascular disorders like myocardial ischemia, and cardiac arrest.
  • Pulmonary complications like pulmonary embolism, adult respiratory distress syndrome (ARDS), pulmonary edema and even respiratory failure.
  • Renal complications can include acute kidney injury and chronic renal failure requiring dialysis and nephrogenic diabetes insipidus.
  • Liver complications like ascites, liver failure and liver hemorrhage. In addition, hematomas can form in the liver with possible rupture.
  • Cerebral complications can include: cerebral edema, seizures and retinal detachment.

HELLP syndrome can cause complications in the baby as well. Commonly, babies born are premature and may have growth restriction. In about one-third of the babies, there is thrombocytopenia or reduced platelet count. Consequently, chances of hemorrhage are increased, with intraventricular hemorrhage being most common.

What are the risk factors of HELLP syndrome?

The associated risk factors of HELLP syndrome are:

  • Preeclampsia: the single greatest risk factor for HELLP syndrome is preeclampsia.
  • Age: the risk of HELLP syndrome is higher in women who are giving birth after the age of 35 years.
  • Weight: the chances of developing preeclampsia and HELLP syndrome are higher in overweight and obese women.
  • Previous history: as mentioned before, the chances of HELLP syndrome in subsequent pregnancies are higher if it has already occurred once before.
  • History of Hypertension: women who already suffer from cardiovascular disorders like hypertension are at increased risk.
  • Chronic diseases: other diseases predisposing one to HELLP syndrome include: diabetes and chronic kidney disease.

How is HELLP syndrome diagnosed?

In women suspected of HELLP syndrome, the healthcare provider performs a thorough examination, following by some confirmatory investigations. During the examination, the doctor will check for enlarged liver, tenderness in the abdomen and excessive swelling in the limbs. The doctor will also ask you to chart your blood pressure readings.

The investigations include:

  • Complete blood count: this is done to evaluate the red blood cell count and checking the extent of hemolysis and the platelet count.
  • Liver function tests: the liver enzymes are often raised in HELLP syndrome and are checked through LFTs.
  • Complete urine exam: checks for protein in the urine
  • MRI to check for liver bleeds

HELLP syndrome is treated by Best Gynecologist in Islamabad, definitively through delivery of the baby and symptomatic management.