The joy of pregnancy comes with plenty of expected symptoms, like morning sickness, bloating and fatigue. But sometimes, a more serious, unexpected condition like HELLP syndrome (which may appear if you’re at risk of preeclampsia or high blood pressure) can crop up.
Luckily, HELLP syndrome is fairly rare, occurring in about 1 or 2 in 1,000 pregnancies. Among women with severe preeclampsia or eclampsia, the number is higher, appearing in 10 to 20% of pregnancies.[1]
If you develop HELLP syndrome during your pregnancy, you’ll need to get treatment right away. Here are some symptoms to look out for — plus when to call your doctor.
What is HELLP syndrome?
HELLP syndrome is a rare pregnancy complication that affects the liver and blood.
The acronym for HELLP syndrome stands for:[2]
- Hemolysis (H), where your red blood cells are broken down too soon, causing dangerously low red-cell blood counts.
- Elevated liver enzymes (EL), which indicate that some of the cells of the liver are injured and releasing enzymes.
- Low platelet count (LP), which makes proper blood-clotting by the body difficult and could cause increased bleeding during labor.
HELLP syndrome symptoms to look for
HELLP typically occurs during the third trimester, although some cases develop in the week after delivery. Possible symptoms include:
- Pain and tenderness in the upper right side of the abdomen
- Nausea and vomiting that worsens
- Headaches
- Blurry vision
- General malaise
- Nosebleeds (in rare cases)
- Quick weight gain or swelling
- Seizures (in rare cases)
It can be easy to confuse some of these symptoms with the common complaints of a normal pregnancy. Sometimes, HELLP syndrome can even be misdiagnosed as the flu, hepatitis or gallbladder disease.
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Let your health care provider know if you notice any of these changes, or if you simply don’t feel right — especially if you have or are at risk of preeclampsia. If your doctor isn’t available, head to the local emergency room right away.
What causes HELLP syndrome?
Experts don't fully understand what causes HELLP syndrome. However, you’re at greater risk if you have preeclampsia, pregnancy-related high blood pressure coupled with protein in the urine, or eclampsia.
Eclampsia is a very serious condition accompanied by seizures that can evolve if preeclampsia is left untreated. HELLP is also a more severe form of preeclampsia-related disease.
Women who had HELLP in a previous pregnancy have about a 1 in 4 chance of recurrence in future pregnancies.[3]
How is HELLP syndrome diagnosed?
In many cases, women are diagnosed with preeclampsia before being diagnosed with HELLP. If your doctor suspects that you have HELLP, you'll have a physical exam to check for abdominal soreness (especially in the upper right side), swelling in your legs, an enlarged liver, and high blood pressure.
Your practitioner will also likely do a blood test to check your liver enzymes (which may be high) and a complete blood count, which would show low platelets and lower red blood cells. You may also have a non-stress test, which monitors your baby’s heart rate, as well as an ultrasound to see how your baby is doing.
What are the possible complications of HELLP syndrome?
HELLP syndrome can threaten both your life and that of your baby if it’s not diagnosed and treated quickly. Some of the complications linked to HELLP include:
- A buildup of fluid in the lungs (pulmonary edema), which can cause difficulty breathing
- Extensive liver damage or liver failure
- Stroke
- Kidney failure
- Placenta abruption, in which the placenta tears away from the uterine wall, causing severe blood loss that often requires a blood transfusion
Fortunately, most complications will improve once your baby is delivered and you have time to recover.
If HELLP is diagnosed before your pregnancy reaches full-term, your baby will be delivered early and may require monitoring for complications related to prematurity, including lungs that aren’t fully developed.
How is HELLP syndrome treated?
The main treatment for HELLP syndrome is delivery of your baby, even if she’s born prematurely. That’s because the complications of HELLP can cause problems to both you and your baby if they progress.
If you develop HELLP when you’re at least 34 weeks pregnant, your health care provider will likely want to deliver your baby right away, before the condition progresses and presents further risks.
Vaginal delivery is most common, if possible, as blood-clotting issues associated with HELLP can complicate a C-section. If baby’s lungs aren’t yet mature, you may receive corticosteroids to speed up their maturity before delivery.
If you develop HELLP earlier in your pregnancy, your practitioner may attempt to delay delivery until your fetus has more time to develop. You’d most likely be kept under observation in the hospital. Your doctor may also give you:
- Blood pressure medication to treat high blood pressure
- Magnesium sulfate to prevent seizures
How can you prevent HELLP syndrome?
There is no known way to prevent HELLP, although a healthy diet and regular exercise may lower your risk if you are obese. Some practitioners may treat patients who have a history of preeclampsia in prior pregnancies with low-dose aspirin to lower the risk of recurrence.
It is, however, possible to prevent serious complications by letting your doctor know if you experienced HELLP in a previous pregnancy and calling as soon as you experience any of the syndrome’s symptoms so you can be treated and monitored closely.
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