HELLP Syndrome Symptoms, Signs, & More

By Dr. Kenosha Gleaton, OBGYN

HELLP syndrome is a serious condition that can impact liver and kidney function and potentially cause harm to both mom and baby. It’s vital that healthcare providers and parents know the warning signs and symptoms in order to seek out care as quickly as possible. 

What Is HELLP Syndrome?

HELLP syndrome is an acronym that stands for:

• Hemolysis (the breakdown of red blood cells)
• Elevated liver enzymes (indicative of inflammation or damage to liver cells)
• Low platelet count (fewer than 150,000 platelets per microliter of blood)

HELLP syndrome can impact both pregnant and postpartum people and has often been associated with the progression or complication of severe preeclampsia. [1] Some recent evidence suggests that HELLP syndrome may actually have a separate cause than preeclampsia. [1] Additionally, the symptoms and diagnostic criteria can vary between HELLP syndrome and preeclampsia. Leaving this condition untreated can be very dangerous, which is why knowing the common signs and symptoms is so important. [1-2] Learn more about preeclampsia → 

How Common Is HELLP Syndrome?

In general HELLP syndrome is thought to occur in less than 1% of pregnancies. [1]  In those that do have preeclampsia or eclampsia, the condition can develop in up to 20% of cases. [2] In the majority of cases, HELLP syndrome will occur in the third trimester of pregnancy, but the condition can also develop within 48 hours after childbirth. [1] 

What Is the Difference Between HELLP and Preeclampsia?

For many years researchers have believed that HELLP syndrome was directly tied to preeclampsia, but recent evidence suggests that these conditions may have separate causes. [1] In fact, some research reports that in 20% of HELLP syndrome cases there is no evidence of pre-eclampsia before or during labor. [3] People with preeclampsia have high blood pressure during pregnancy and high levels of protein in their urine, while HELLP syndrome is not dependent on these symptoms. [4] HELLP syndrome occurs less frequently than preeclampsia, has different diagnostic criteria, and may lead to serious blood and liver problems. 

Symptoms to Watch Out For

If someone does have HELLP syndrome, they may notice symptoms around the third trimester of pregnancy or within two days after giving birth. Potential symptoms include [1,2,4]:

• Abdominal pain
• Fatigue
• Headache
• Nausea and vomiting
• Blurry vision
• Nosebleed 
• Seizures
• Swelling or quick weight gain
• Jaundice
• Hypertension (high blood pressure)

Treating HELLP syndrome should always be done as quickly as possible. If you do notice any of these symptoms or have other concerning symptoms, be sure to visit a healthcare provider right away. [4] 

What Causes HELLP Syndrome?

The exact cause of HELLP syndrome is unknown, but researchers have identified some factors that can increase the risk of the condition. These risk factors include [1,2,4]:

• Preeclampsia
• Eclampsia
• Obesity
• Older age 
• History of HELLP syndrome in a previous pregnancy
• History of diabetes or renal disease
• History of high blood pressure
• Previous delivery, with risk increasing in those who have had more than one pregnancy
• Race, with white women at higher risk.
• SARS-Cov-2 infection during pregnancy

Some research also suggests that an underlying disease can lead to HELLP syndrome, such as antiphospholipid syndrome. [2] 

What Happens to the Baby in HELLP Syndrome?

HELLP syndrome can lead to negative health outcomes for both mom and baby, so it’s important to seek out a medical professional as soon as possible if you’re exhibiting symptoms. The good news is that HELLP syndrome itself doesn’t seem to impact the liver function or other organ functions of the baby, but there are other complications that may arise. [4] Research shows that HELLP syndrome may increase the risk of fetal distress, intrauterine growth restrictions, the need for mechanical ventilation, and neonatal intensive care. [5] 

Preterm delivery is the best course of action for treating HELLP syndrome. [4] Depending on gestational age, preterm birth can increase the risk of various fetal complications. In general, the longer the pregnancy continues, the better the outcome for the baby. [4] Your healthcare provider can go over your options for treatment and management to delay preterm delivery for as long as possible while still managing your symptoms. 

How Is HELLP Diagnosed?

HELLP can sometimes be misdiagnosed as the flu, hepatitis, gallbladder disease, and other conditions or illnesses. [2] In many cases, someone will already be diagnosed with preeclampsia before developing HELLP syndrome, which may aid in the diagnosis of HELLP. [2] Healthcare providers should ask patients about any symptoms, specifically leg swelling and abdominal pain. Healthcare providers will also order blood tests to check for some key diagnostic criteria: blood count, liver function, and kidney function. [1,4] In severe cases, they may use imaging tests to check for an enlarged liver or bleeding in the liver. [4] 

If someone does have preeclampsia or high blood pressure during pregnancy, it’s important that they see their healthcare provider regularly for monitoring and checkups. The worsening of any symptoms should be taken very seriously and should be treated promptly. 

Treatment Options

Immediate treatment options should include a fetal assessment and medication when necessary. Those with severe hypertension may benefit from intravenous drugs to lower blood pressure. [1] Ultimately, the only effective treatment for HELLP syndrome is the delivery of the baby. [2,4] Depending on the gestational age, various medications can be given to help mature the lungs and prepare the baby for life outside of the womb. [1] Once delivery occurs, HELLP syndrome usually resolves in a few days. If someone develops HELLP syndrome after delivery, they may still be given medications to help prevent seizures and lower blood pressure. [1,2] A blood transfusion can also be given as needed in severe circumstances. [4] Read about betamethasone for preterm labor management.  

Prevention and Precautions

Unfortunately there is no known way to prevent HELLP syndrome at this time. Researchers do believe that maintaining a healthy lifestyle and preventing conditions such as hypertension and diabetes may be helpful in reducing the risk of developing HELLP. [1] Routine prenatal care starting as early as possible and continuing after childbirth is also extremely important for supporting a healthy pregnancy and postpartum period. [4] Catching conditions like HELLP early on can significantly improve outcomes, so be mindful of any symptoms you experience and report them to a healthcare provider right away. [1,2,4] In some cases, taking a low dose aspirin during pregnancy may be helpful for those at high risk. Other habits that promote a healthy pregnancy include [1]:

• Taking a prenatal vitamin
• Eating nutrient-dense and balanced meals
• Drinking plenty of water (and other hydrating drink options)
• Exercising regularly as approved by your provider
• Getting at least eight hours of sleep 

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References:

1. Khalid F, Mahendraker N, Tonismae T. HELLP Syndrome. [Updated 2023 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560615/
2. Jacobson, J. Linda, L. Dugdale, D. Conaway, B. HELLP syndrome. Medline Plus. November 2022. URL. 
3. Pop-Trajković S, Antić V, Kopitović V, Popović J, Trenkić M, Vacić N. Postpartum HELLP syndrome--the case of lost battle. Ups J Med Sci. 2013;118(1):51-53. doi:10.3109/03009734.2012.725431
4. HELLP Syndrome. Cleveland Clinic. March 2021. URL. 
5. Aslan H, Gul A, Cebeci A. Neonatal outcome in pregnancies after preterm delivery for HELLP syndrome. Gynecol Obstet Invest. 2004;58(2):96-99. doi:10.1159/000078679