HELLP

HELLP syndrome is a serious pregnancy complication that is considered a variant of preeclampsia. The acronym stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. HELLP most often develops in the third trimester but can occur earlier or after delivery. It can occur with or without high blood pressure and may be associated with other signs of preeclampsia, such as headaches or swelling, but some cases present with minimal symptoms.

Diagnosis relies on laboratory findings rather than symptoms alone. Key features include evidence of hemolysis (such as anemia and abnormal red blood cell shapes), elevated liver enzymes (AST and/or ALT), and a reduced platelet count. Additional tests may show elevated bilirubin or LDH, and coagulation abnormalities if DIC develops. Clinically, patients may have right upper quadrant or epigastric pain, nausea, vomiting, or malaise, and blood pressure may be elevated.

Management requires urgent medical care in a hospital setting. The condition is managed by stabilizing the mother, monitoring fetal status, and delivering the baby when feasible. Delivery is the definitive treatment and is often indicated for significant maternal or fetal risk. Corticosteroids may be given to accelerate fetal lung maturity if delivery is anticipated preterm. In cases of severe disease, delivery may be urgent regardless of gestational age. Postpartum improvement is common within 48 to 72 hours, though some women may have ongoing health issues.

Prognosis has improved with modern obstetric care, but HELLP can lead to serious complications such as liver injury, placental abruption, kidney failure, DIC, or maternal death. Recurrence risk exists in future pregnancies, particularly if preeclampsia recurs.