HELLPSyndrom

HELLP syndrome is a rare but life-threatening obstetric complication defined by hemolysis, elevated liver enzymes, and a low platelet count. It most often arises in association with preeclampsia but can occur without overt hypertension and may present during pregnancy or postpartum. It affects about 0.5–0.9% of pregnancies.

Patients commonly report right upper quadrant or epigastric pain, nausea or vomiting, malaise, and headaches. Hypertension and proteinuria may be present; rapid clinical change can occur, and severe cases can lead to liver rupture or fetal distress.

Laboratory features include hemolysis with elevated LDH and indirect bilirubin, low haptoglobin, reduced platelets (<100,000/µL), and elevated transaminases (AST/ALT). Peripheral smear may show schistocytes. Diagnosis is clinical and lab-based, requiring urgent evaluation when preeclampsia is suspected.

Pathophysiology involves abnormal placental development causing systemic endothelial dysfunction, platelet activation, and microangiopathic processes that damage the liver and other organs.

Management requires urgent multidisciplinary care. Stabilization, seizure prophylaxis with magnesium sulfate, and blood pressure control with IV antihypertensives are essential. If maternal condition allows, delivery is the definitive treatment; otherwise rapid expedited delivery is pursued. Corticosteroids may be used to promote fetal maturation in preterm cases and can sometimes aid maternal recovery; platelets may be transfused if counts are severely low or if bleeding occurs.

Prognosis improves with prompt treatment but HELLP carries significant maternal and fetal risks, including DIC, hepatic hemorrhage, renal injury, premature birth, and neonatal complications. In high-resource settings, maternal mortality is low with timely management, though ongoing postpartum monitoring is necessary.