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    HELLP syndrome

    HELLP syndrome is a group of symptoms that occur in pregnant women who have:

    • H -- hemolysis (the breakdown of red blood cells)
    • EL -- elevated liver enzymes
    • LP -- low platelet count

    Causes

    Thecauseof HELLP syndrome has not been found.

    HELLP syndrome occurs in about 1 to 2 out of 1,000 pregnancies, and in 10-20% of pregnant women with severe preeclampsia or eclampsia.

    Most often HELLP develops before the pregnancy is 37 weeks along. Sometimes it develops in the week after the baby is born.

    Many women have high blood pressure and are diagnosed with preeclampsia before they develop HELLP syndrome. In some cases, HELLP symptoms are the first warning of preeclampsia and the conditioncan bemisdiagnosed as:

    • Flu or other viral illness
    • Gallbladder disease
    • Hepatitis
    • Idiopathic thrombocytopenic purpura (ITP)
    • Lupus flare
    • Thrombotic thrombocytopenic purpura

    Symptoms

    • Fatigue or feeling unwell
    • Fluid retention and excess weight gain
    • Headache
    • Nausea and vomiting that continues to get worse
    • Pain in the upper right part of the abdomen
    • Blurry vision
    • Nosebleed or other bleeding that won't stop easily (rare)
    • Seizures or convulsions (rare)

    Exams and Tests

    During a physical examination, the doctor may discover:

    • Abdominal tenderness, especially in the right upper side
    • Enlarged liver
    • High blood pressure
    • Swelling in the legs

    Liver function tests (liver enzymes) may be high. Platelet counts may be low. A CT scan may show bleeding into the liver.

    Tests of the baby's health will be done. Tests include fetal non-stress test, ultrasound, among others.

    Treatment

    The main treatment is to deliver the baby as soon as possible, even if the baby is premature. Problems with the liver and other complications of HELLP syndrome can quickly get worse and be harmful to both the mother and child.

    Your doctor may induce labor by giving you drugs to start labor, or may perform a C-section.

    You may also receive:

    • A blood transfusion if bleeding problems become severe
    • Corticosteroid medications to help the baby's lungs develop faster
    • Medications to treat high blood pressure

    Outlook (Prognosis)

    When thecondition is not treated early, up to 1 of 4 women develop serious complications. Without treatment, a small number of women die.

    The death rate among babies born to mothers with HELLP syndrome depends on birth weight and the development of the baby's organs, especially the lungs.Many babies are bornprematurely(born before 37 weeks of pregnancy).

    HELLP syndrome may return in up to 1 out of 4 future pregnancies.

    Possible Complications

    There can be complications before and after the baby is delivered, including:

    • Disseminated intravascular coagulation (DIC) -- a clotting disorder that leads to excess bleeding (hemorrhage)
    • Fluid in the lungs (pulmonary edema)
    • Kidney failure
    • Liver hemorrhage and failure
    • Separation of the placenta from the uterine wall (placental abruption)

    After the baby is born and HELLP syndrome has time to improve, most of these complications will go away.

    When to Contact a Medical Professional

    If symptoms of HELLP syndrome occur during pregnancy:

    • See your obstetrician right away
    • Call the local emergency number (such as 911)
    • Get to the hospital emergency room or labor and delivery unit

    There is no known way to prevent HELLP syndrome. This is whyit is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as HELLP syndrome early.

    References

    Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 35.

    Wakim-Fleming J. Liver disease in pregnancy. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2010:section 6.

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    • Preeclampsia

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      • Preeclampsia

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      A Closer Look

        Self Care

          Tests for HELLP syndrome

            Review Date: 11/8/2012

            Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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