HELLP is a syndrome that occurs in very rare cases during pregnancy; nevertheless, it is life-threatening and requires urgent medical treatment. It effectively causes red cells in your blood to start breaking down, as well as leading to issues in the liver function, dangerous levels of excessive bleeding and sub-optimal blood pressure.
In this guide, we will take you through what HELLP is, the symptoms you need to watch out for, and the treatment options available should a pregnant mother develop the syndrome. Early treatment is key for both the baby and expectant mothers, which means symptoms, even if seemingly non-serious, should not be ignored.
What Does HELLP Stand For?
To fully understand HELLP, it is most helpful to explore the acronym:
Haemolysis. When red blood cells break down too soon and far too rapidly, it is known as haemolysis. This causes low levels of red blood cells, which can, in some cases, lead to anemia. This condition is problematic, as it means the blood is not carrying enough necessary oxygen throughout your body.
Elevated Liver enzymes. Injured or inflamed liver cells can leak high levels of this protein into your blood. When high levels of enzymes are recorded in the liver, it may be a sign of extensive damage.
Low Platelet count. Platelets perform an essential role in the blood. A low platelet count translates to poor blood clotting, which is necessary to control and prevent excessive bleeding.
When Does HELLP Occur?
In most cases, HELLP develops in the final trimester of pregnancy. It may also occur earlier, although HELLP occurring prior to 20 weeks of gestation is highly uncommon. In very rare cases, HELLP has been known to occur postpartum, however, this is extremely rare.
Medical professionals are still unsure about the exact causes of HELLP, although it is thought that several pre-existing conditions can heighten risk. For example, high blood pressure, diabetes, twin or multiple baby pregnancies, prior occurrences of preeclampsia, and advanced maternal age (35+) have all been linked to HELLP.
HELLP is closely associated with preeclampsia, with approximately 10-20% of pregnant women who suffer preeclampsia also developing HELLP. There is still heavy debate in the medical profession concerning whether HELLP is a separate condition, or ‘simply’ a more severe form of preeclampsia. In any case, it is important to be aware that preeclampsia is linked with several complications during pregnancy, including convulsions, HELLP and stroke.
The Symptoms to Watch Out For
There are a number of common symptoms associated with HELLP. However, it is important to note that suffering from any of these symptoms does not necessarily translate to HELLP syndrome; consult a medical professional if you are concerned.
● Pain in the abdomen, particularly the top-right side. General pain around the stomach is also possible, or just under the ribs.
● Headaches are also very common in patients suffering from HELLP syndrome.
● Blurry vision.
● Protein in the urine.
● Swelling.
● Vomiting or nausea.
● Flu-like symptoms.
● Fatigue.
● Swelling, particularly at night.
These symptoms may also point to other issues, particularly those related to high blood pressure. Your healthcare provider will be in the best position to provide an accurate diagnosis. It may be helpful to keep a diary of any symptoms that are out of the ordinary, including the severity and timeline.
How is HELLP Treated?
There are several treatment options your doctor will explore, depending on the situation. Treatments may include the following:
● Bed rest. It is important the patient rests as much as possible, either in the hospital or in a monitored home environment.
● Treatment of seizures via prescription medicine may be required.
● Lowering blood pressure through medicine.
● Blood transfusions may be necessary, depending on the platelet count and whether the patient is suffering from anemia
● Dialysis and ventilatory support may be necessary in severe cases of HELLP, although this is uncommon.
Doctors will also commonly decide to monitor the mother and baby under hospital conditions, including close fetal monitoring. For example, non-stress testing will determine the heart rate when the baby is moving. Doppler flow studies use sound waves to help measure blood flow. Lab tests of urine, blood and the liver can also suggest whether HELLP syndrome is improving or getting worse, helping to determine treatment options.
In some cases, the baby will need to be delivered early. This is the safest way to treat HELLP in the majority of cases. Should a pregnant mother develop the syndrome, delivery usually happens around week 34, with most babies being delivered via cesarean section.
Doctors may prescribe corticosteroid medicines to assist lung maturity in the baby prior to delivery. Having the mother under professional medical care in a hospital setting, allowing for the best treatment options, will help with the full recovery of the patient.
How HELLP Affects the Baby
Mothers will naturally be very concerned about how HELLP can negatively impact the health of the baby. The outcome generally depends on when the mother is diagnosed, and how early labour is induced. If the baby is born before 37 weeks, close monitoring is required.
For example, the baby may need to stay in a neonatal intensive care unit. Should the baby weigh a minimum of 1 kg at birth, research has shown they are just as likely to survive as non-HELLP babies. It must be noted, however, that the stillbirth rate is higher. For every 1 000 HELLP pregnancies, 51 babies are stillborn.
Remember, HELLP Is Rare!
Expectant mothers have enough to worry about during their pregnancy and reading about conditions such as HELLP can lead to unnecessary anxiety. Perhaps the statistics can help assuage any concerns: approximately 0.5% to 0.9% of expectant mothers will develop HELLP, with most women seeing full recovery.
Nevertheless, it is undoubtedly true that HELLP syndrome is a potentially life-threatening condition, both for the pregnant mother and the unborn baby. For the best outcome, prompt medical treatment must not be delayed.
The most important takeaway is to be aware of the symptoms, as catching HELLP early makes a significant difference in the recovery process. In most women, the side effects and most symptoms will disappear completely within weeks or even days following the delivery of the baby. However, close monitoring delivery should remain a priority.