HELLP Syndrome

INFORMATION FOR WOMEN WHO DEVELOP HELLP SYNDROME DURING PREGNANCY

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is HELLP syndrome in pregnancy?

HELLP is an acronym that stands for Hemolysis (the breakdown of red blood cells), Elevated Liver enzymes (concentrations in the blood of enzymes from the liver are too high), and Low Platelet count (the number of blood-clotting cells (platelets) in the blood is too low). HELLP is a syndrome that can occur as a life-threatening complication of pregnancy. Sometimes it can occur as a further complication of another pregnancy condition called preeclampsia, but the relationship between HELLP and preeclampsia is controversial. Many cases of HELLP develop in women who do not have preeclampsia, and preeclampsia and HELLP tend to strike mothers-to-be of different age groups, so many researchers consider HELLP and preeclampsia to be separate conditions.

How common is HELLP syndrome during pregnancy?

HELLP occurs in 0.5 0.9 percent of pregnancies overall, and in 10 20 percent of women who suffer from severe preeclampsia.  Additionally, it tends to strike women who are at least 25 years of age, and is most common in Caucasian women, in contrast with preeclampsia that tends to strike younger women, particularly those of non-white ethnicity.

How is HELLP syndrome diagnosed?

Initial suspicion of HELLP is based on your history and physical exam. First of all, HELLP is a third trimester complication that also can begin soon after delivery, but generally not earlier in pregnancy.  Common symptoms are pain in the right upper abdomen and headache. Like preeclampsia, patients developing HELLP also may suffer from high blood pressure and the presence of protein in the urine. HELLP is then diagnosed based on the results of a handful of blood tests. These include a liver panel (looking especially at the enzymes AST and ALT, and also at bilirubin), a complete blood count (CBC) showing a low platelet count [thrombocytopenia], low hematocrit, elevated reticulocytes, and a peripheral blood smear showing schizocytes (red blood cell fragments) or shrunken, spiked red blood cells (called Burr cells). Doctors also may perform computed tomography (CT) of the abdomen to look for a further complication called subcapsular liver hematoma.

Does HELLP cause problems during pregnancy?

HELLP syndrome can develop into further, very severe complications. One such complication is eclampsia in which, on top of the problems of platelets and organ trouble, the woman has seizures. The blood clotting problem connected with platelets can deteriorate into what is called disseminated intravascular coagulation (DIC), plus the kidneys can stop functioning, fluid can accumulate in the lungs and abdomen, clots can block blood vessels in the brain and liver, the retina of the eyes can detach, and there can be bleeding in the brain.

Does HELLP during pregnancy cause problems for the baby?

HELLP can cause intrauterine growth restriction, where the developing baby does not grow as quickly and as completely as it should, plus the condition can lead to preterm delivery, which itself is connected with numerous complications for the newborn. HELLP can also cause abruptio placentae, when the placenta detaches from the uterus too early, cutting off circulation to the baby and causing severe uterine bleeding. Newborns of mothers with HELLP can suffer from neonatal thrombocytopenia (low platelet count resulting in severe bleeding), and respiratory distress syndrome.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the HELLP syndrome
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat HELLP syndrome during pregnancy?

Medications for patients with HELLP consist of corticosteroids, particularly betamethasone. This helps the mother with the effects of HELLP but also accelerates the development of the baby’s lungs, which is vital because the main strategy in HELLP is to deliver the baby as early as possible. The patient also is given magnesium sulfate to prevent seizures, which is also not harmful to the baby. The mother may also be given a number of pregnancy-safe blood pressure drugs. The latter must be done with extreme caution, since lowering blood pressure too much can reduce circulation through the placenta, which can harm the developing baby.

Who should NOT stop taking medication for HELPP syndrome during pregnancy?

The medication given for HELLP is to prevent further complications that can be life-threatening, so nobody who needs these drugs should avoid them.

What should I know about choosing a medication for my HELLP syndrome during pregnancy?

You may find Pregistrys expert reports about the individual medications used to treat HELLP here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my HELLP syndrome when I am breastfeeding?

Generally, delivery resolves HELLP.  In cases of HELLP that develop after delivery, the main strategy is to prevent seizures with magnesium sulfate and this is not harmful to a nursing infant.

What alternative therapies besides medications can I use to treat HELLP syndrome during pregnancy?

Delivery is the main treatment strategy. How soon this can be carried out depends on the condition of the mother and the gestational age of the baby. Whether delivery can be vaginal or must be cesarean also depends on a variety of details relating to the baby and mother.

What can I do for myself and my baby when I have HELLP during pregnancy?

Cooperate with your physicians. HELLP is a serious complication of pregnancy, but if recognized early and managed efficiently it is easily survivable both for mother and child.

Resources for HELLP syndrome in pregnancy:

For more information about HELLP syndrome during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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