What is HELLP syndrome?
HELLP syndrome is a complication during pregnancy considered a variant of preeclampsia. It usually appears in late pregnancy and sometimes after delivery. The acronym is derived from some of the characteristics of the disease:
- Hemolytic anemia or hemolysis (Hemolytic anemia).
- Elevated Liver enzymes (Elevated Liver enzyme)
- Thrombocytopenia or low platelet count (Low Platelet count).
The syndrome occurs in about 1 or 2 out of every 1,000 pregnancies, so it is rare. It usually appears in the third trimester of pregnancy (between the 26th and 40th week of gestation) and sometimes even the week after the baby is born.
HELLP syndrome is a variant of preeclampsia.
Prognosis of the disease
HELLP syndrome is a serious complication in which the life of the patient and the baby may be at risk. The overall mortality rate is around 25%. Hence, it is essential that pregnant women with HELLP syndrome be well screened and diagnosed in order to receive treatment as early as possible.
Symptoms of HELLP syndrome
Typical symptoms that patients with HELLP syndrome usually have are:
- Blurred vision
- Headache
- Nausea, vomiting and indigestion
- Epigastric pain
- Paresthesia
- Tenderness in the abdomen and chest, and pain in the upper right side (or hepatic distention)
- Shoulder pain with heavy breathing
- Bleeding
- Feeling of swelling
In addition, some patients also present with edema and anemia, which is usually microangiopathic hemolytic type and not autoimmune. Although pregnancy-induced hypertension is common, it is not a condition to be considered HELLP syndrome, as other patients with the pathology have normal blood pressure.
Other less common signs or symptoms include hepatic capsule rupture with secondary hepatic hematoma, disseminated intravascular coagulation, and acute renal failure. Some patients with early HELLP syndrome may be misdiagnosed, increasing the risk of morbidity and liver failure.
Medical tests for HELLP syndrome
When the OB/GYN specialist suspects that the patient may have HELLP syndrome, blood tests containing a complete blood count, liver function tests, kidney function tests, coagulation studies, and electrolytes should be performed.
Fibrin degradation products, which may be elevated, should also be measured. The same occurs with the enzyme lactate dehydrogenase, which is a marker of hemolysis that is also elevated. Proteinuria levels can also be studied, as they are also usually present, albeit mildly. On the other hand, positive D-dimer testing associated with preeclampsia may be predictive in patients with HELLP syndrome.
HELLP syndrome can be difficult to diagnose, especially if blood pressure and urine protein are not present. Hence, symptoms are sometimes mistaken for gastritis, hepatitis, gallbladder disease or even influenza.
What are the causes of HELLP syndrome?
There is no specific cause of HELLP syndrome. It is considered a variant of preeclampsia and is sometimes due to an underlying cause, such as antiphospholipid syndrome.
A genetic component has also been suggested as a cause. This pathology is more frequent in patients whose mothers suffered this complication during pregnancy. It is also more frequent in multiple pregnancies, in the first pregnancy, in women over 35 years of age and in patients with immune system diseases.
Can it be prevented?
There is no way to prevent HELLP syndrome. However, it is recommended:
- Be in good physical shape before pregnancy.
- Have regular prenatal visits throughout the pregnancy so that early diagnosis can be made.
- Inform the specialist of previous risk pregnancies, as well as a family history of HELLP syndrome, pre-eclampsia or hypertensive disorders.
Treatments for HELLP syndrome
Treatment is usually based on the use of antihypertensive medication and blood component transfusions. If necessary, the patient will be admitted for fetal well-being checks, blood tests and a low-salt diet.
If the baby has grown enough, in some cases delivery will be induced. The fetal condition must be assessed and the weeks of gestation must be taken into account. It is also essential that the delivery takes place in a hospital with a maternal and neonatal intensive care unit.
Which specialist treats you?
The specialist in charge of studying, diagnosing and treating women with HELLP syndrome is the expert in Gynecology and Obstetrics. Specifically, those specialized in fetal medicine and high-risk pregnancy, who will know how to distinguish the symptoms and establish the most accurate diagnosis possible.