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HELLP Syndrome: Are You At Risk?

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Pregnancy related image Photo: Getty Images

Often misdiagnosed at first, HELLP syndrome occurs in one to two out of every 1,000 pregnancies and can lead to serious complications if not treated early. The acronym HELLP stands for Hemolysis, Elevated Liver enzymes and Low Platelet count.

While some researchers believe HELLP syndrome is a variant of preeclampsia, it can also occur independent of preeclampsia. The cause of HELLP syndrome remains unknown.

Many women exhibit symptoms that lead to diagnosis of HELLP syndrome:

  • Fatigue
  • Excess weight gain
  • Fluid retention
  • Headache
  • Nausea later in pregnancy
  • Pain or tenderness in the upper right side of the abdomen
  • High blood pressure
  • Swelling, particularly in the fact or hands
  • Blurry vision
  • Nosebleed
  • Seizures

Of course, some of these symptoms are normal for any pregnant woman during the third trimester. Blood tests can help determine if symptoms are a result of HELLP syndrome. However, not all women are symptomatic, and the disease can present without any forewarning.

When Susan Shay’s waters began to leak a week and a half before her due date, she had no idea she was in labor. The San Francisco mom had planned to labor at home for as long as possible, but because of the leakage she went to the hospital. Doctors did blood tests immediately and found a low platelet count and high liver enzymes.

“My platelet count was incredibly low,” said Shay, “the lowest they told me they’d ever seen at the hospital, and my liver enzymes were the highest they’d ever seen.”

While at first the doctors believed Shay might have preeclampsia, the numbers did not improve after several hours, and it became clear that this was HELLP syndrome.

HELLP generally develops in the third trimester, usually before the 37th week of pregnancy, although it can also present soon after childbirth. Many women have high blood pressure before developing HELLP syndrome. This was not the case for Shay. “I actually have low blood pressure,” she stressed. “I had no symptoms at all. I was 38.5 weeks pregnant. Three days before I gave birth, my blood pressure was totally normal. I hadn’t had blood tests for weeks, so I don’t know about those levels, but I wasn’t feeling any differently.” Doctors told her that most women in her situation would have been puffed up like a balloon from edema, but she didn’t experience any swelling. In fact, she displayed none of the typical symptoms of the syndrome and has no idea what caused its onset.

The cause of HELLP syndrome continues to elude medical professionals. Researchers have found that women over 25 years of age, and especially Caucasians, are more likely to develop HELLP syndrome. The risk is also higher for women who have already had children or who have had problematic pregnancies in the past.

Because the cause is unknown, there is really no way to prevent the onset of HELLP syndrome. It’s a good idea to see a healthcare professional throughout pregnancy and discuss any symptoms that arise.

Although magnesium sulfate can help prevent seizures in women with HELLP syndrome, the ultimate treatment for HELLP is to give birth. For Shay, this required a pitocin drip after six hours when her labor was not progressing. “It was becoming urgent to have this baby,” she said, “not for the baby’s sake, but for my sake. The baby would have been fine. It was for me.”

Even after birth, the syndrome may not disappear immediately. “Delivery is what cures this,” noted Shay, “but I continued to have blood tests still every six hours because my numbers weren’t improving. The first 24 hours after giving birth, I was so thirsty! I was not allowed to have more than one pitcher of liquid the entire day.” Because of HELLP syndrome’s effects on the liver, it is critical for doctors to ensure the kidneys are functioning correctly and that the woman doesn’t experience severe swelling.

HELLP syndrome can endanger a baby as well as its mother, primarily because its onset may require inducing labor, even if the pregnancy hasn’t reached full term. Some research has shown that bed rest, fluids and close observation can help manage the syndrome in pregnancies less than 32 weeks, allowing for the fetus to develop further before childbirth becomes necessary. Other treatment options are also available, including steroids, but if levels aren’t stabilized induction may be necessary.

A baby’s survival rate depends on its level of development at birth. If the pregnancy is far enough along, the baby may have no complications at all. This was true for Shay’s baby. “She was jaundiced and had trouble nursing, but she was also born 10 days early. We don’t know if it was because of HELLP, my IV fluids or her being born early. Who knows? They know very little about this syndrome.”

HELLP syndrome recurs in 19 - 27 percent of subsequent pregnancies. The risk of preeclampsia in future pregnancies can be as high as 43 percent. Usually HELLP syndrome is less severe the second time, and it tends to develop later in the pregnancy.

For Shay, the possibility of experiencing HELLP syndrome again is frightening. However, she feels confident that with extra monitoring everything will work out just fine. She knows her next birth experience will be different as a result of having had HELLP. “The instant I’m in labor, I have to go to the hospital. I don’t have the option of waiting it out.”


"HELLP syndrome - PubMed Health." National Center for Biotechnology Information. Web. 10 Aug. 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001892

“HELLP syndrome and your pregnancy.” American Family Physician. Web. 10 Aug. 2011.

"HELLP Syndrome: Recognition and Perinatal Management - September 1, 1999 - American Academy of Family Physicians." Home Page -- American Academy of Family Physicians. Web. 10 Aug. 2011. http://www.aafp.org/afp/990901ap/829.html

Shay, Susan. Telephone interview. 10 Aug. 2011.

Reviewed August 11, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith

Add a Comment5 Comments

EmpowHER Guest

my sister had hellp syndrome with her first born and he was taken by emergency c-section at 26 weeks. she was in icu for quite awhile herself and was told that she may had residual liver and kidney damage. She was followed by high risk obgyn's prior to the diagnosis due to her regular obgyn felt something was not quite right but nothing showed. This was a horrible life changing experience for the entire family. There was times that we did not know if she/baby was going to survive. Lucky this is 5 years later and both are fine. This is a very serious condition that not only effects the mother but the child also.

April 1, 2012 - 10:33am

I also would like to note that although I was on magnesium, IV fluid (b/c of the magnesium) and a pit drip, I had a pain-medication free delivery. Would I have rather had "no interventions"/a completely natural labor? Yes. But, I am proof that a woman can have a pit drip without having to have pain meds/an epidural and feel that they are delivering as naturally as possible - this was important to me.

I hated having those three needles in my body (I called them my "Christmas tree" as the large metal stand stood in for a tree during my December delivery). I also hated having to take a "break" during my pushing phase to have vials of blood taken for my tests - taken every 6 hours. This was incredibly difficult, but as any woman in labor can attest to, it is not the worst thing in the world. I have a healthy baby and that is all I asked for during my pregnancy.

HELLP is a serious matter that is not spoken of widely - I may have been more freaked out during my labor if I had known of the possible complications.

August 11, 2011 - 9:33pm


I am sorry that you also went through this. HELLP is indeed a serious condition. Unfortunately, medical professionals don't know the exact cause and many symptoms also correspond to other complications of pregnancy. I think the best piece of advice is "when in doubt, head to the hospital" - the worst thing that can happen is that you are sent home. We were (as you read) not sent home and have a happy, healthy toddler now. HELLP can manifest in many ways and is probably wider spread that statistics may show. It is important for women to be in touch with their OBs/midwives throughout pregnancy and at the first sign of labor (especially in the first full pregnancy).

Best wishes to you,
Susan Shay

August 11, 2011 - 9:23pm
EmpowHER Guest

HELLP is more serious than this article makes it sounds. If not treated, you will go into a coma and die. I had HELLP @ 30 weeks 4 days and within 6 hours of being admitted to hospital, was having an emergency c section. If you have a severe headache, nausea, pain in your side or are vomiting, go to the hospital immediately. Heartburn is also a symptom that may show up long before the pain or headaches.

August 11, 2011 - 3:23pm
(reply to Anonymous)

I'm sorry you had to go through this. As Susan Shay says in her comments below, sometimes too much information ahead of time can terrify a woman. I agree that this is a very serious matter, but at the same time if a woman is aware of changes in her body and communicates with her health care practitioner, hopefully HELLP will be recognized and treated before it becomes too advanced.

According to the Padden article in American Family Physician, "The mortality rate for women with HELLP syndrome is approximately 1.1 percent." Most women, fortunately, do not progress to the level of coma and death.

I certainly do not mean to minimize the severity of HELLP Syndrome. This is a very serious -- and scary -- condition, which is why I felt it was important to write about it and educate women who might be experiencing some of the symptoms.

Hillary Easom

August 11, 2011 - 10:22pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.



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