HELLP syndrome is a life-threatening, but treatable, form of preeclampsia that can occur in late pregnancy. What makes this condition more severe than most cases of preeclampsia is the specific effects it has on other parts of the body.

Although HELLP is rare (affecting less than 1% of all pregnancies), preeclampsia-related conditions like it cause 15-20% of pregnancy-associated deaths in the United States.

What happens in the body?

The name “HELLP” stands for the three signs of the condition.

1. Hemolysis.

This is when red blood cells break down and are destroyed. When this happens, a person may become anemic and is more likely to require blood transfusions. 

2. ELevated liver enzymes.

Elevated liver enzymes injure the liver, which can result in sudden problems with everything the liver helps our bodies to do, like making blood clots, allowing medicines to work, and removing toxins from our blood. Long-term or permanent damage to the liver can occur as a result.

3. Low Platelet count.

Platelets, which help the body form blood clots to slow down and stop bleeding, are low. If platelet levels are low, a person is more likely to have excessive bleeding after a delivery. 

How is HELLP syndrome diagnosed?

HELLP is typically diagnosed if blood tests show red blood cell destruction, a low platelet count and high liver enzymes with no other reasonable explanation for these findings. 

“HELLP syndrome can be very tricky to diagnose, because it doesn’t look the same way for everyone,” says maternal-fetal medicine specialist Maggie Kuhlmann, MD. “While most patients will have high blood pressure, some do not, and will only present with vague symptoms like abdominal pain, nausea, or generally not feeling well.”

• If blood pressure is high: Specific blood tests will examine red blood cell and platelet counts, and liver and kidney function, which usually confirms the diagnosis.
• If blood pressure is not high: Diagnosis can be trickier because in some people, it simply doesn’t appear. About 15% of people with HELLP syndrome will not have elevated blood pressure. In this case, the evaluation process may include additional testing, depending on how a person reports they are feeling.

What are the risks?

Risks can involve short and long-term complications, depending on the circumstances.

There are risks for both the mother and the baby. 

“For the mother, there can be permanent damage to vital organs, and if not detected soon enough, this can even lead to death,” says Dr. Kuhlmann. “HELLP syndrome will not affect the baby directly, but because a baby’s health is dependent on the mother’s health, HELLP syndrome can affect the baby as well. This typically occurs by affecting the blood flow to the placenta, which is how the baby receives oxygen and nutrition before birth.”

It does not only occur during pregnancy. 

About one-third of cases occur after delivery, which can make recognition and diagnosis more difficult. Any new or worsening symptoms after birth should be promptly evaluated.

“If, after your delivery, you’re suddenly not feeling well or think that something is wrong, go to your doctor’s office or the hospital to be seen right away,” advises Dr. Kuhlmann. “HELLP syndrome can become more severe over just hours, so timely diagnosis and treatment can be life-saving.”

It can cause long-term liver damage.

While preeclampsia during pregnancy can affect long-term cardiovascular health, HELLP syndrome can cause permanent liver damage.

Most people with HELLP syndrome will recover enough liver function for it to perform all its regular activities in your body right afterwards. Still, the liver will be more susceptible to damage from other sources in the future, and this increases the risk of liver failure later in life.

What changes in care may be required?

While some less severe forms of preeclampsia can be watched closely to allow the baby more time to grow and mature, pregnancies with HELLP syndrome typically need to be delivered immediately.

Care may involve transferring to a hospital with a NICU if your baby is premature, or to a hospital that can deal with serious complications like liver failure or the need for large blood transfusions.

Can HELLP syndrome be prevented?

While there isn’t a way to prevent HELLP syndrome, following through with regular prenatal care is the best way to reduce your risk. Early treatment reduces your chances of developing serious complications.

If you are at higher risk for HELLP syndrome and other forms of preeclampsia, Dr. Kuhlmann advises talking with your doctor about beginning a daily low-dose aspirin in early pregnancy, beginning around 12 weeks of gestation. While this does not eliminate the risk, research supports that it reduces it.