A woman at 34 weeks puts her nausea down to a bad curry and the ache under her right ribs down to the baby’s foot. By the next morning she’s in an operating theatre. That’s how HELLP syndrome tends to announce itself: quietly, in the language of ordinary late-pregnancy discomfort, then all at once. Most people have heard of pre-eclampsia. Far fewer have heard of the rarer, more dangerous condition it can turn into, until it happens to them or someone they know.
Below: what HELLP syndrome is, the warning signs to act on, and what it means for mother and baby.
HELLP syndrome is a severe pregnancy complication affecting the blood and liver, usually in the third trimester. The classic warning sign is pain in the upper right abdomen or the pit of the stomach, and it needs emergency care.
The only cure is delivery. Caught in time, most mothers recover fully within days of the birth.
What HELLP syndrome is
The name is a set of initials for what goes wrong in the blood and liver:
- H for haemolysis, the breaking down of red blood cells
- EL for elevated liver enzymes, a sign the liver is under strain
- LP for low platelet count, which affects the blood’s ability to clot
It’s usually considered a severe form of pre-eclampsia, the pregnancy condition marked by high blood pressure. Most women who develop HELLP have pre-eclampsia first, though 15 to 20% don’t have the raised blood pressure or protein in the urine that would normally flag it, and that’s part of what makes it easy to miss. About 4 to 12% of women with pre-eclampsia go on to develop HELLP.
When it happens
Most cases appear in the third trimester, between 28 and 40 weeks, but it can start any time from the second half of pregnancy, from around 20 weeks. It can also develop in the week after the birth. It’s rare, occurring in fewer than 1 in 100 pregnancies, but it’s serious, and it can worsen quickly.
The warning signs
HELLP can feel, at first, like a bad bout of late-pregnancy misery. The signs to take seriously:
- Pain in the upper right abdomen or the pit of the stomach, under the ribs, from the liver. This is the most telling sign.
- Nausea or vomiting that’s new or getting worse
- A headache that won’t shift
- Vision changes, such as blurring or spots
- General unwellness, like coming down with flu
- Pain in the right shoulder, or when breathing in deeply
- Swelling, and sudden weight gain
Any of these in the second half of pregnancy is a reason to be seen the same day. Upper-abdominal or stomach pain that’s new and persistent, in particular, should never be brushed off as indigestion late in pregnancy.
How it’s treated
The definitive treatment is to deliver the baby, because the condition is driven by the pregnancy itself. What happens next depends on how far along the pregnancy is:
- At or near term, delivery is usually arranged straight away, often by caesarean.
- Before 34 weeks, and if mother and baby are stable, doctors may give corticosteroid injections to speed up the baby’s lung development before delivering, and magnesium sulphate to prevent seizures.
- Blood transfusions may be needed for the anaemia and low platelets.
- Blood pressure medication if pressure is high.
The mother is monitored closely in hospital, sometimes in intensive care, because the liver and clotting problems can take a few days to turn around. In most cases the numbers start recovering within 48 hours of delivery, and mothers go on to recover fully. Once you’re home and past the worst of it, the ordinary questions come back: what’s safe to take, when to book that overdue check-up, whether breastfeeding after dental work means pumping and dumping. Your obstetrician can answer most of them in one visit.
What it means for the baby
Because delivery is often the treatment, many HELLP babies are born premature, and how they do depends mostly on how early they arrive. Babies born very early spend time in the neonatal intensive care unit and are cared for like other preterm infants. The corticosteroid injections given before an early delivery help their lungs, and the earlier the condition is caught and managed, the more room doctors have to plan. Nothing about HELLP is picked up on an ultrasound, incidentally: the mid-pregnancy scans look for structural problems in the baby, from heart defects to rarities like arhinia and the anomaly scan findings that come with it, while HELLP shows up in your bloods and your blood pressure.
Who’s at higher risk, and future pregnancies
HELLP is more likely in women who’ve had pre-eclampsia or HELLP before, in first pregnancies, in pregnancies with twins or more, and with pre-existing high blood pressure or diabetes. Having had HELLP once raises the risk in a future pregnancy, so later pregnancies are monitored more closely. It can’t reliably be prevented, so knowing the warning signs matters more than anything. If your HELLP delivery was by caesarean and you’re planning another baby, it’s worth raising the caesarean scar niche and secondary infertility with your doctor too, since scar healing can affect how the next pregnancy starts.
Common questions
What is HELLP syndrome?
A severe pregnancy complication affecting the blood and liver. The initials stand for haemolysis, elevated liver enzymes and low platelets. It’s usually a severe form of pre-eclampsia and needs emergency care.
What are the warning signs of HELLP syndrome?
Pain in the upper right abdomen or the pit of the stomach is the classic sign, along with nausea, a persistent headache, vision changes, feeling generally unwell, and swelling. Any of these in the second half of pregnancy needs same-day medical attention.
When does HELLP syndrome occur?
Most often in the third trimester, from 28 weeks, but it can start from about 20 weeks or in the week after birth.
How is HELLP syndrome treated?
By delivering the baby, since the pregnancy drives the condition. Before 34 weeks, doctors may give steroids for the baby’s lungs and magnesium sulphate to prevent seizures first. Blood transfusions and blood pressure medication may also be needed.
Can you survive HELLP syndrome?
Yes. It’s serious and needs prompt treatment, but caught in time most mothers recover fully within days of delivery. The danger comes from delay.
Can HELLP syndrome happen again in another pregnancy?
Having had it once raises the risk in a future pregnancy, so later pregnancies are monitored more closely. It can’t reliably be prevented.
The pain that shouldn’t wait until morning
If you’re past 20 weeks and there’s a new, stubborn ache high in your abdomen or under your right ribs, ring the hospital instead of lying down and hoping. Every part of HELLP that goes badly tends to start with a woman deciding she was making a fuss. The cure is delivery, most mothers are back to themselves within days of treatment, and the babies get the same careful preterm care as any other early arrival. What nobody can give you back is the hours you spent waiting to see if it would pass.
More on pregnancy complications
Medical information is drawn from the Cleveland Clinic, the Preeclampsia Foundation and March of Dimes. This is general information, not a substitute for your obstetrician’s advice. For any warning sign in pregnancy, contact your hospital.
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