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HELLP Syndrome

2 min read

References:

  1. Maternal & Child Health Nursing: Care of the childbearing & childrearing family, 8th Edition, ISBN 978-1-4963-4813-5, by JoAnne Silbert-Flagg and Adele Pillitteri (Ch. 21)
  2. The Topranker’s Guide: A Comprehensive Study Guide for the Nurse Licensure Exam (pp. 283–284)

HELLP syndrome is a variation of the gestational hypertensive process named for the common symptoms that occur:

  1. Hemolysis that leads to anemia,
  2. Elevated Liver enzymes that lead to epigastric pain, and
  3. Low Platelets that lead to abnormal bleeding/clotting.

This syndrome occurs in 4% to 12% of patients who have elevated blood pressure during pregnancy. It is a serious syndrome because it results in a maternal mortality rate as high as 24% and an infant mortality rate as high as 35%. Its cause is unknown, although women with antiphospholipid syndrome (APS) or the presence of antiphospholipid antibodies in maternal blood are much more likely to develop HELLP syndrome, similar to preeclampsia. It occurs in both primigravidas and multigravidas.

Signs and Symptoms

In addition to proteinuria, edema, and increased blood pressure:

  1. Liver inflammation: nausea, epigastric pain, general malaise, and right upper quadrant tenderness.
  2. Laboratory studies reveal hemolysis of red blood cells, thrombocytopenia, and elevated liver enzyme levels (ALT, AST), which are all effects of hemorrhage and necrosis of the liver.

Complications

Subcapsular liver hematoma, hyponatremia, renal failure, hypoglycemia from poor liver function, cerebral hemorrhages, aspiration pneumonia, and hypoxic encephalopathy. The fetus may experience growth restriction and preterm birth.

Therapeutic Management

Therapy for the condition is transfusion of fresh frozen plasma or platelets in order to improve the platelet count. Extremely close monitoring for bleeding is required, in addition to the observations necessary for preeclampsia.

  1. If hypoglycemia is present, this is corrected by an intravenous glucose infusion.
  2. The infant is born as soon as feasible by either vaginal or cesarean birth. However, be alert for maternal hemorrhage due to thrombocytopenia. Epidural anesthesia may not be possible because of the high possibility of bleeding at the epidural site.
  3. The HELLP syndrome will disappear soon after birth, the same as preeclamptic symptoms, but the experience of developing the HELLP syndrome is frightening. Women need assurance afterward that symptoms were pregnancy-related and so will not return.

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