The joy of pregnancy often comes with a host of physical side effects like water retention, headaches and nausea. But, if you have — or are at risk for — high blood pressure or preeclampsia, these “common” symptoms could be the signs of a rare but dangerous liver and blood-clotting disorder called HELLP Syndrome. Luckily, the condition is fairly rare, occurring in between 10 to 20 percent of severe preeclamptic or eclamptic pregnancies and about one to two in 1,000 pregnancies.
What Is HELLP Syndrome?
The acronym for HELLP Syndrome stands for:
- Hemolysis (H), where your red blood cells are broken down too soon, causing dangerously low red-cell blood counts
- Elevated liver enzymes (EL), which indicate that your liver is functioning poorly and is unable to process toxins in your body efficiently
- Low platelet count (LP), which would make it difficult for your body to form blood clots and could cause you to hemorrhage during labor
What Causes HELLP?
It’s not yet fully understood what causes HELLP syndrome. An estimated 70 to 80 percent of the time, pregnant women with the condition also have preeclampsia (a condition characterized by high blood pressure coupled with protein in the urine). Pregnancy-induced hypertension (high blood pressure) and eclampsia (the result of severe uncontrolled preeclampsia that causes convulsions) also increase a woman’s risk of developing HELLP.
Women who had HELLP in a previous pregnancy have about a one in four chance of recurrence in future pregnancies, according to the National Institutes of Health (NIH).
Symptoms of HELLP
- Pain and tenderness in the upper right side of the abdomen
- Nausea and/or vomiting
- Blurry vision
- General malaise
- Water retention and/or edema (swelling)
- Weight gain
- Seizures (in rare cases)
It can be easy to confuse many of these symptoms with the common complaints of a normal pregnancy. That’s why it’s important to let your healthcare provider know if you notice any of these changes, or if you simply don’t feel right — especially if you have or are at risk for preeclampsia. If your doctor isn’t available, head right away to the local emergency room.
If your doctor suspects you have HELLP, he’ll do a physical exam where he’ll check for belly soreness (especially in the upper right side), swelling in your legs, an enlarged liver and high blood pressure. He’ll likely check your liver function (enzymes may be high), test your blood (platelet counts may be low) and perform a CT scan (to see if there’s any bleeding in the liver). He’ll also check how your baby’s doing with tests including a non-stress test and an ultrasound.
HELLP Syndrome can threaten both your life and that of your baby if it’s not diagnosed and treated quickly. Mothers with HELLP run about a one in four chance of suffering serious complications including fluid in the lungs, extensive liver damage, stroke, kidney failure and/or placenta abruption (where the placenta tears away from your uterine wall, which can cause severe blood loss that often requires a blood transfusion). Fortunately most of these complications will go away once your baby is delivered and you have time to recover.
Since the diagnosis of HELLP often leads to an early delivery, your baby will most likely need extra monitoring for complications related to prematurity, like lungs that aren’t fully developed.
Can it Be Prevented?
There is no known way to prevent HELLP, although a healthy diet and regular exercise may lower your risk. It is, however, possible to prevent serious complications by ensuring your healthcare provider knows if you experienced HELLP in a previous pregnancy and notifying him as soon you experience any of the syndrome’s symptoms so he can monitor you closely.
The only effective treatment for HELLP Syndrome is delivery of your baby. If you develop HELLP when you’re at least 34 weeks pregnant, your healthcare provider will likely want to induce labor right away before the condition progresses and presents further risks. Vaginal delivery is most common, if possible, as blood-clotting issues associated with HELLP can complicate a cesarean delivery. If baby’s lungs aren’t yet mature, you’ll receive corticosteroids to speed up their maturity before delivery.
If you develop HELLP earlier in your pregnancy, your healthcare provider may attempt to delay delivery until your fetus has more time to develop. You’d most likely be kept under observation in the hospital while receiving blood pressure medication, magnesium sulfate and corticosteroids.
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