What you need to know about HELLP Syndrome

HELLP syndrome is a rare but serious syndrome, which can put you and your baby at high risk for serious, or even fatal, pregnancy complications

You’ve heard about pre- eclampsia, but did you know there’s a life- threatening condition that’s a severe complication of pre-eclampsia? Fortunately, HELLP syndrome is extremely rare. While preeclampsia will affect six to eight percent of pregnant women, less than one percent of all pregnancies are complicated by HELLP syndrome.

HOW IS HELLP DIFFERENT?

Pre-eclampsia is a pregnancy-specific blood pressure complication. “Pre-eclampsia itself can lead to complications like lung failure, kidney failure, stroke, fits and HELLP syndrome. HELLP syndrome is when liver failure leads to the destruction of red blood cells and leaky blood vessel walls leading to a low platelet count,” explains Dr Jana Rossouw, a gynaecologist and obstetrician at Tygerberg Hospital. Without early treatment, this condition can lead to disseminated intravascular coagulation (DIC), a clotting disorder that leads to excessive bleeding, fluid in the lungs, kidney failure, liver haemorrhage and failure, or placental abruption. However, the condition usually resolves once the baby is delivered.

WHY IS IT SO DANGEROUS?

HELLP syndrome can be difficult to diagnose, especially when high blood pressure and protein in the urine (both classic symptoms of pre-eclampsia) aren’t present. The symptoms of HELLP can mimic many other conditions or pregnancy complications, for example feeling generally unwell or fatigued, experiencing nausea or headaches. “HELLP syndrome is considered a severe complication of preeclampsia. It increases the risk of other complications of liver failure, bleeding, kidney failure and even death,” explains Dr Rossouw. Although it most often develops in the third trimester, HELLP can develop any time after 20 weeks’ gestation, or even after delivery of the baby, although the longer the time after delivery, the less likely you are to develop it. “Early onset of pre-eclampsia and HELLP syndrome is considered a severe complication and urgent management by an obstetrician and maternal foetal medicine specialist is needed,” she cautions.

HOW WILL I KNOW IF I’M AT RISK?

There’s a familial link for preeclampsia, so if your mother, aunt or sister has suffered from pre-eclampsia or HELLP syndrome, your risk factors are higher. Other risk factors for pre-eclampsia include age (either very young or older than 35), if you suffer from chronic hypertension, diabetes mellitus, kidney disease, auto-immune diseases, or are overweight. If this is your second pregnancy and you had pre-eclampsia in your first pregnancy, you’ll also be at higher risk of developing pre-eclampsia or HELLP.

WHAT ARE THE SYMPTOMS?

“Symptoms of pre-eclampsia include severe, sudden onset of swelling of the feet, face or the whole body. Complaints of severe headache, visual disturbances and upper abdominal pain can accompany the swelling. When HELLP syndrome develops, patients may notice that their urine is dark in colour and that bleeding of gums, nose or other drip sites occurs. Patients can, however experience no symptoms either,” says Dr Rossouw. If you suspect that you have HELLP syndrome, see your doctor immediately or go to your hospital emergency room. Your doctor will perform a physical examination, feeling for abdominal tenderness, an enlarged liver and excess swelling, and may order a blood test to check your platelet levels and red blood cell count,

as well as a urine test to check for elevated liver enzymes and abnormal proteins.

TREATMENT

If you’re diagnosed with HELLP syndrome, your pregnancy will need to be managed by an obstetrician and maternal foetal medicine specialist, advises Dr Rossouw. “Management entails timing of administration of steroids to improve foetal lung maturity, careful planning of delivery and monitoring of blood pressure, kidney and liver functions,” she explains. Most often, the definitive treatment for HELLP syndrome is the delivery of your baby, which stops the condition from causing any serious complications for both the mom and baby. If you’re diagnosed, you’re likely to be hospitalised until the birth so that you and your baby can be monitored. Many babies are born prematurely (before 37 weeks), because problems with the liver and other complications of HELLP can quickly get worse or be harmful to both the mother and baby. Early treatment is extremely important to prevent complications from developing.

IS THERE ANY WAY TO PREVENT HELLP?

“To reduce your risk, plan your inter-pregnancy interval for longer than one year, but less than five years. Start folate three months before conceiving. Aspirin and calcium from 12 weeks will reduce the risk of pre-eclampsia in the current pregnancy,” advises Dr Rossouw.

EARLY ONSET OF PRE-ECLAMPSIA AND HELLP SYNDROME IS CONSIDERED A SEVERE COMPLICATION AND URGENT MANAGEMENT BY AN OBSTETRICIAN AND MATERNAL FOETAL MEDICINE SPECIALIST IS NEEDED