When Ms. K. suddenly felt a pulling pain in her upper right abdomen one evening during her 32nd week of pregnancy, she initially thought it was a stomach flu. She lay down, waited for the pain to subside, and didn’t realize until hours later that there was something else going on. It is precisely this misdiagnosis that is one of the most dangerous aspects of HELLP syndrome: the symptoms seem harmless, but the consequences can be far-reaching.
In this magazin what the acronym HELLP stands for. You’ll find out which symptoms you should take seriously, how doctors make the diagnosis, and what treatment is most important right now—so that you, as a pregnant woman or a family member, can take the right steps in an emergency.
What is HELLP syndrome?
HELLP is an acronym for the following terms: Hemolysis (the breakdown of red blood cells), Elevated Liver Enzymes, and Low Platelet Count. Together, these three changes in the blood constitute a distinct clinical syndrome that is among the most severe pregnancy-related conditions of all.
HELLP syndrome is considered a particularly dangerous form of preeclampsia, or classic pregnancy-induced hypertension (gestosis). However, it can also develop without a prior history of preeclampsia, which is one reason why the condition is so often underestimated. Some doctors describe it as a distinct form of pregnancy-related illness with its own course, which differs significantly from other forms of gestosis.
How common is HELLP syndrome?
The reported incidence varies depending on the source: Overall, it is estimated that HELLP syndrome occurs in about 1 in 150 to 300 pregnancies, which corresponds to less than 1% of all pregnancies. The condition usually manifests during the second half of pregnancy, particularly in the third trimester, but it can also occur after delivery: In about 30% of cases, HELLP syndrome develops postpartum, that is, after the baby has already been born.
Causes and risk factors
The exact causes of HELLP syndrome remain unclear to this day. It is believed that abnormal development of the placenta, combined with impaired blood flow in the vessels, plays a central role—which in turn affects the liver, blood clotting, and other organs.
Get the support that suits you.
Contact us now and we will get back to you as soon as possible!
*Mandatory fields
**Weprocess and store your data exclusively for the purpose of establishing contact and initiating business. We do not pass on your data. You can object to the storage of your personal data at any time by sending an e-mail to datenschutz@agfh.de at any time. In this case, we will immediately delete the data stored about you in due time, provided that no statutory retention periods must be observed.
You can find further information, including about other rights you have to protect your data, in our data protection information.
Risk factors include, among others:
- Existing high blood pressure (hypertension) or pregnancy-induced hypertension
- Diabetes
- Lupus erythematosus
- A genetic predisposition that further increases the risk
- A history of preeclampsia or HELLP syndrome
Important to know: Even women without any known risk factors can be affected. Women who have previously had HELLP syndrome have a recurrence risk of about 5 to 19% in a subsequent pregnancy.
Symptoms: What to Look For
The tricky thing about HELLP syndrome is that the initial symptoms often seem nonspecific. Over 90% of affected women report severe upper abdominal pain in the area of the liver, often accompanied by nausea, vomiting, or a general feeling of illness. Unfortunately, it is precisely this combination of symptoms that is often mistakenly dismissed as a stomach flu or heartburn.
Other possible signs include:
- A sudden rise in blood pressure—or, more specifically, abnormal blood pressure readings
- Severe headaches
- Vision problems such as flickering before the eyes or blurred vision
- Protein in the Urine (Proteinuria)
- A vague feeling that “something isn’t right.”
If you are pregnant and experience persistent upper abdominal pain, severe headaches, or vision problems, this is always a reason to contact your OB-GYN immediately or go directly to a hospital. When in doubt, it’s better to get it checked out one time too often than too late.
Diagnosis: Why Blood Tests Are Crucial
Because the physical symptoms are so nonspecific, HELLP syndrome can ultimately only be diagnosed with certainty based on laboratory test results. The main tests performed are:
- Signs of hemolysis in the blood
- Elevated liver enzymes or liver function test results
- A significantly reduced platelet count (thrombocytopenia)
In addition, doctors monitor blood pressure, urine, kidney function, and blood clotting. If there is reasonable suspicion of HELLP syndrome, the patient is usually admitted immediately to a hospital with an intensive care unit, as HELLP syndrome can deteriorate dramatically within a few hours.
What complications might arise?
If left untreated, HELLP syndrome can be life-threatening for both the mother and the baby. Possible complications include:
- Liver hemorrhages, including liver rupture
- Severe blood clotting disorders
- Kidney failure
- Placental detachment
- Growth disorders or acute danger to the unborn child
This range of possible complications is why HELLP syndrome is considered a true medical emergency in obstetrics. Prompt action is crucial, as every hour counts with this condition.
Treatment: Childbirth as the Only Effective Treatment
The only curative treatment for HELLP syndrome is termination of the pregnancy, that is, delivery. Everything else is supportive care intended to buy time or stabilize the patient's condition.
Until the birth, this usually includes:
- Close monitoring of blood pressure, blood test results, and the child's vital signs
- Blood Pressure-Lowering Medications
- Magnesium sulfate for the prevention of seizures
- If necessary, platelet or blood transfusions
If the pregnancy is still before the 34th week and the condition of the mother and baby allows it, delivery can be briefly delayed under close monitoring to promote the baby’s lung maturity. From the 34th week of pregnancy onward, delivery is usually performed promptly, often by cesarean section, especially if complications arise or there is no time for a vaginal delivery.
Important to know: The delivery does not stop the symptoms immediately. After delivery, medication is first used to stabilize the mother’s condition, and blood values usually do not return to normal until about three days later.
Prognosis and Follow-Up Care
For most women, symptoms and lab results improve significantly after delivery; however, the first few days of the postpartum period remain a sensitive time during which close monitoring continues. Since the risk of recurrence in a subsequent pregnancy ranges from 5 to 19 percent, women affected by this condition are advised to undergo particularly careful prenatal care during future pregnancies, and in some cases to take a low dose of aspirin as recommended by a doctor.
Key Points at a Glance
HELLP syndrome is rare but potentially life-threatening for both the mother and the baby. It often—though not always—occurs in connection with preeclampsia and is primarily characterized by upper abdominal pain, high blood pressure, headaches, and visual disturbances. Because the symptoms can easily be mistaken for harmless ailments, seeking prompt medical evaluation is always the safest course of action when in doubt. The only effective treatment is delivery; all other measures are aimed at protecting the mother and baby as much as possible until then.
If you're pregnant and unsure whether your symptoms are harmless or not, talk to your doctor about it. That's exactly what your OB-GYN is there for. When in doubt, it's better to get checked out one too many times.
This article is not a substitute for medical advice. If you experience acute symptoms during pregnancy, please contact your doctor or a medical facility immediately.
