Every woman dreams to mother a healthy child. Some small complaints in pregnancy can be suggestive of serious problems. Therefore, no symptom, how much ever trivial, should be ignored.
HELLP is a constellation of symptoms that occurs in pregnant women and is named after the component features. ‘H’ signifies hemolysis, a breakdown of red cells; ‘EL’ is elevated liver enzymes, implying an altered function of the liver; and ‘LP’ is a low count of platelets, the cells that help is clot formation in the blood.
About HELLP
HELLP is a life-threatening condition. It affects around 0.2-0.6% of all pregnancies.
HELLP is said to be a variant of pre eclampsia, a medical condition that occurs beyond 20 weeks of pregnancy in which a pregnant woman develops a high blood pressure and proteins appear in the urine. The very severe cases of pre eclampsia can develop convulsions when it is called eclampsia. At many times, a high blood pressure may not be evident in pre eclampsia and HELLP may be the first warning sign. HELLP is not easy to diagnose. It can be mistaken for a liver or gallbladder disease or a bleeding disorder. HELLP is said to occur in around 10% of women who develop pre eclampsia.
HELLP usually presents in the last three months of pregnancy though it may occur in the earlier weeks in few women. The syndrome may also set in antepartum, i.e., just before delivery, or postpartum, i.e. after delivery. When it occurs postpartum, it usually occurs within 2 days of delivery though sometimes it may be delayed for up to 7 days after delivery.
At Risk
Any woman who is pregnant can get HELLP syndrome. Some, however are at a greater risk. These are women who are either below the age of 20 years, or are more than 35 years in age. Women are at greater risk if they have been pregnant more than twice. Pregnant women who develop a high blood pressure or convulsions during pregnancy or have had similar complaints in past pregnancies are also at more risk. Women who have had prior episodes of HELLP are at risk of developing one again.
Symptoms
Some symptoms that are suggestive of HELLP syndrome are headaches, a feeling of vomiting, flu like illness, fatigue and tiredness, and pain in the abdomen. These symptoms should never be ignored and medical help should never be delayed. There may be blurring of vision, swelling in the feet or elsewhere in the body, bleeding spots in the skin, or any other type of bleeding.
The doctor may advise some blood tests. The liver function tests assess the levels of enzymes which when elevated are suggestive of a deranged liver function. Blood counts typically show breakdown of red cells and low numbers of platelets. Complete blood cell (CBC) counts and liver function tests should be done for every pregnant woman who presents with malaise and fatigue in the last three months of pregnancy.
Treatment
The treatment of HELLP syndrome depends upon the stage of pregnancy. Ideally, delivery is the best course of action to prevent any further harm to the mother or the baby. If the pregnancy has not completed 34 weeks, the lung functions of the baby are evaluated and delivery planned accordingly. The patient may be given a medicine called corticosteroid which can help the baby’s lung to mature faster. If the pregnancy has completed 34 weeks and if HELLP begins to deteriorate, delivery is the best option. Until the baby is delivered the mother is hospitalized and put on bed rest. Magnesium sulphate may be given if convulsions are thought to be likely and the blood pressure is controlled by using medicines. If platelet counts are low, blood transfusions are used to replenish them. The status of the mother and the developing baby is constantly monitored. The delivery may be done surgically, i.e. by a caesarean section. However, if the pregnancy has completed 34 weeks of duration, then a trial of labor can be done under vigilance. Most problems due to HELLP subside with 2-3 days of delivery.
Complications
Left undiagnosed or untreated, HELLP can cause serious complications in both the mother and the developing baby. These can be life threatening. The mother may develop convulsions. There may be a detachment of the placenta, the organ that connects the developing baby to the womb of the mother and allows exchange of gases and nutrition between the mother and the baby. It can cause disseminated intravascular coagulation (DIC), a serious medical condition of clotting mechanisms that can result in profuse bleeding. Fluid may accumulate in the lungs and respiratory distress and lung failure develops. Bleeding in the liver can lead to accumulation of blood that may burst to cause further damage to the liver. In due course of the illness, the kidneys start failing and urine output is reduced. The baby’s lungs being immature can easily go into failure called infant respiratory distress syndrome.
The outcome of HELLP is not good for either the mother or the baby. Up to 25% pregnant women with HELLP may develop serious complications. The baby may be affected depending upon the birth weight, stage of pregnancy when born, and the maturity of lungs and other organs.
Get help to prevent HELLP
HELLP is known to recur in future pregnancies and its occurrence cannot be prevented. One should be watchful and report to the doctor even on subtle signs like a headache, pain in abdomen, or a blurred vision. A medicine called aspirin may be prescribed if the duration of the pregnancy is less than 32 weeks. Timely diagnosis and treatment can help to prevent damage to both mother and baby due to HELLP. Be vigilant and make your pregnancy the most wonderful experience.
