Facts and Information on HELLP

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by C. Picklyk

Although the two have been considered related and HELLP can develop after preeclampsia manifests itself, HELLP can also occur on its own. HELLP syndrome occurs in approximately 0.2 to 0.6% of all pregnancies, whereas preeclampsia is present in 5 to 7% of all pregnancies.
It goes without saying that HELLP is very rare.

The acronym HELLP stands for:



Liver enzymes



The syndrome generally appears in the third trimester, although it can appear before 27 weeks in approximately 11% of cases. 31% of cases are postpartum, onset being typically within the first 48 hours but may not show up until 7 days after delivery.

The nature of the syndrome makes it easy to overlook and misdiagnose: women are often initially misdiagnosed with other disorders such as cholecystitis, esophagitis, gastritis, hepatitis, or idiopathic thrombocytopenia. However, early detection is critical. Symptoms to look for are:

  • pain in the upper right quadrant (can be described as “rib pain”)
  • edema
  • hypertension
  • protein in the urine
  • nausea
  • vomiting
  • headache

There are 2 classifications systems for HELLP syndrome: one based on the number of abnormalities present, and the second based on the platelet count. In the first classification, women with one or two abnormalities are considered to have “partial” HELLP syndrome; “full” HELLP syndrome indicates the presence of all three abnormalities (haemolysis, elevated liver enzymes, and low platelets). In the second classification there are three grades:

Class III: a platelet count of 100 000 to 150 000

Class II: a platelet count of 50 000 to 100 000

Class I: a platelet count of less than 50 000

If platelets drop below 30 000, a platelet transfusion is necessary. I was considered Class I, but narrowly missed a transfusion (32 000). Patients with class I HELLP are at higher risk for maternal morbidity and mortality than patients with class II or III. The maternal mortality rate is approximately 1.1%, and infant morbidity and mortality ranges from 10 to 60%, depending on the severity of the mother’s case. Although conservative management of a case of HELLP may be considered, the only “cure” is delivery, regardless of gestation (infant mortality due to HELLP syndrome is generally caused by severe prematurity). Symptoms typically worsen after delivery and then improve over the next 3 to 4 days.

There is a risk of 19 to 27% chance of a recurrence of HELLP in subsequent pregnancies. When one considers the initial odds (0.2 to 0.6% of all pregnancies develop HELLP), these odds are staggering. Women classified as having Class I HELLP are at the highest risk for recurrence. However, when the syndrome recurs, it often manifests itself later in the pregnancy and is generally less severe after 2 episodes.

Please know that I am not a doctor, and that the information in this article has been procured by my own research on-line and through discussion with my doctors and doula. That being said, I have done my best to provide both an accurate picture of HELLP, as well as verified statistics.

Article reprinted with permission.

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