HELLP syndrome is a pregnancy complication that usually presents in women who have pre-eclampsia or eclampsia. Affected women also show signs of liver damage and abnormalities in blood clotting.

HELLP syndrome is characterised by:

  • Haemolysis
  • ELevated liver enzymes
  • Low Platelet count


This syndrome occurs in around 0.5% of all pregnancies. It usually occurs late in the third trimester but has been reported late in the second trimester too. About 33% of patients with HELLP will present just after delivery.

Clinical presentation

Initial symptoms are often vague and include nausea, headaches, malaise, epigastric/right upper quadrant pain. Raised blood pressure, proteinuria and oedema may be found on examination.

Investigations may reveal haemolysis on a blood film, raised liver enzymes, low platelets, raised LDH and raised bilirubin.


The mainstay of treatment is the delivery of the baby. Tight blood pressure control is imperative. Magnesium sulphate is often used as it appears to reduce the risk of progression to eclampsia. If DIC occurs, treatment with fresh frozen plasma is needed.


Complications may occur, and these include:

  • DIC
  • Renal failure
  • Liver failure
  • Pulmonary oedema
  • Placental abruptions
  • Retinal detachment

Without prompt recognition, around 25% suffer severe complications. With treatment, the mortality rate for the mother is around 1%. The mortality rate for the baby is approximately 5-10%; much of this is dependent on the gestational age at the time of delivery.



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