HELLP syndrome
HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) is a severe, life‑threatening variant of the hypertensive disorders of pregnancy. It most commonly presents in the third trimester but may develop or first present in the early postpartum period (usually within 7 days).
HELLP is associated with significant maternal morbidity (DIC, hepatic haematoma/rupture, acute kidney injury, respiratory failure) and often requires urgent multidisciplinary management and decisive timing of delivery (NICE NG133).
Clinical context: suspect HELLP in any pregnant or recently postpartum woman with new or worsening hypertension accompanied by right upper quadrant or epigastric pain, nausea and vomiting, severe headache, visual symptoms, malaise, or bleeding and bruising.
Pathophysiology
- HELLP reflects systemic endothelial injury and microangiopathic haemolysis triggered by placental dysfunction.
- Microvascular thrombosis in the liver and elsewhere causes hepatocellular injury and platelet consumption.
- The resulting triad-haemolysis, transaminitis and thrombocytopenia-predisposes to DIC, hepatic haematoma/rupture and multi‑organ dysfunction.
- Definitive treatment is delivery of the fetus and placenta; emergency supportive care stabilises the mother until delivery.
Presentation
- Symptoms: right upper quadrant or epigastric pain (classical), nausea and vomiting, malaise, headache, visual disturbance, and bleeding or bruising when platelets are low. Symptoms may worsen or first appear postpartum.
- Signs: usually hypertensive (often severe: systolic ≥160 mm Hg and/or diastolic ≥110 mm Hg), right upper quadrant tenderness, peripheral oedema, hyperreflexia, petechiae or bleeding if coagulopathy....