HELLP Syndrome – Causes, Symptoms, and Treatment Methods

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Hypertension occurs in about 5–10% of pregnant women and is one of the primary causes of morbidity and even mortality among mothers and newborns. If the blood pressure exceeds 140/90 mmHg, accompanied by proteinuria of more than 300 mg/day, a pre-eclampsia stage is diagnosed. However, a particularly hazardous complication during pregnancy is the HELLP syndrome, which poses a serious risk to both the mother and the child. How can this condition be identified and effectively treated to reduce the risk of complications?

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The HELLP syndrome

The HELLP syndrome affects 0.5-0.9% of all pregnancies and occurs in 10-20% of women with pre-eclampsia or eclampsia. In 70% of cases, symptoms arise during pregnancy (typically between the 27th and 37th week), while in 30% it is diagnosed during labor, primarily within the first 48 hours, though symptoms may persist up to the 7th day postpartum. Initially, the HELLP syndrome was regarded as a severe manifestation of pre-eclampsia, but it is now recognized as a distinct clinical entity, even in pregnant women without hypertension or proteinuria. Approximately 15% of women with HELLP syndrome exhibit neither hypertension nor proteinuria. The syndrome is defined by hemolysis, elevated alanine and aspartate aminotransferase levels, and thrombocytopenia. Pregnant women with HELLP syndrome face a significant risk of developing eclampsia. If the pregnancy exceeds 34 weeks, delivery should be initiated within 24 hours via vaginal or operative means. For pregnancies between 24 and 34 weeks, steroid therapy is administered to accelerate fetal lung maturity, deferring delivery by at least 48 hours.

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Pathogenesis of HELLP Syndrome - unraveling the enigma

The exact causes of HELLP syndrome remain elusive. Research indicates that this condition more commonly affects women over 25 years old of Caucasian descent who have had multiple pregnancies. During preeclampsia, endothelial damage occurs, triggering platelet activation and localized vasoconstriction. Consequently, fibrin deposits form on vascular walls, leading to red blood cell destruction and anemia. Furthermore, elevated liver enzyme activity results from hepatic ischemia and necrosis, reducing platelet counts.

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Clinical Features of HELLP Syndrome

The clinical manifestations of HELLP Syndrome can be divided into three sequential stages. The initial phase, referred to as the laboratory phase, is marked by a reduced platelet count, decreased antithrombin III levels, elevated D-dimer concentrations, increased liver enzyme activity (ASPAT and ALAT), heightened bilirubin levels, and elevated LDH activity.

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HELLP Syndrome – Therapeutic Approaches

The management of HELLP syndrome is contingent upon the pregnancy stage. After the 34th week of gestation, immediate termination of pregnancy is mandated. Between the 27th and 34th weeks, delivery is initiated within 48 hours of diagnosis. Initially, the patient's condition must be stabilized, and glucocorticoids administered. Prior to the 27th week, a conservative approach is adopted [5]. Women with HELLP syndrome require specialized medical attention, often necessitating intensive care. The nature of care depends on the maternal and fetal health status. Conservative management is feasible only if blood pressure is controlled, diuresis is normal, and hepatic symptoms are absent. Many patients require blood product transfusions [2]. HELLP syndrome is a multisystem disorder affecting 0.5-0.9% of pregnancies, frequently resulting in complications. Prompt diagnosis and intervention are critical to mitigate risks for both mother and child.

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