HELLP is the term for one of the most serious complications of pre-eclampsia, in which there is a combined liver and blood clotting disorder.
H stands for Haemolysis (rupture of the red blood cells);
EL stands for Elevated Liver enzymes in the blood (reflecting liver damage);
LP stands for Low blood levels of Platelets (special blood cells which are vital for clotting).
HELLP is as dangerous as eclampsia and possibly more common, although it is less easy to diagnose. .
WHAT ARE THE SIGNS AND SYMPTOMS?
HELLP syndrome may be preceded by clear signs of pre-eclampsia - most typically high blood pressure, protein in the urine and swelling of hands, feet or face. But, like eclampsia, it can also arise out of the blue without any of the classic warning signs.
The typical presenting symptom is pain just below the ribs (Ďepigastric painí), sometimes accompanied by vomiting and headaches and/or visual disturbances.
This pain is sometimes confused with the discomfort of heartburn, a very common problem during pregnancy. But, unlike heartburn, the pain of HELLP syndrome is not burning, does not spread upwards towards the throat and is not relieved by antacid.
The pain is often very severe and is associated with tenderness over the liver.(under the ribs to the right).
It is not uncommon for women with this pain to be diagnosed as suffering from some other acute abdominal condition, typically inflammation of the gall bladder (cholecystitis) or even gallstones.
WHEN DOES IT OCCUR?
As with eclampsia, HELLP syndrome is most likely to occur immediately after delivery - sometimes developing with devastating speed.
However, it can arise at any stage during the second half of pregnancy after 20 weeks - and some rare cases have been recorded even earlier.
WHAT ARE THE RISKS?
HELLP syndrome may be associated with one or more of the following problems:
* Severely disturbed blood clotting function, leading to heavy, uncontrollable bleeding, particularly after surgery;
* Severe liver damage, which can lead to failure or even rupture of this vital organ;
* Severe kidney problems, including kidney failure;
* Breathing difficulties, which may be severe enough for the mother to need artificial ventilation.
* Stroke (cerebral haemorrhage) with or without eclampsia.
HOW IS IT TREATED?
The diagnosis of HELLP syndrome can only be confirmed in hospital, and emergency admission is essential for all suspected cases.
Once the syndrome is diagnosed the baby should be delivered as soon as the motherís condition is stable, regardless of the maturity of the baby, since delivery is the only cure for this life-threatening condition.
the blood clotting system is severely disturbed it may be necessary to give transfusions of the platelets essential to clotting before delivery can take place.
It is not uncommon for the symptoms to become worse - or to develop for the first time - in the 48 hours following delivery, and treatment in an intensive care unit may be necessary.
All treatment is aimed at supporting the motherís systems which have failed (liver, kidney, lungs, clotting) until such time as they have recovered enough to cope on their own.
Providing no permanent damage has occurred, the mother should enjoy a full recovery. This may take as little as a few days or as long as three month depending on the severity of impact on the mother.
HOW IS THE BABY AFFECTED?
HELLP is a maternal problem which has no specific effects on the unborn baby.
However, as with all cases of severe pre-eclampsia, the baby may suffer growth restriction and even distress as a result of the underlying cause - a shortage of maternal blood flow to the placenta. The increased risk of bleeding may present in placental abrubtion.
Most cases of HELLP delivery is for the motherís benefit, sometimes with tragic results for babies who are too premature to survive outside the womb.
WHAT HAPPENS IN THE NEXT PREGNANCY?
About one sufferer in every 20 will suffer a recurrence of HELLP in her next pregnancy. However, there is no way of predicting who is most likely to suffer a recurrence and no specific means of prevention, although treatment with low-dose aspirin may be recommended in cases where the syndrome developed relatively early in pregnancy - ie before 32 weeks. For optimum safety, any woman who has suffered HELLP in one pregnancy should be considered Ďat higher riskí in the next pregnancy and monitored carefully throughout with a view to detecting signs of recurrence at the earliest possible stage.
Preconception counselling with an expert to devise an appropriate antenatal care programme for the next pregnancy is advisable.
Every Woman is entitled to understand what happened in her pregnancy when pre eclampsia strikes. I hope to be able to support that process.