The HELLP syndrome is a pregnancy related condition and is an abbreviation for
- elevated liver enzymes and
- low platelets
It is considered a severe and life threatening form of pre-eclampsia.
The estimated incidence is at ~ 0.17 - 0.85 of live births 9. The condition often occurs in the 3rd trimeter of pregnancy (and occasionally post partum). It tends to present in young primagravid women.
Presentation can be variable and can include malaise , epigastric / right upper-quadrant pain, and nausea / vomiting. Some may have non-specific viral-syndrome-like symptoms. Hypertension and proteinuria (classic symptoms of pre eclampsia) may be absent or slight 7.
On liver histology, there is may a combination of deposited fibrin, haemorrhage and hepatocellular necrosis surrounding portal areas 6.
The place of CT is mainly to assess for complications.
When considering a CT scan the radiologist needs to discuss with the obstetrician regarding radiation risk to fetus from radiation versus clinical suspicion of a complications in order to make a rational judgement. The CT scan may show hepatic complications such as rupture, sub capsular haematoma or hepatic infarction.
- disseminated intravascular coagulation : reported to occur in ~ 20 – 40 % of patients 5
- hepatic infarction
- hepatic haematoma
- hepatic rupture
- placental abruption
Treatment and prognosis
Management is often supportive. Patients with hepatic rupture + / - intraperitoneal bleeding require immediate surgery or selective hepatic arterial embolisation.
The condition was originally described Pritchard et al in 1954 3 with the acronym later coined by L Weinstein in 1982 4.
- 1. Nunes JO, Turner MA, Fulcher AS. Abdominal imaging features of HELLP syndrome: a 10-year retrospective review. AJR Am J Roentgenol. 2005;185 (5): 1205-10. doi:10.2214/AJR.04.0817 - Pubmed citation
- 2. Woodfield CA, Lazarus E, Chen KC et-al. Abdominal pain in pregnancy: diagnoses and imaging unique to pregnancy--self-assessment module. AJR Am J Roentgenol. 2010;194 (6): S42-5. doi:10.2214/AJR.10.7224 - Pubmed citation
- 3. Pritchard JA, Weisman R, Ratnoff OD, Vosburgh GJ. Intravascular hemolysis, thrombocytopenia and other hematologic abnormalities associated with severe toxemia of pregnancy. N Engl J Med1954; 250:89 –98
- 4. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am. J. Obstet. Gynecol. 1982;142 (2): 159-67. - Pubmed citation
- 5. Lubner M, Menias C, Rucker C et-al. Blood in the belly: CT findings of hemoperitoneum. Radiographics. 27 (1): 109-25. doi:10.1148/rg.271065042 - Pubmed citation
- 6. Gamanagatti S, Kumar S. Acute abdomen after the termination of pregnancy. Br J Radiol. 2008;81 (969): 758-9. doi:10.1259/bjr/58583394 - Pubmed citation
- 7. Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am. J. Obstet. Gynecol. 1990;162 (2): 311-6. - Pubmed citation
- 8. Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. J Perinat Med. 2000;28 (4): 249-60. doi:10.1515/JPM.2000.033 - Pubmed citation
- 9. Furlan A, Fakhran S, Federle MP. Spontaneous abdominal hemorrhage: causes, CT findings, and clinical implications. AJR Am J Roentgenol. 2009;193 (4): 1077-87. doi:10.2214/AJR.08.2231 - Pubmed citation
- 10. Haddad B, Barton JR, Livingston JC et-al. HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus severe preeclampsia: onset at Am. J. Obstet. Gynecol. (link) - Pubmed citation
- 11. Vigil-de gracia P. Acute fatty liver and HELLP syndrome: two distinct pregnancy disorders. Int J Gynaecol Obstet. 2001;73 (3): 215-20. Int J Gynaecol Obstet (link) - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Haemolysis, elevated liver enzymes and low platelets||✓|