HELLP syndrome
Updates to Article Attributes
HELLP syndrome is a pregnancy-related condition and is an abbreviation for:
- haemolysis
- elevated liver enzymes and
- low platelets
It is considered a severe and life-threatening form of pre-eclampsia although it can occur without co-existing pre-eclampsia.
Epidemiology
The estimated incidence is ~0.5% (range 0.17-0.85%) of live births 9. The condition often occurs in the 3rd trimester of pregnancy (and postpartum 13). It tends to present in young primigravid women.
Clinical presentation
The presentation can be variable and can include malaise, epigastric and/or right upper quadrant pain, and nausea and vomiting. Some may have non-specific viral-like symptoms. Hypertension and proteinuria (classic symptoms of pre-eclampsia) may be absent or slight 7.
Pathology
The aetiology and pathophysiology remain incompletely understood with multiple theories 12:
- immune-mediated: maternal acute rejection reaction to fetal antigens
- placenta-mediated liver injury
- systemic inflammatory response syndrome in the setting of pre-eclampsia
Histology
On liver histology, there is a combination of deposited fibrin, haemorrhage, and hepatocellular necrosis surrounding portal areas 6.
Radiographic features
General features predominantly involve hepatic sequelae:
- hepatomegaly: especially the right lobe
- haemorrhage, subcapsular haematoma, rupture
- hepatic infarction
Ultrasound
Generally preferred over CT, an ultrasound is usually preferred to avoid ionising radiation.
CT
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 complications in order to make a rational judgmentjudgement. The CT scan may show hepatic complications as described above.
Treatment and prognosis
Management is often supportive. Patients with hepatic rupture +/- intraperitoneal bleeding require immediate surgery or selective hepatic arterial embolisation.
Complications
- disseminated intravascular coagulation: reported to occur in ~30% (range 20-40%) of patients 5
- hepatic infarction
- hepatic haematoma
- hepatic rupture
- placental abruption
History and etymology
The condition was originally described by Pritchard et al. in 1954 3 with the acronym later coined by L Weinstein in 1982 4.
-</ul><p>It is considered a severe and life-threatening form of <a href="/articles/pre-eclampsia">pre-eclampsia</a> although it can occur without co-existing pre-eclampsia. </p><h4>Epidemiology</h4><p>The estimated incidence is ~0.5% (range 0.17-0.85%) of live births <sup>9</sup>. The condition often occurs in the <a href="/articles/third-trimester">3<sup>rd</sup> trimester of pregnancy</a> (and postpartum <sup>13</sup>). It tends to present in young primigravid women. </p><h4>Clinical presentation</h4><p>The presentation can be variable and can include malaise, epigastric and/or <a title="RUQ pain" href="/articles/ruq-pain">right upper quadrant pain</a>, and nausea and vomiting. Some may have non-specific viral-like symptoms. <a href="/articles/hypertension">Hypertension</a> and <a title="proteinuria" href="/articles/proteinuria">proteinuria</a> (classic symptoms of pre-eclampsia) may be absent or slight <sup>7</sup>. </p><h4>Pathology</h4><p>The aetiology and pathophysiology remain incompletely understood with multiple theories <sup>12</sup>:</p><ul>- +</ul><p>It is considered a severe and life-threatening form of <a href="/articles/pre-eclampsia">pre-eclampsia</a> although it can occur without co-existing pre-eclampsia. </p><h4>Epidemiology</h4><p>The estimated incidence is ~0.5% (range 0.17-0.85%) of live births <sup>9</sup>. The condition often occurs in the <a href="/articles/third-trimester">3<sup>rd</sup> trimester of pregnancy</a> (and postpartum <sup>13</sup>). It tends to present in young primigravid women. </p><h4>Clinical presentation</h4><p>The presentation can be variable and can include malaise, epigastric and/or <a href="/articles/ruq-pain">right upper quadrant pain</a>, and nausea and vomiting. Some may have non-specific viral-like symptoms. <a href="/articles/hypertension">Hypertension</a> and <a href="/articles/proteinuria">proteinuria</a> (classic symptoms of pre-eclampsia) may be absent or slight <sup>7</sup>. </p><h4>Pathology</h4><p>The aetiology and pathophysiology remain incompletely understood with multiple theories <sup>12</sup>:</p><ul>
-</ul><h5>Ultrasound</h5><p>Generally preferred over CT, an ultrasound is usually preferred to avoid ionising radiation.</p><h5>CT</h5><p>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 complications in order to make a rational judgment. The CT scan may show hepatic complications as described above.</p><h4>Treatment and prognosis</h4><p>Management is often supportive. Patients with hepatic rupture +/- intraperitoneal bleeding require immediate surgery or selective <a href="/articles/hepatic-arterial-embolisation">hepatic arterial embolisation</a>. </p><h5>Complications</h5><ul>- +</ul><h5>Ultrasound</h5><p>Generally preferred over CT, an ultrasound is usually preferred to avoid ionising radiation.</p><h5>CT</h5><p>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 complications in order to make a rational judgement. The CT scan may show hepatic complications as described above.</p><h4>Treatment and prognosis</h4><p>Management is often supportive. Patients with hepatic rupture +/- intraperitoneal bleeding require immediate surgery or selective <a href="/articles/hepatic-arterial-embolisation">hepatic arterial embolisation</a>. </p><h5>Complications</h5><ul>