HELLP Syndrome - Signs and Symptoms

Signs and Symptoms

HELLP usually begins during the third trimester; rare cases have been reported as early as 23 weeks gestation. Often, a patient who develops HELLP syndrome has already been followed up for pregnancy-induced hypertension (gestational hypertension), or is suspected to develop pre-eclampsia (high blood pressure and proteinuria). Up to 8% of all cases present after delivery.

Women with HELLP syndrome often "do not look very sick." Early symptoms can include:

• In 90% of cases, either epigastric pain described as "heartburn" or right upper quadrant pain.
• In 90% of cases, malaise.
• In 50% of cases, nausea or vomiting.

There can be gradual but marked onset of headaches (30%), blurred vision, and paresthesia (tingling in the extremities). Edema may occur but its absence does not exclude HELLP syndrome. Arterial hypertension is a diagnostic requirement, but may be mild. Rupture of the liver capsule and a resultant hematoma may occur. If the patient has a seizure or coma, the condition has progressed into full-blown eclampsia.

Disseminated intravascular coagulation is also seen in about 20% of all women with HELLP syndrome, and in 84% when HELLP is complicated by acute renal failure. Pulmonary edema is found in 6% of all women with HELLP syndrome, and in 44% when HELLP is complicated by acute renal failure.

Patients who present with symptoms of HELLP can be misdiagnosed in the early stages, increasing the risk of liver failure and morbidity. Rarely, post caesarean patients may present in shock condition mimicking either pulmonary embolism or reactionary haemorrhage.