HELLP Syndrome
Content reviewed against published ACOG, NIH, March of Dimes guidelines
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If your baby has been diagnosed with or you suspect hellp syndrome, here is what the evidence says.
The short answer
HELLP syndrome is a serious pregnancy complication involving Hemolysis (breakdown of red blood cells), Elevated Liver enzymes, and Low Platelet count. It affects about 1-2 in 1,000 pregnancies and is often related to preeclampsia. HELLP is a medical emergency that typically requires prompt delivery. With early recognition and immediate medical care, most mothers and babies have good outcomes.
Key takeaways
- HELLP syndrome is a serious pregnancy complication involving Hemolysis (breakdown of red blood cells), Elevated Liver enzymes, and Low Platelet count. It affects about 1-2 in 1,000 pregnancies and is often related to preeclampsia. HELLP is a medical emergency that typically requires prompt delivery. With early recognition and immediate medical care, most mothers and babies have good outcomes.
- Usually normal when: Mild nausea or heartburn-like symptoms in pregnancy without elevated blood pressure or other warning signs
- Call your doctor if: You have severe upper right abdominal or epigastric pain with nausea, vomiting, headache, or visual changes - go to the emergency room immediately
- Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
Parents everywhere have the same worry. You are doing the right thing by looking into it.
By Age
What to expect by age
First trimester
HELLP syndrome does not develop in the first trimester. However, women with a history of HELLP in a prior pregnancy, chronic hypertension, or autoimmune conditions are at higher risk and should discuss this with their provider early. Low-dose aspirin may be recommended starting at 12-16 weeks to reduce the risk of preeclampsia-related conditions including HELLP.
Second trimester
HELLP syndrome can rarely develop as early as the mid-second trimester, though this is uncommon. The most common symptoms are upper right abdominal pain or epigastric pain (below the breastbone), nausea, vomiting, malaise, and headache. These symptoms can mimic heartburn, flu, or gallbladder disease, so blood work is essential for diagnosis.
Third trimester
Most cases of HELLP develop in the third trimester, particularly between 28-36 weeks. It can develop rapidly. Key symptoms include severe upper abdominal pain (especially right-sided), nausea and vomiting, headache, visual disturbances, and general malaise. Blood pressure may or may not be elevated. Diagnosis requires blood tests showing hemolysis, elevated liver enzymes (AST/ALT), and low platelets.
Postpartum
About 30% of HELLP cases develop within 48 hours after delivery. Postpartum HELLP presents with the same symptoms and requires the same urgent evaluation. Recovery typically takes days to weeks after delivery, with close monitoring of blood counts and liver function. Most women recover fully, though there is a small recurrence risk in future pregnancies.
What Should You Do?
When to take action
- Mild nausea or heartburn-like symptoms in pregnancy without elevated blood pressure or other warning signs
- Routine blood work shows normal liver enzymes and platelet counts
- Upper abdominal discomfort that is clearly related to eating or positioning and resolves with antacids
- You have preeclampsia risk factors but your labs remain normal at prenatal visits
- You have persistent upper abdominal pain, especially right-sided, that does not resolve with typical remedies
- You feel generally unwell with flu-like symptoms, fatigue, nausea, or vomiting in the second or third trimester
- You had HELLP syndrome in a previous pregnancy and want to discuss monitoring
- You have severe upper right abdominal or epigastric pain with nausea, vomiting, headache, or visual changes - go to the emergency room immediately
- You experience signs of internal bleeding such as easy bruising, nosebleeds, bleeding gums, or dark tarry stools along with abdominal pain and feeling unwell
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss HELLP Syndrome.
Things to mention
- You have persistent upper abdominal pain, especially right-sided, that does not resolve with typical remedies
- You feel generally unwell with flu-like symptoms, fatigue, nausea, or vomiting in the second or third trimester
- You had HELLP syndrome in a previous pregnancy and want to discuss monitoring
Observations to share
- You have persistent upper abdominal pain, especially right-sided, that does not resolve with typical remedies
- You feel generally unwell with flu-like symptoms, fatigue, nausea, or vomiting in the second or third trimester
- You had HELLP syndrome in a previous pregnancy and want to discuss monitoring
Urgent signs to report immediately
- You have severe upper right abdominal or epigastric pain with nausea, vomiting, headache, or visual changes - go to the emergency room immediately
- You experience signs of internal bleeding such as easy bruising, nosebleeds, bleeding gums, or dark tarry stools along with abdominal pain and feeling unwell
My notes
From ismybabyalright.com — free, evidence-based baby health guides
Related Resources
Frequently asked questions
Is hellp syndrome normal?
When should I call the doctor about hellp syndrome?
When is hellp syndrome normal?
What causes hellp syndrome?
What should I mention to my pediatrician about hellp syndrome?
Is hellp syndrome normal at First trimester?
Is hellp syndrome normal at Second trimester?
Should I go to the ER for hellp syndrome?
Does hellp syndrome go away on its own?
References
- [1]American College of Obstetricians and Gynecologists. HELLP Syndrome. ACOG Clinical, 2022. ACOG
- [2]National Institutes of Health. HELLP Syndrome. MedlinePlus, 2023. NIH
- [3]March of Dimes. HELLP syndrome. March of Dimes, 2023. March of Dimes
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Bottom line
Most cases of hellp syndrome are normal. Talk to your pediatrician if you have severe upper right abdominal or epigastric pain with nausea, vomiting, headache, or visual changes - go to the emergency room immediately.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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