Open Journal of Obstetrics and Gynecology, 2012, 2, 318-320 OJOG
http://dx.doi.org/10.4236/ojog.2012.23066 Published Online September 2012 (http://www.SciRP.org/journal/ojog/)
A review of HELLP syndrome, in 17 patients
Davut Güven1, Kadir Bakay2*, İdris Koçak1, Cazip Üstün1
1Department of Obstetrics and Gynecology, 19 Mayis University School of Medicine, Samsun, Turkey
2Private Hospital Department of Obstetrics and Gynecology, Turkey
Received 15 May 2012; revised 27 June 2012; accepted 9 July 2012
Introduction: Preeclampsia is a well known obstetric
complication characterized with hypertension and
proteinuria whereas HELLP syndrome (hemolysis,
elevated liver enzymes, low platelet count) which was
first stated by Prichard in 1954 and described by
Weinstein in 1982, is a multisystemic disease usually
seen in the third trimester and in the postpartum
period, usually in 48 - 72 hours following delivery .
Aim: In this study we aim to share our experience in
17 patients with HELLP syndrome treated in our
clinic between January 2005 and March 2008 in re-
gard of the current literature. Material and Methods:
17 patients diagnosed with HELLP syndrome between
January 2005 and March 2008 were retrospectively
re-evaluated in regard of symptoms, treatment op-
tions and prognosis. As such this is a retrospective
study focusing on case reports. Conclusion: As noted
before main focus of treatment should be on patient
stability, in other words, palliative care under in-
tensive care conditions.
Keywords: HELLP; Preeclampsia; Eclampsia; 17
Preeclampsia (eclampsia; Greek, “shining forth”) is a
well known obstetric complication characterized with
hypertension and proteinuria whereas HELLP syndrome
(hemolysis, elevated liver enzymes, low platelet count)
which was first stated by Prichard in 1954 and described
by Weinstein in 1982, is a multisystemic disease usually
seen in the third trimester and in the postpartum period,
usually in 48 - 72 hours following delivery .
With an incidence of 0.2% - 0.8% in all pregnancies
and 10% in severe pregnancy its etiology and pathogene-
sis is still not fully revealed though it is assumed genetic
inheritance, abnormal placentation, immunologic factors
and maternal vasculo endothelial dysfunction may play a
These factors may cause segmental vasospasms and
endothelial lesions causing fibrine deposits that result in
micro circulatory dysfunctions .
Changes described in HELLP syndrome can adversely
affect liver and renal functions causing elevated liver
enzymes and proteinuria .
There are various complications known to be associ-
ated with HELLP syndrome, including but not limited to;
ascites, pleural effusion, pulmonary edema and dissemi-
nated intravascular coagulation (DIC) [1,5,6].
In this study we aim to share our experience in 17 pa-
tients with HELLP syndrome that were treated in our
clinic between January 2005 and March 2008 in regard
of the current literature.
Of the 17 cases we have thus reviewed, 3 required in-
tensive care management, the remaining 14 recovered in
24 hours after delivery without any complications hence
were monitored in the obstetric clinic.
In this study we aim to share our clinical experience in
17 patients with HELLP syndrome treated in our clinic
between January 2005 and March 2008 in regard of the
current literature. We especially aim to present 3 cases
who were treated in the intensive care unit to remark
treatment options and prognosis in such extreme con-
3. MATERIAL AND METHODS
17 patients diagnosed with HELLP syndrome between
January 2005 and March 2008 were retrospectively re-
evaluated in regard of symptoms, treatment options and
prognosis. As such this is a retrospective study focusing
on case reports. Patients who were treated in intensive
care unit are presented in detail as an example of how far
the disease could progress and how dramatically it can
fully resolve if managed right.
3.1. Case 1
A 25 years old 35 weeks twin pregnancy patient admitted
D. Güven et al. / Open Journal of Obstetrics and Gynecology 2 (2012) 318-320 319
to our clinic complaining of headache and nausea. Upon
initial examination blood pressure was 170/120 mmHg
with ascites and remarkable pretibial edema. In pelvic
examination cervix was firm and closed. Ultrasonogra-
phy showed two viable fetuses. Initial laboratory results
were as follows; Hb: 9.8 g/dl, Hct: 32.9%, Platelets:
177.000, SGOT: 42 IU/l, SGPT: 48 IU/l, proteinuria was
present and coagulation parameters were in normal range.
Immediate caesarean section was performed and two
viable fetuses were delivered.
2 hours following delivery a second laparotomy was
deemed necessary due to uncontrollable vaginal bleeding.
An increase in liver enzymes and a severe drop in plate-
let count were observed right after operation with SGOT:
66 IU/l, SGPT: 81 IU/l and 89.000 respectively.
With the appearence of tonic-clonic seizures and se-
vere breathing irregularity along with persistant high
blood pressure, patient was intubated and transferred to
the intensive care unit.
While undergoing palliative therapy and close moni-
toring a one session of hemodialysis was needed because
of anuria and edema. Blood transfusion and fresh frozen
plasma had to be administered to stabilize hemodynamic
parameters and vascular stability.
With the return of renal functions, viable vital signs
and normal laboratory results patient was extubated on
the 3rd day in intensive care unit. During follow-up no
other complications were observed and the patient was
discharged 10 days after operation.
3.2. Case 2
A 31 years old 20 weeks pregnancy diagnosed with pre-
eclampsia was brought to our clinic after having suffered
a tonic-clonic seizure at home. Upon initial examination
patient was comatose with a Glascow Coma Score of 9
and blood pressure was 140/90 mmHg, fetal cardiac ac-
tivity was absent. Laboratory results were as follows; Hb:
10.9 g/dl, Hct: 34 %, Platelets: 73.000, SGOT: 81 IU/l,
SGPT: 67 IU/l and coagulation parameters were in nor-
Immediate caesarean section was performed and the
patient transferred to the intensive care unit right after
the operation without extubation.
MgSO4 therapy was initiated closely monitoring mag-
nesium levels and urinary output along with replacement
therapy. Hemodialysis was required after stopping
MgSO4 due to anuria and edema albeit normal magne-
After having been intubated for 4 days in the intensive
care unit, with continuous monitoring and replacement
therapy renal functions returned to normal and liver en-
zymes were in a normal range. Patient was transferred
back to our clinic after 7 days in the intensive care unit
and discharged on the 10th day after operation without
any further complications.
3.3. Case 3
A 24 years old 33 weeks pregnancy with a previous his-
tory of caesarean section and diagnosed with preeclamp-
sia admitted to our clinic complaining of pelvic pain and
contractions. Upon initial examination blood pressure
was 150/110 mmHg pretibial edema was present. In pel-
vic examination cervix was dilated 3 cm with an efface-
ment of 70% indicating active labor. Ultrasonography
showed one viable fetus. Initial laboratory results were as
follows; Hb: 12.8 g/dl, Hct: 36%, Platelets: 141.000,
SGOT: 32 IU/l, SGPT: 37 IU/l, proteinuria was present
and coagulation parameters were in normal range.
Immediate caesarean section was performed and a
single viable fetus was delivered.
After a rise in blood pressure and liver enzymes along
with a decrease in platelet count in the post operative 8th
hour, patient was transferred to the intensive care unit for
close monitorization. Patient’s renal functions were nor-
mal and with palliative therapy vital signs and laboratory
results returned to normal range. Patient was transferred
back to our clinic after 3 days in the intensive care unit
and discharged on the 8th day after operation without
any further complications.
HELLP syndrome is diagnosed with hemolysis, elevated
liver enzymes and low platelets first stated by Prichard in
1954 and described by Dr. Louis Weinstein in 1982 .
In current literature HELLP syndrome is described as
a complication usually seen in the early post partum
period, up to 6 days, most frequently in the first 48 hours
Of the 3 cases we discussed above, 2 had acute renal
failure requiring hemodialysis. Acute renal failure in
HELLP syndrome is a very serious complication with an
incidence of 7.3% as stated by Sibai .
Endothelial damage, vasospasm, platelet activation
and a decrease in endothelium derived relaxing factor
activity may be blamed for acute renal failure in HELLP
Whatever the cause, acute renal failure in HELLP
syndrome is a serious condition which requires early
intervention and intensive care management. Also pa-
tients with HELLP syndrome and acute renal failure are
more susceptible to other severe complications such as
multi organ failure including lungs, brain and heart.
Hemolysis in HELLP syndrome can lead to DIC if left
unattended therefore it is fairly important to intervene
early if such a condition arises. There is no decisive
marker to foretell if hemolysis will occur in a preeclamp-
Copyright © 2012 SciRes. OPEN ACCESS
D. Güven et al. / Open Journal of Obstetrics and Gynecology 2 (2012) 318-320
Copyright © 2012 SciRes.
tic patient but a review of current literature shows Hap-
toglobin to be the most sensitive parameter .
 Sibai, B.M., Taslimi, M.M., EL-Nazer, A., Aman, E.,
Mabie, B.C. and Ryan, G.M. (1986) Maternal-perinatal
outcome associated with the syndrome of hemolysis,
elevated liver enzymes, and low platelets in severe pre-
eclampsia, eclampsia. American Journal of Obstetrics &
Gynecology, 155, 501-509.
Even after numerous studies there is still debate on the
diagnosis and treatment of HELLP syndrome [11,12].
Main focus should be on palliative care and replacement
therapy but as shown in our study hemodialysis might be
necessary if renal failure is observed.
It is debatable whether or not to administer platelet
transfusion to patients with low platelet count to prevent
hemorrhage. But transfusion is recommended to patients
prior to labor if their platelet count is below 50.000 .
Rahman et al. administered steroids to patients with 24
- 34 weeks of pregnancy to further fetal maturation and
they observed that when used on patients with HELLP
syndrome their platelet count showed a tendency to rise
Also Martin et al. suggested that dexamethasone might
benefit patients with a postpartum onset HELLP syn-
As noted before main focus of treatment should be on
patient stability, in other words, palliative care under
intensive care conditions.
But more importantly all patients with preeclampsia
should be closely monitored both in the antepartum and
postpartum period. Awareness in these patients is what
 Weinstein, L. (1982) Syndrome of hemolysis, elevated
liver enzymes, and low platelet count: A severe con-
sequence of hypertension in pregnancy. American Jour-
nal of Obstetrics & Gynecology, 142, 159-167.
 Sezik, M., Özkaya, M.O., Sezik, H.T., Yapar, E. and Kaya,
H. (2005) HELLP sendromlu hastalarda umblikal arter
doppler incelemesinin perinatal sonuçlarla ilişkisi. Per-
inatoloji Dergisi, 13, 198-202.
 Loos/Rath (1992) Das HELLP-syndrom-ein “gestaltwan-
del der praeklampsie”. Geburtsh. u. Frauenheilk, 52,
 Keleş, G.T., Topçu, İ., Kefi, A., Ekinci, Z. and Sakarya, M.
(2006) Yoğun bakım ünitesinde obstetrik olgular. Fırat
Tıp Dergisi, 11, 62-65.
 Weinstein, L. (1985) Preeclampsi/eclampsi with hemoly-
sis, ele vated liver enzymes and trombocytopenia. Obstet-
rics & Gynecology, 66, 657.
 Tsoe, E., Reid, R.P., Barish, R.A. and Browne, B.J. (1987)
Late past partum eclampsia. Annals of Emergency Me-
dicine, 16, 907-909. doi:10.1016/S0196-0644(87)80533-4
 Sibai, B.M. and Ramadan, K.M. (1993) Acute renal
failure in pregnancies comp licated by hemolysis, ele-
vated liver enzymes, ad low platelets. American Journal
of Obstetrics & Gynecology, 168, 1682-1690.
 Sibai, B.M., Villar, M.A. and Mabie, B.C. (1990) Acute
renal failure in hypertensi ve disorders: Pregnancy out-
come and remote prognosis in thirty-one consecutive
cases. American Journal of Obstetrics & Gynecology,
 Kuhn, W., Rath, W., Loos, W. and Graeff, H. (1992) Le
syndrome hellp. Resultats cliniques et d’analyse en
laboratoire. Rev Fr Gynecol Obstet, 87, 323.
 Sibai, B.M. (2004) Diagnosis, controversies, and manage-
ment of the syndrome of hemolysis, elevated liver en-
zymes, and low platelet count. Obstetrics & Gynecology,
 Haddad, B., Barton, J.R., Livingston, J.C., Chahine, R.
and Sibai, B.M. (2000) HELLP (hemolysis, elevated liver
enzymes, and low platelet count) syndrome versus severe
preeclampsia: Onset at< or =28.0 weeks’ gestation. Ame-
rican Journal of Obstetrics & Gynecology, 183, 1475-
 Rahman, T.M. and Wendan, J. (2002) Severe hepatic
dysfunction in pregnancy. An International Journal of
Medicine, 95, 343-357.
 Martin, J.N. Jr, Perry, K.G. Jr, Blake, P.G., May, W.A.,
Moore, A. and Robinette, L. (1997) Beter maternal
outcomes are achieved with dexamethasone therapy for
postpartum HELLP (hemolysis, elevated liver enzymes
and trombocytopenia) syndrome. American Journal of
Obstetrics & Gynecology, 177, 1011-1017.
HELLP: hemolysis, elevated liver enzymes, low platelet
DIC: disseminated intravascular coagulation;
MgSO4: magnesium sulphate.