The HELLP syndrome

The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10- 20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, treatment, mode of delivery and risk of recurrence. Clinical reviews published between 2000 and 2009 were screened using PubMed and Cochrane databases. About 70% of cases develop before delivery, the majority in the third trimester of pregnancy; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (48 hours) is controversial. Delivery is indicated if the HELLP syndrome occurs after the 34th week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. In gestational ages between 24 and 34 weeks, a single course of corticosteroid for foetal lung maturation is recommended. Standard corticosteroid treatment is, owever, of uncertain clinical value in the maternal HELLP syndrome. Close surveillance of the mother should be continued for at least 48 hours after delivery.The recognition of HELLP syndrome and an aggressive multidisciplinary approach and prompt transfer of these women to obstetric centres with expertise in this field are required for the improvement of materno-foetal prognosis.