HELLP Syndrome

Key points

• HELLP stands for Haemolysis, Elevated Liver enzymes, and Low Platelet count.
• HELLP syndrome is a rare but serious condition that happens when you are pregnant and is linked to pre-eclampsia (high blood pressure and protein in urine during pregnancy).
• It affects the liver, blood pressure, and blood clotting.
• It usually happens in the third trimester but can develop earlier or soon after birth.
• HELLP is a life-threatening condition and needs urgent medical treatment for both mother and baby, usually including early delivery.

---

What is HELLP syndrome?

HELLP syndrome is a life-threatening complication of pregnancy. It stands for:

Haemolysis (breaking down of red blood cells)
ELevated Liver enzymes (high liver blood tests)
Low Platelets (platelets are a part of the blood that help with blood clotting)

These things together can lead to severe liver injury and liver failure and can be very dangerous for both the mother and baby.

Pre-eclampsia happens in about 1 in every 10 women during pregnancy. Pre-eclampsia is high blood pressure, protein in the urine and swelling of hands, face and feet.

HELLP syndrome can occur in 1 or 2 in every 10 women with pre-eclampsia. That means it’s very rare (less than 1 in every 100 pregnancies).

Although most cases of HELLP syndrome will occur with pre-eclampsia, it can sometimes happen without high blood pressure or protein in urine. It usually happens during the third trimester of pregnancy (between 28-40 weeks). It can also develop shortly after birth (usually within 48 hours).

---

Who is at risk of HELLP syndrome?

Anyone who has pre-eclampsia is at a higher risk of developing HELLP syndrome. Other risk factors include:

• History of HELLP in a previous pregnancy.
• Family history of pre-eclampsia or HELLP syndrome.
• Being pregnant with more than one baby or have had a previous multiple pregnancy.
• Being over 35 years old.
• Having chronic conditions like:
  • High blood pressure
  • Diabetes
  • Kidney disease
  • Autoimmune diseases (e.g. lupus)
  • Obesity

---

What are the symptoms of HELLP syndrome?

• Severe pain in the top right side of your belly
• Nausea (feeling sick) or vomiting, or indigestion and pain after eating
• Headache that won’t go away, even after taking a medication such as paracetamol
• Shoulder pain, or pain when breathing deeply
• Vision problems – blurred vision or flashing lights
• Swelling in your face, hands, or feet
• Feeling very tired or unwell
• Shortness of breath
• Jaundice (yellowing of the whites of your eyes)
• Dark urine, or passing urine less frequently
• Bruising easily or bleeding more than usual, for example nose bleeds or bleeding gums

---

How is HELLP syndrome diagnosed?

If you have any of the symptoms listed above, or you just don’t feel right, you should get checked out by your obstetrician or midwife as soon as possible. If you are very unwell you should go straight to the emergency department of your maternity hospital. Some of the things that your doctor will do include:

• Blood tests to check liver enzymes, red blood cells, and platelets.
• Physical exam to look for swelling in the face, hands and feet as well as pain or tenderness in the right upper abdomen.
• Checking your blood pressure.
• Urine tests (to check for protein).
• Scans such as an ultrasound or MRI to look at the liver for signs of bleeding or enlargement.
• Scans to check the baby’s growth and health.

If your doctor thinks you might have HELLP syndrome you will be admitted to hospital straight away so that you and your baby can be closely monitored.

---

Why did I get HELLP syndrome?

The exact cause of HELLP syndrome isn’t known and there is no way to stop it happening. It may be related to problems with the placenta.

You may be more at risk if you’ve had pre-eclampsia or HELLP syndrome in a past pregnancy.

If HELLP syndrome is diagnosed early the outcomes for mother and baby are generally good. So, it is important to attend all your prenatal appointments and let you doctor or midwife know of any new symptoms.

---

Possible complications of HELLP syndrome

Without treatment, HELLP syndrome can be very serious for mother and baby and can be life-threatening. Some of the complications of pre-eclampsia and HELLP syndrome are:

• Placental abruption (separation of the placenta from the uterus)
• Liver bleeding or rupture
• Seizures (eclampsia)
• Organ failure (kidney or liver)
• Preterm birth or stillbirth

It is important to remember that outcomes for both mother and baby are very good if the condition is diagnosed and treated early.

---

How is HELLP syndrome treated?

If you are diagnosed with HELLP syndrome you will be admitted into hospital, and sometimes into an intensive care unit.

The most common treatment for HELLP syndrome is to deliver the baby and placenta. This is the only solution to completely treat HELLP syndrome. This may mean your baby is born early, but they will be very well cared for.

Delivery is often by caesarean section as this is quicker and more controlled than natural labour. After delivery of the baby, HELLP syndrome will usually resolve in a few days.

If your baby is still too little to be delivered, you may also have the following:

• Medicine to lower your blood pressure and decrease the risk of seizures
• Blood transfusion to treat low platelets
• Steroids to help your baby’s lungs develop so they can breathe on their own after birth
• If you are very unwell and have liver failure, in rare cases a liver transplant may be performed.

Your baby will be monitored closely before birth. If your baby is born weighing more than 1kg, the survival rates are similar to a non-HELLP baby of a similar size. In general, the longer your pregnancy continues, the better the outcome for your baby.

---

After pregnancy

The good news is that most women will recover fully after delivery of their baby.  The survival rate for women with HELLP syndrome is 99%

You will need to have regular check-ups for at least a few months after birth to make sure that all your blood tests are returning to normal.

You may be at higher risk of having high blood pressure or heart disease and may be at a higher risk of having a stroke. But if you have regular checks with your doctor and follow their advice you can live a healthy life. This can include things like keeping a healthy weight, regular exercise, eating a well-balanced diet and not smoking.

---

Future pregnancies

If you have had HELLP syndrome before, you are at an increased risk of developing pre-eclampsia in subsequent pregnancies. Up to 1 in every 5 women who have had HELLP syndrome before may get it again

Any future pregnancies will be closely monitored, and you will be strongly encouraged to report any symptoms.

It’s important to talk to your doctor about future pregnancies and what your risk might be before you fall pregnant again. It is also important to look after your own emotional health and wellbeing, so talk to your doctor about support if you need it.

---

More information and support

Read more about living well.

Reviewed August 2026