Preeclampsia and HELLP Syndrome: A Quick Overview

About this course

Preeclampsia and Hemolysis, Elevated Liver enzymes, and Low Platelet (HELLP) syndrome are two serious pregnancy conditions that pose a substantial risk to the health of pregnant women and the fetus. Preeclampsia is a hypertensive disorder that usually develops after 20 weeks of gestation and is characterized by extremely high blood pressure and protein presence in the urine, and Hemolysis, Elevated Liver enzymes, and Low Platelet (HELLP) syndrome is a life-threatening variant of preeclampsia usually seen in the later stages of pregnancy or soon after childbirth. This course defines the cause, clinical presentation, and risk factors associated with Preeclampsia and HELLP syndrome. Additionally, it discusses treatment options and vital nursing considerations for both conditions that can be implemented to manage symptoms and improve health outcomes.

Learning objectives

• Describe preeclampsia and its four subtypes.
• Describe HELLP syndrome and its classifications.
• Identify risk factors for preeclampsia and HELLP syndrome.
• Review the signs and symptoms of preeclampsia and HELLP syndrome.
• Differentiate between preeclampsia and HELLP syndrome and their treatment options.

Course outline

22 sections · finish in any order across devices

1. 1

   Introduction

   Preeclampsia and Hemolysis, Elevated Liver enzymes, and Low Platelet (HELLP) syndrome are two serious pregnancy conditions that pose a substantial risk to the health of pregnant women and the fetus. Preeclampsia is a hypertensive disorder that usually develops after 20 weeks of gestation and is char

   4 min

2. 2

   Defining Preeclampsia

   Preeclampsia is a multi-system progressive disorder that is most often seen after 20 weeks of pregnancy. It is characterized by either the new onset of hypertension, proteinuria, and excessive swelling, or the new onset of hypertension, end-organ dysfunction with or without proteinuria.4, 5 Clinical

   4 min

3. 3

   Gestational Hypertension

   It is important to note that while gestational hypertension is considered an early or mild form of preeclampsia, it is not the same condition. Gestational hypertension is elevated blood pressure in pregnant women who previously had normal blood pressure. In most cases, it does not affect the mother

   4 min

4. 4

   Preeclampsia vs. Eclampsia

   Both preeclampsia and eclampsia are pregnancy-related hypertensive disorders, such that women with preeclampsia can develop seizures and coma if the seizure is severe enough to affect brain function. This condition is known as eclampsia, a life-threatening medical emergency that requires immediate t

   4 min

5. 5

   History of Preeclampsia

   Women with a history of preeclampsia are among the most at risk of developing the condition again in subsequent pregnancies.4,7 Additionally, the severity of previous cases of preeclampsia can strongly impact the likelihood of preeclampsia recuring. Women with severe preeclampsia in their second tri

   4 min

6. 6

   Preexisting Medical Conditions

   Women with underlying medical conditions are more susceptible to developing preeclampsia. These conditions include a history of chronic hypertension, pre-gestational diabetes or insulin resistance, chronic kidney disease, vascular disease, pre-pregnancy obesity, and abnormal lipid metabolism.1, 4,7

   4 min

7. 7

   Pregnancy Specific Factors

   Several pregnancy-specific factors have been shown to increase the likelihood of preeclampsia. Nulliparous women, those who have not had a pregnancy beyond 20 weeks, are at a higher risk of developing preeclampsia. This includes women who have had a miscarriage and elective abortion.11, 12

   4 min

8. 8

   Causes of Preeclampsia

   The exact cause of preeclampsia is still not completely understood. Current research points to abnormal placentation; the abnormal formation of the placenta. This issue is believed to play a significant role in the complication seen with preeclampsia.13

   4 min

9. 9

   Signs and Symptoms of Preeclampsia

   Pregnant women who develop preeclampsia often present with a sudden new onset of severe headaches with no history of headaches or migraines. These headaches are often unresponsive to medication. The early sign of a headache is typically followed by other symptoms, such as blurred vision or visual di

   4 min

10. 10

    Treatment Options for Preeclampsia

    Treatment and management for preeclampsia depends on when it develops and its severity. If the pregnancy has reached 37 weeks or later, delivering the fetus is the definitive treatment regardless of severity, as it avoids further complications.1 However, if the fetus is under 37 weeks, then the seve

    4 min

11. 11

    Defining HELLP Syndrome

    Hemolysis, Elevated Liver enzymes, and Low Platelet (HELLP) syndrome is a life-threatening variant of preeclampsia usually seen in the later stages of pregnancy or soon after childbirth.2 Its name is an acronym for its primary symptoms:

    4 min

12. 12

    Complications of HELLP Syndrome

    Immediate complications from HELLP syndrome include eclampsia, placental abruption, DIC, acute renal failure, severe ascites, pulmonary edema, cerebral edema, liver rupture, liver failure, hepatic infarction, cerebral hemorrhage, infection and sepsis, fetal growth restriction, preterm delivery, peri

    4 min

13. 13

    HELLP Syndrome Classification

    HELLP syndrome is classified based on its severity. Specific blood tests assess the condition of the maternal blood vessels, liver, and other organs, by measuring specific levels of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and platelet count.2, 18

    4 min

14. 14

    When HELLP Syndrome is Likely to Occur

    Studies have shown that 20% of women with preeclampsia will develop HELLP syndrome, which is why many of the risk factors associated with preeclampsia are also associated with this condition. 24 The most common risk factors include a history of preeclampsia or eclampsia, pre-pregnancy or chronic hyp

    4 min

15. 15

    Causes of HELLP Syndrome

    The exact trigger of HELLP syndrome is currently unknown.2, 18 Still, it is understood to be a systemic inflammatory disorder that sets off cascading events in the body. In most cases, there is much similarity with preeclampsia, such as poor or abnormal placenta development and the failed remodeling

    4 min

16. 16

    Signs and Symptoms of HELLP Syndrome

    The physical signs and symptoms of HELLP syndrome are remarkably like preeclampsia and often begin with new-onset headaches that persist and are medication resistant.2 Other common symptoms include blurred vision or other vision issues such as seeing double, flashing lights, auras, or halos. Patient

    4 min

17. 17

    Treatment Options for HELLP Syndrome

    The treatment options for HELLP syndrome are primarily supportive, as there is no cure for this condition. At most, symptoms can be managed to prevent further organ damage. Hospitalization is recommended to provide immediate maternal and neonatal care.2

    4 min

18. 18

    Risk of Fetal Complications in Preeclampsia and HELLP Syndrome

    Among the most serious concerns of preeclampsia and HELLP Syndrome are fetal growth restriction, stillbirth, and neonatal death. In a fetus who is small for gestational age, there is an increased risk of 35% in preeclampsia and approximately 40% in HELLP syndrome of fetal loss.1, 2, 4

    4 min

19. 19

    Long-Term Cognitive and Behavioral Concerns

    As preeclampsia and HELLP syndrome can put a fetus in distress in-utero, it can cause impaired fetal development, where the brain and other organs do not fully develop and mature. After birth, this may result in cognitive delays and behavioral concerns such as lower IQ or cognitive impairments, diso

    4 min

20. 20

    Measures to Reduce Risks of Fetal Complications

    Cases of preeclampsia and HELLP syndrome are difficult to predict. While certain risk factors increase the likelihood of developing either of these conditions, there is no definitive screening test.1, 2 At most, screening practices can identify high-risk pregnancies by checking blood pressure and pr

    4 min

21. 21

    Nursing Considerations

    A pregnant or postpartum woman with preeclampsia or HELLP syndrome can rapidly deteriorate and become critically ill, resulting in life-threatening medical emergencies. Once symptoms present, management and monitoring are critical.1, 2 The pregnant woman's blood pressure must be monitored closely, a

    4 min

22. 22

    Conclusion

    Preeclampsia and HELLP syndrome are high-risk pregnancy-related medical conditions that can threaten the life of a mother and her unborn child. Prompt diagnosis and immediate intervention are necessary to prevent the progression of these disorders and avoid short and long-term complications that can

    4 min

This course satisfies

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References and resources

• Eclampsia/Preeclampsia. (n.d.). SpringerReference. https://doi.org/10.1007/springerreference_95465Sakhy, Y. (2023). Hepatic infarct complicating HELLP syndrome. Radiopaedia.org. https://doi.org/10.53347/rid-159064
• Salvi, P., Gaikwad, V., & Ali, R. (2021). Clinical correlation of platelet indices in Preeclamptic patients without HELLP syndrome. International Journal of Pharmaceutical Sciences and Medicine, 6(3), 62-75. https://doi.org/10.47760/ijpsm.2021.v06i03.006
• Kınay, T., Küçük, C.,Kayıkçıoğlu, F., & Karakaya, J. (2015). Severe Preeclampsia versus HELLP Syndrome: Maternal and Perinatal Outcomes at <34 and ≥34 Weeks' Gestation. Balkan Medical Journal, 32(4), 359-363. https://doi.org/10.5152/balkanmedj.2015.15777
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• Henderson, J. T., Vesco, K. K., Senger, C. A., Thomas, R. G., & Redmond, N. (2021). Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality. JAMA, 326(12), 1192. https://doi.org/10.1001/jama.2021.8551
• Roberts MD, J. M. (2014). Pathophysiology of ischemic placental disease. Seminars in Perinatology, 38(3), 139–145. https://doi.org/10.1053/j.semperi.2014.03.005
• Goulopoulou, S. (2017). Maternal Vascular Physiology in Preeclampsia. Hypertension, 70(6), 1066–1073. https://doi.org/10.1161/hypertensionaha.117.08821
• Roberts MD, J. M. (2014). Pathophysiology of ischemic placental disease. Seminars in Perinatology, 38(3), 139–145. https://doi.org/10.1053/j.semperi.2014.03.005
• Alexander, B. T., Bennett, W. A., Khalil, R. A., & Granger, J. P. (2001). Preeclampsia: Linking Placental Ischemia with Cardiovascular-Renal Dysfunction. Physiology, 16(6), 282–286. https://doi.org/10.1152/physiologyonline.2001.16.6.282
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• Spartz, E., Sarwar, R., Jacobs, K., & Thomson, M. (2021). Elevated liver enzymes secondary to early second trimester HELLP syndrome (Hemolysis, elevated liver enzymes, low platelet count). American Journal of Gastroenterology, 116(9), 1963-1964. https://doi.org/10.14309/ajg.0000000000001288
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• Weinstock, D. (2020, June 11). What Are the Key Risk Factors for HELLP Syndrome? The ObG Project. https://www.obgproject.com/2020/06/10/what-are-the-key-risk-factors-for-hellp-syndrome/
• Malmström, O., & Morken, N.-H. (2018). HELLP syndrome, risk factors in first and second pregnancy: a population-based cohort study. Acta Obstetricia et Gynecologica Scandinavica, 97(6), 709–716. https://doi.org/10.1111/aogs.13322
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