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Hypertensive Medical emergency

HELLP syndrome

Also known as Hemolysis, Elevated Liver enzymes, Low Platelets. Third trimester or the days after birth.

HELLP syndrome is a severe, fast-moving complication of pregnancy, usually a variant of preeclampsia. Its name is a checklist of what it does to your blood: Hemolysis (red cells breaking apart), Elevated Liver enzymes, and Low Platelets. Its danger is its disguise. It often mimics a stomach bug or the flu, with upper-belly pain, nausea, and a run-down feeling, and in some people the blood pressure is not even high at first. Upper-belly pain and feeling unwell in late pregnancy or just after birth is a reason to be checked, not to wait out.

Know the warning signs When to call a provider
How common
About 1 to 2 in 1,000
Develops in 10% to 20% of people with severe preeclampsia.
When
Third trimester or postpartum
Around a third of cases appear or worsen after birth.
Urgency
Emergency
Upper-belly pain with feeling unwell in late pregnancy needs care now.
Outlook
Good if treated early
Delivery is the cure; the danger is delay from mistaking it for the flu.

This can be a medical emergency. Upper-right or upper-middle belly pain, or chest pain, especially with nausea If this happens, go to the ER or call 911 right away.

Understanding it

What is HELLP syndrome?

HELLP syndrome ranks among the most serious complications a pregnancy can develop, its name spelling out what is going wrong in the blood: red cells destroyed, the liver inflamed, platelets low. It is usually a severe form of preeclampsia, though tellingly about 15% to 20% of people with HELLP have neither high blood pressure nor protein in the urine when it begins.

It is uncommon, roughly 1 to 2 in 1,000 pregnancies, and develops in about 10% to 20% of those with severe preeclampsia. Most cases hit in the third trimester, but around a third appear or worsen after birth, a window easy to overlook once attention turns to the baby.

Much of HELLP's danger is that it feels utterly ordinary at first. The classic symptoms, upper-belly pain, nausea and vomiting, and a general sense of being unwell, get mistaken for a stomach bug, gallbladder trouble, or the flu. That delay costs dearly, because HELLP can race to liver injury, bleeding problems, and stroke.

Against that, HELLP is treatable, and the plan is clear: stabilize you, prevent seizures with magnesium sulfate, control blood pressure, protect your baby, and deliver, the definitive cure. Caught early, most people recover well, which is why recognizing those flu-like warning signs matters so much.

Symptoms

What are the symptoms?

The classic symptoms, upper-belly pain and feeling generally unwell, are easily mistaken for a stomach bug. In late pregnancy or after birth, treat that combination as a reason to be seen urgently.

Early signs

  • Upper-right or upper-middle belly pain, under the ribs
  • Nausea and vomiting
  • Feeling generally unwell, run down, or flu-like
  • Headache
  • Sometimes shoulder pain, easy bruising, or swelling

Emergency signs — call 911

  • Upper-right or upper-middle belly pain, or chest pain, especially with nausea
  • A headache that will not go away, or vision changes
  • Shoulder pain, or pain when breathing deeply
  • Unusual bruising, bleeding, or nosebleeds
  • A seizure, which is a 911 emergency

Why it matters

Risks to you and baby

Liver injury and bleeding

HELLP can cause bleeding within the liver and, rarely, a liver rupture, a catastrophic emergency, part of why upper-belly and shoulder pain are taken so seriously.

Clotting problems (DIC)

With platelets falling and clotting proteins consumed, the blood can lose its ability to clot, raising the risk of dangerous bleeding.

Other severe complications

HELLP can occur with placental abruption, kidney failure, stroke, and fluid in the lungs, so it is managed in hospital with close monitoring.

Effects on your baby

Because delivery is often early, prematurity is common. Babies can also have growth restriction and low platelets. Steroids are given for the lungs when time allows.

Why speed matters

HELLP can worsen quickly and is life-threatening untreated. Early recognition and delivery turn a dangerous condition into a recoverable one.

How it's found

How is it diagnosed?

Because HELLP is defined by what is happening in the blood, it is diagnosed with blood tests. Symptoms raise the suspicion; the labs confirm it.

Complete blood count

A low platelet count (under 100,000) is a core criterion, and signs of red blood cell destruction may be seen.

Hemolysis tests

A blood smear with damaged red cells, a low haptoglobin, and elevated LDH and bilirubin confirm red cells are breaking apart.

Liver enzyme tests

Liver enzymes (AST and ALT) more than twice the normal level indicate the liver is inflamed.

Blood pressure and urine

Often show preeclampsia, but can be normal in HELLP, which is why the diagnosis rests on the blood tests.

When you have upper-belly pain, nausea, or a run-down feeling in the second half of pregnancy or after birth, especially with preeclampsia. Prompt bloodwork catches it.

Treatment

How is it managed?

HELLP is a medical emergency, managed in hospital. Care stabilizes you and moves quickly to delivery, the definitive treatment.

Treatment paths

You are admitted. Magnesium sulfate prevents seizures, medication controls severe blood pressure, and if birth will be preterm and you are stable, steroids may be given for the baby's lungs. Blood or platelet transfusions go in if you are bleeding or counts run very low. The central step is delivery.

Medication

Magnesium sulfate to prevent seizures and antihypertensives for severe blood pressure are standard.

Monitoring

Your blood counts and liver and kidney tests are followed closely, since HELLP can worsen for a day or two after delivery before it turns the corner.

Can it recur?

The risk of HELLP again is meaningfully elevated, roughly 2% to 27% across studies, and of preeclampsia higher still. Early prenatal care, blood pressure monitoring, and low-dose aspirin lower it, and any future pregnancy is watched closely.

What you can do

Can it be prevented?

  • Catch and treat preeclampsia early

    Because HELLP is usually severe preeclampsia, the prenatal visits and blood pressure checks that catch preeclampsia are the first line of defense.

  • Low-dose aspirin when indicated

    For those at higher risk of preeclampsia, low-dose aspirin lowers the chance of developing it, and so of HELLP.

  • Know the flu-like warning signs

    Know that upper-belly pain, nausea, and feeling unwell in late pregnancy or postpartum can be HELLP; get evaluated rather than assuming a stomach bug.

Who is more at risk

Risk factors

Preeclampsia or eclampsia
The main setting for HELLP, though it can occur without the classic high blood pressure at first.
A prior HELLP or preeclampsia
Having had either before raises the risk of a HELLP recurrence.
Age and parity
It is more common in people over 35 and in those who have been pregnant before.
Other factors
Some infections in pregnancy, including COVID-19, have been linked to a higher risk of preeclampsia and HELLP.

Do not wait

When to call your provider or 911

  • Go in or call 911 for upper-belly pain, especially with nausea, a headache that will not go away, vision changes, or shoulder pain, in late pregnancy or after birth.
  • Seek emergency care for unusual bruising or bleeding, or if you simply feel severely unwell and something seems off.
  • Call 911 for a seizure.
  • Do not write off upper-belly pain and feeling run down late in pregnancy or postpartum as a stomach bug; it can be HELLP, and a blood test tells.
  • If you have preeclampsia, report new upper-belly pain or feeling unwell right away.

Talking to your team

Questions to ask your provider

  • Do my blood tests show HELLP syndrome, and how severe is it?
  • Do I need to deliver now, and will it be a cesarean?
  • Will I need magnesium sulfate, blood pressure medication, or a transfusion?
  • Will my baby need lung steroids, and what other support?
  • How will you monitor me after delivery, since HELLP can worsen for a day or two?
  • What is my risk of recurrence, and how would a future pregnancy be managed?

Keep reading

More on HELLP syndrome

All pregnancy guides articles

Good to Know

HELLP syndrome FAQs

Common questions about HELLP syndrome, answered.

What does HELLP stand for?

An acronym for what it does to your blood: Hemolysis (red cells breaking apart), Elevated Liver enzymes (an inflamed liver), and Low Platelets (the cells that clot). Together they define the syndrome, which is why blood tests diagnose it.

Is HELLP the same as preeclampsia?

Usually a severe form of it. The twist: about 15% to 20% of people with HELLP have no high blood pressure or urine protein at first, so a normal reading does not rule it out.

I feel like I have the flu or a stomach bug. Could it be HELLP?

In late pregnancy or just after birth, yes, worth ruling out. HELLP classically brings upper-belly pain, nausea, and a run-down feeling that mimic a stomach bug. A blood test tells the difference, and catching it early matters.

Is HELLP dangerous?

Yes. It can race to liver injury, bleeding problems, and stroke, and is life-threatening untreated. But it is treatable, and delivery cures it, so prompt recognition matters.

Will I have to deliver my baby?

Almost always. Delivery is the definitive treatment. At 34 weeks or beyond, or if you are severely ill, it is prompt. Earlier, if you are stable, steroids may come first for your baby's lungs while you are watched closely.

Can HELLP happen after I give birth?

Yes. Around a third of cases appear or worsen after delivery, usually within 48 hours. Do not dismiss upper-belly pain, a persistent headache, or feeling very unwell after birth; seek care.

Will it happen again in my next pregnancy?

Your risk of HELLP again is elevated, and of preeclampsia higher still. Early prenatal care, blood pressure monitoring, and low-dose aspirin lower it, and a future pregnancy is followed closely.

Will my blood counts recover?

Usually. Platelets and liver tests often dip further in the first day or two after delivery, then steadily improve. Your team watches closely until you are on the mend.

Medically Reviewed · Updated

Reviewed by Dr. Grace Lin, MD, FACOG · OB-GYN

Obstetrician-gynecologist focused on reproductive and sexual health for women: pregnancy, BV, yeast, trichomoniasis and HPV/cervical screening. Our editorial guidelines →

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