The HELLP syndrome (haemolysis, elevated liver enzymes, low platelet count) is a variant of the pre-eclampsia/eclampsia syndrome occurring in 10-20% of patients whose diseases are labelled as severe.
Although the majority of cases of HELLP syndrome occur antepartum, the disease can present in the postpartum period, usually within 48 hours of delivery. Hypertension and proteinuria may not be detected in 10-20% of cases.
As the HELLP syndrome and concurrent eclampsia have been implicated in as many as 5-6 of every 10 maternal deaths it is apparent that such patients require the expertise of a multidisciplinary team (e.g haematologist, maternal fetal medicine experts, and critical care specialists).
There is no conclusive evidence supporting the use of high dose corticosteroids in the treatment of HELLP syndrome. Steroids for the use of accelerating fetal lung maturity and decreasing the high perinatal mortality associated with severe pre-eclampsia and the HELLP syndrome is however of proven benefit.
The aetiology of pre-eclampsia complicated by the HELLP syndrome is unknown, but data from animal models suggest roles for circulating anti angiogenic proteins. The consensus is that delivery is followed by rapid return of the haematological system to normal. Pregnancies between 24-34 gestational weeks usually should, if possible, receive a standard corticosteroid course, followed by delivery. In pregnancies > 35 weeks, rapid delivery alone suffices. Most clinicians would not attempt expectant management in gestations < 24 weeks.