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HELLP Syndrome
Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Hemolysis, elevated liver enzymes, low platelets (HELLP)
            • Definitions

              • Severe variant of preeclampsia

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Sadaf N et al: Maternal and foetal outcome in HELLP syndrome at tertiary care hospital. J Pak Med Assoc. 63(12):1500-3, 2013
                                            2. Heller MT et al: Imaging of hepatobiliary disorders complicating pregnancy. AJR Am J Roentgenol. 197(3):W528-36, 2011
                                            3. Benedetto C et al: Biochemistry of HELLP syndrome. Adv Clin Chem. 53:85-104, 2011
                                            4. Jank A et al: Effect of steroids on angiogenic factors in pregnant women with HELLP syndrome. J Perinat Med. 39(5):611-3, 2011
                                            5. Murao K et al: Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with pituitary apoplexy. Fertil Steril. 96(1):260-1, 2011
                                            6. Publications Committee et al: Evaluation and management of severe preeclampsia before 34 weeks' gestation. Am J Obstet Gynecol. 205(3):191-8, 2011
                                            7. Nunes JO et al: Abdominal imaging features of HELLP syndrome: a 10-year retrospective review. AJR Am J Roentgenol. 185(5):1205-10, 2005
                                            8. Araujo AC et al: Characteristics and treatment of hepatic rupture caused by HELLP syndrome. Am J Obstet Gynecol. 195(1):129-33, 2006
                                            9. Di Salvo DN: Sonographic imaging of maternal complications of pregnancy. J Ultrasound Med. 22(1):69-89, 2003
                                            10. Suarez B et al: Abdominal pain and preeclampsia: sonographic findings in the maternal liver. J Ultrasound Med. 21(10):1077-83; quiz 1085-6, 2002
                                            11. Casillas VJ et al: Imaging of nontraumatic hemorrhagic hepatic lesions. Radiographics. 20(2):367-78, 2000
                                            12. Haddad B et al: HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus severe preeclampsia: onset at < or =28.0 weeks' gestation. Am J Obstet Gynecol. 183(6):1475-9, 2000
                                            13. Chan AD et al: Imaging of subcapsular hepatic and renal hematomas in pregnancy complicated by preeclampsia and the HELLP syndrome. J Clin Ultrasound. 27(1):35-40, 1999
                                            14. Risseeuw JJ et al: Liver rupture postpartum associated with preeclampsia and HELLP syndrome. J Matern Fetal Med. 8(1):32-5, 1999
                                            15. van Pampus MG et al: Maternal and perinatal outcome after expectant management of the HELLP syndrome compared with pre-eclampsia without HELLP syndrome. Eur J Obstet Gynecol Reprod Biol. 76(1):31-6, 1998
                                            16. Barton JR et al: Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am J Obstet Gynecol. 174(6):1820-5; discussion 1825-7, 1996
                                            17. Sibai BM et al: Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol. 172(1 Pt 1):125-9, 1995
                                            18. Peitz U et al: Sonographic findings of liver and gallbladder in early hemolysis, elevated liver enzymes, and low platelet count syndrome. J Clin Ultrasound. 21(8):557-60, 1993
                                            19. Reubinoff BE et al: HELLP syndrome--a syndrome of hemolysis, elevated liver enzymes and low platelet count--complicating preeclampsia-eclampsia. Int J Gynaecol Obstet. 36(2):95-102, 1991
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Hemolysis, elevated liver enzymes, low platelets (HELLP)
                                                      • Definitions

                                                        • Severe variant of preeclampsia

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Sadaf N et al: Maternal and foetal outcome in HELLP syndrome at tertiary care hospital. J Pak Med Assoc. 63(12):1500-3, 2013
                                                                                      2. Heller MT et al: Imaging of hepatobiliary disorders complicating pregnancy. AJR Am J Roentgenol. 197(3):W528-36, 2011
                                                                                      3. Benedetto C et al: Biochemistry of HELLP syndrome. Adv Clin Chem. 53:85-104, 2011
                                                                                      4. Jank A et al: Effect of steroids on angiogenic factors in pregnant women with HELLP syndrome. J Perinat Med. 39(5):611-3, 2011
                                                                                      5. Murao K et al: Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with pituitary apoplexy. Fertil Steril. 96(1):260-1, 2011
                                                                                      6. Publications Committee et al: Evaluation and management of severe preeclampsia before 34 weeks' gestation. Am J Obstet Gynecol. 205(3):191-8, 2011
                                                                                      7. Nunes JO et al: Abdominal imaging features of HELLP syndrome: a 10-year retrospective review. AJR Am J Roentgenol. 185(5):1205-10, 2005
                                                                                      8. Araujo AC et al: Characteristics and treatment of hepatic rupture caused by HELLP syndrome. Am J Obstet Gynecol. 195(1):129-33, 2006
                                                                                      9. Di Salvo DN: Sonographic imaging of maternal complications of pregnancy. J Ultrasound Med. 22(1):69-89, 2003
                                                                                      10. Suarez B et al: Abdominal pain and preeclampsia: sonographic findings in the maternal liver. J Ultrasound Med. 21(10):1077-83; quiz 1085-6, 2002
                                                                                      11. Casillas VJ et al: Imaging of nontraumatic hemorrhagic hepatic lesions. Radiographics. 20(2):367-78, 2000
                                                                                      12. Haddad B et al: HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus severe preeclampsia: onset at < or =28.0 weeks' gestation. Am J Obstet Gynecol. 183(6):1475-9, 2000
                                                                                      13. Chan AD et al: Imaging of subcapsular hepatic and renal hematomas in pregnancy complicated by preeclampsia and the HELLP syndrome. J Clin Ultrasound. 27(1):35-40, 1999
                                                                                      14. Risseeuw JJ et al: Liver rupture postpartum associated with preeclampsia and HELLP syndrome. J Matern Fetal Med. 8(1):32-5, 1999
                                                                                      15. van Pampus MG et al: Maternal and perinatal outcome after expectant management of the HELLP syndrome compared with pre-eclampsia without HELLP syndrome. Eur J Obstet Gynecol Reprod Biol. 76(1):31-6, 1998
                                                                                      16. Barton JR et al: Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am J Obstet Gynecol. 174(6):1820-5; discussion 1825-7, 1996
                                                                                      17. Sibai BM et al: Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol. 172(1 Pt 1):125-9, 1995
                                                                                      18. Peitz U et al: Sonographic findings of liver and gallbladder in early hemolysis, elevated liver enzymes, and low platelet count syndrome. J Clin Ultrasound. 21(8):557-60, 1993
                                                                                      19. Reubinoff BE et al: HELLP syndrome--a syndrome of hemolysis, elevated liver enzymes and low platelet count--complicating preeclampsia-eclampsia. Int J Gynaecol Obstet. 36(2):95-102, 1991